Treatment of Measles in Adults

High-Risk Populations Requiring Enhanced Management

Pregnant women require hospitalization more frequently than non-pregnant adults, with 25% of adults with measles requiring at least 1 day of hospitalization, and face increased risks of spontaneous abortion, premature labor, and low birth weight infants, according to the American College of Obstetricians and Gynecologists 1
Pregnant women cannot receive the measles vaccine as pregnancy is an absolute contraindication, and should receive immune globulin (IG) 0.25 mL/kg IM (maximum 15 mL) within 6 days of exposure for post-exposure prophylaxis if susceptible, as recommended by the American College of Obstetricians and Gynecologists 1

The Centers for Disease Control and Prevention recommends administering MMR vaccine within 72 hours of exposure to susceptible adults, as this is most likely to provide protection during that window 3
If vaccination is contraindicated or the 72-hour window has passed, give immune globulin 0.25 mL/kg IM (maximum 15 mL) within 6 days of exposure to prevent or modify infection, according to the Centers for Disease Control and Prevention 3, 1

The Centers for Disease Control and Prevention recommends implementing airborne precautions immediately for all suspected or confirmed measles cases, including isolating in an airborne infection isolation room with negative pressure, and all healthcare personnel must use N95 respirators regardless of immunity status 2
Maintain isolation from 4 days before rash onset through 4 days after rash onset, and exclude exposed healthcare workers without immunity from work days 5-21 post-exposure, as recommended by the Centers for Disease Control and Prevention 2

Adults face the highest risk of severe complications, with encephalitis or death occurring in approximately 1 per 1,000 cases, and monitor closely for encephalitis, which requires immediate evaluation, according to the Centers for Disease Control and Prevention 4, 2

Do not delay IG administration beyond 6 days post-exposure when indicated, as efficacy is time-dependent, and do not assume adults born before 1957 are immune, as up to 9.3% may be susceptible, particularly healthcare workers, according to the American Medical Association 1, 5
Do not use standard droplet precautions, as measles requires airborne precautions with N95 respirators, as recommended by the Centers for Disease Control and Prevention 2