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*''[[Haemophilus influenza]]'' type B
*''[[Haemophilus influenza]]'' type B
*''[[Streptococcus pneumoniae]]''
*''[[Streptococcus pneumoniae]]''
==Medical Therapy==
:* '''Measles<ref name=CDC Measles treatment>{{cite web | title = CDC Measles treatment | url =http://www.cdc.gov/measles/hcp/index.html }}</ref>'''
::* 1.1. '''Prevention'''
:::* 1.1.1. '''Vaccines'''
::::* Note (1): Measles can be prevented with measles-containing vaccine, which is primarily administered as the combination measles-mumps-rubella (MMR) vaccine. The combination measles-mumps-rubella-varicella (MMRV) vaccine can be used for children aged 12 months through 12 years for protection against measles, mumps, rubella and varicella. Single-antigen measles vaccine is not available.
::::* Note (2): Vaccination recommendations
:::::* Children: CDC recommends routine childhood immunization for MMR vaccine starting with the first dose at 12 through 15 months of age, and the second dose at 4 through 6 years of age or at least 28 days following the first dose.
:::::* Students at post-high school educational institutions: Students at post-high school educational institutions without evidence of measles immunity need two doses of MMR vaccine, with the second dose administered no earlier than 28 days after the first dose.
:::::* Adults: People who are born during or after 1957 who do not have evidence of immunity against measles should get at least one dose of MMR vaccine.
:::::* International travelers: People 6 months of age or older who will be traveling internationally should be protected against measles. Before travelling internationally,
::::::* Infants 6 through 11 months of age should receive one dose of MMR vaccine
::::::* Children 12 months of age or older should have documentation of two doses of MMR vaccine (the first dose of MMR vaccine should be administered at age 12 months or older; the second dose no earlier than 28 days after the first dose)
::::::* Teenagers and adults born during or after 1957 without evidence of immunity against measles should have documentation of two doses of MMR vaccine, with the second dose administered no earlier than 28 days after the first dose
:::* 1.1.2. '''Post-exposure Prophylaxis'''
::::* 1.1.2.1. '''Indication'''
:::::* People exposed to measles who cannot readily show that they have evidence of immunity against measles should be offered post-exposure prophylaxis (PEP) or be excluded from the setting (school, hospital, childcare). MMR vaccine, if administered within 72 hours of initial measles exposure, or immunoglobulin (IG), if administered within six days of exposure, may provide some protection or modify the clinical course of disease.
::::* Note (1): If MMR vaccine is not administered within 72 hours of exposure as PEP, MMR vaccine should still be offered at any interval following exposure to the disease in order to offer protection from future exposures. People who receive MMR vaccine or IG as PEP should be monitored for signs and symptoms consistent with measles for at least one incubation period.
::::* Note (2): If many measles cases are occurring among infants younger than 12 months of age, measles vaccination of infants as young as 6 months of age may be used as an outbreak control measure. Note that children vaccinated before their first birthday should be revaccinated when they are 12 through 15 months old and again when they are 4 through 6 years of age.
::::* Note (3): People who are at risk for severe illness and complications from measles, such as infants younger than 12 months of age, pregnant women without evidence of measles immunity, and people with severely compromised immune systems, should receive IG. Intramuscular IG (IGIM) should be given to all infants younger than 12 months of age who have been exposed to measles.
::::* Note (4):  For infants aged 6 through 11 months, MMR vaccine can be given in place of IG, if administered within 72 hours of exposure. Because pregnant women might be at higher risk for severe measles and complications, intravenous IG (IGIV) should be administered to pregnant women without evidence of measles immunity who have been exposed to measles. People with severely compromised immune systems who are exposed to measles should receive IGIV regardless of immunologic or vaccination status because they might not be protected by MMR vaccine.
::::* Preferred regimen: The recommended dose of IGIM is 0.5 mL/kg of body weight (maximum dose = 15 mL) and the recommended dose of IGIV is 400 mg/kg.
::::* Note (5): If a healthcare provider without evidence of immunity is exposed to measles, MMR vaccine should be given within 72 hours, or IG should be given within 6 days when available. Exclude healthcare personnel without evidence of immunity from duty from day 5 after first exposure to day 21 after last exposure, regardless of post-exposure vaccine.
::* 1.2. '''Treatment'''
:::* Note (1): There is no specific antiviral therapy for measles. Medical care is supportive and to help relieve symptoms and address complications such as bacterial infections.
:::* Note (2): Severe measles cases among children, such as those who are hospitalized, should be treated with vitamin A. Vitamin A should be administered immediately on diagnosis and repeated the next day. The recommended age-specific daily doses are
::::* 50,000 IU for infants younger than 6 months of age
::::* 100,000 IU for infants 6–11 months of age
::::* 200,000 IU for children 12 months of age and older
{{PBI|Middle East respiratory syndrome}}
:*'''Middle East Respiratory Syndrome treatment'''
::* Preferred regimen: supportive care. There is no antiviral recommended for this infection at this moment, even though experimental therapies are at research (IFNs, [[Ribavirin]], [[Lopinavir]], [[Mycophenolic acid]], [[Cyclosporine]], [[Chloroquine]], [[Chlorpromazine]], [[Loperamide]], [[6-mercaptopurine]] and [[6-thioguanine]]). Supportive care include: administer oxygen to patients with severe acute pulmonary infection with signs of respiratory distress, hypoxaemia or shock; use conservative fluids management, avoid administering high-dose systemic glucocorticoids, use non-invasive ventilation, but, if its nor effective, do not delay endotracheal intubation; use lung-protective strategy for intubated patients, recognize sepsis as early as possible and treat it accordingly.<ref>http://apps.who.int/iris/bitstream/10665/178529/1/WHO_MERS_Clinical_15.1_eng.pdf?ua=1</ref>
====Contraindicated Medications====
====Contraindicated Medications====
*[[Prednisolone]]
*[[Prednisolone]]

Revision as of 20:42, 6 August 2015

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: João André Alves Silva, M.D. [2]

Overview

Despite the efforts made in the past years to develop a treatment regimen for measles, there is still no specific antiviral therapy for uncomplicated cases of measles, however, some drugs such as ribavirin and interferon-α have been used in the more severe cases of the condition, notably for cases of infection of the CNS by the virus. Yet, there is evidence that the administration of two doses of vitamin A in children, under the age of two, was associated with a reduced risk of morbidity and mortality from the disease. For most patients with measles, the standard treatment is focused on supportive care.[1][2][3]

Medical Therapy

According to current data, there is no antiviral therapy for measles infection and standard treatment is focused on supportive care. However, additional therapies have been used successfully to achieve a reduction in morbidity and mortality by measles infection. These Include:[1]

Supportive Care

Supportive care measures aim to minimize the damage done to the body by the viral infection, thereby, aiming to reduce the incidence of complications. This should ensure:[4]

Vitamin A

According to the WHO, children, regardless of the country of residence, who are diagnosed with measles, should receive two doses of vitamin A supplements, given 24 hours apart. During measles infection there is a natural decrease of vitamin A levels, even in the presence of adequate nutrition. Therefore, there is evidence that the administration of 2 doses of vitamin A, in consecutive days, helps restoring the vitamin A levels in the body and contributes to the decrease in morbidity, such as eye damage and blindness, and mortality from this disease. With adequate supplementation, there has been shown a reduction by 50% in the number of deaths.[2][4] For the administration of vitamin A, the WHO recommends administration once a day, in two consecutive days, of the following:

  • Children <6 months of age - 50.000 IU
  • Children >6 months <12 months - 100.000 IU
  • Children ≥12 months - 200.000 IU
  • For children who show evidence of vitamin A deficiency, a third dose, according to the above guideline, should be administered, 2-4 weeks later.

Antiviral Therapies

Although there is no specific antiviral therapy for measles infection, case reports have noted the in vitro susceptibility of measles virus to ribavirin. Also, ribavirin in parallel with other drugs, such as interferon-α, has been used in more severe cases of measles, specially when in the presence of CNS infection.[1][3]

Antibiotics

Concomitant bacterial infections constitute an important cause of morbidity and mortality in measles patients. In order to provide the best management to these patients, it is mandatory to provide prompt antibiotic treatment, whenever indicated.[1][5]

Common bacterial infections in measles patients, requiring antibiotic therapy include:[1][5][4]

Common agents of these infections include:[1][5][4]

Contraindicated Medications

References

  1. 1.0 1.1 1.2 1.3 1.4 1.5 Moss, William J; Griffin, Diane E (2012). "Measles". The Lancet. 379 (9811): 153–164. doi:10.1016/S0140-6736(10)62352-5. ISSN 0140-6736.
  2. 2.0 2.1 Huiming Y, Chaomin W, Meng M (2005). "Vitamin A for treating measles in children". Cochrane Database Syst Rev (4): CD001479. doi:10.1002/14651858.CD001479.pub3. PMID 16235283.
  3. 3.0 3.1 Reuter D, Schneider-Schaulies J (2010). "Measles virus infection of the CNS: human disease, animal models, and approaches to therapy". Med Microbiol Immunol. 199 (3): 261–71. doi:10.1007/s00430-010-0153-2. PMID 20390298.
  4. 4.0 4.1 4.2 4.3 "Measles".
  5. 5.0 5.1 5.2 Kabra, Sushil K; Lodha, Rakesh; Kabra, Sushil K (2008). "Antibiotics for preventing complications in children with measles". doi:10.1002/14651858.CD001477.pub3.

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