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Care priority and warning signs
Care priority
Refer URGENTLY
Red flags
- Any general danger sign
- Clouding of cornea
- Deep or extensive mouth ulcers
- Signs of pneumonia (chest indrawing, fast breathing)
- Stridor
- Severe malnutrition
Assessment
- Ask: Does the child have fever?
- Ask: Has the child had measles within the last 3 months? (Look for generalized rash PLUS one of: cough, runny nose, red eyes).
- If Yes to Measles:
- Check for General Danger Signs (Any ONE: Unable to drink/breastfeed, Vomits everything, Had convulsions, Lethargic/unconscious, Convulsing now).
- Look: Look for clouding of the cornea.
- Look: Look for deep or extensive mouth ulcers.
Classification
- Measles now or within last 3 months AND (Any general danger sign OR Clouding of cornea OR Deep/extensive mouth ulcers) -> SEVERE COMPLICATED MEASLES
Key features
- History of measles (rash + cough/runny nose/red eyes) within last 3 months.
- Presence of ANY General Danger Sign OR Clouding of Cornea OR Deep/extensive mouth ulcers.
- Clouding of cornea indicates severe Vitamin A deficiency and risk of blindness.
- Deep mouth ulcers impair feeding and increase risk of secondary infection/dehydration.
- Requires Vitamin A, pre-referral antibiotic, and urgent referral.
Management
Non-pharmacological management
- Quickly complete assessment.
- Keep child warm.
- Provide supportive care for breathing/airway if needed.
Pharmacological treatment
- Give Vitamin A treatment dose TODAY (Day 1). Dose: Age 6-11 months: 100,000 IU (Blue capsule). Age 12 months - 5 years: 200,000 IU (Red/Yellow capsule). (Note: Give 2nd dose on Day 2, 3rd dose after 2 weeks if eye signs present - managed at referral).
- Give first dose of appropriate IM antibiotic (e.g., Ampicillin + Gentamicin or Ceftriaxone - see page 12 for doses).
- If clouding of cornea or pus draining from eye: Apply Tetracycline eye ointment (1%) into both eyes.
- Treat to prevent low blood sugar (as per page 12).
- Give other necessary pre-referral treatments (e.g., rectal diazepam, antimalarial if co-existing severe classification).
Pre-referral treatment
- Vitamin A Day 1 dose.
- First dose IM antibiotic.
- Tetracycline eye ointment if eye signs.
- Treat for low blood sugar.
- Other essential pre-referral treatments.
Follow-up
- To be managed at referral hospital facility.
Counselling points
- Explain that measles has caused serious complications requiring hospital care.
- Explain treatments given (Vit A, antibiotic, eye ointment).
- Advise on keeping child warm and continuing fluids/breastfeeding if possible during transport.
- Write a detailed referral note mentioning measles, complications found, and all treatments given.
Differential diagnosis
- Measles with Eye/Mouth complications (less severe)
- Uncomplicated Measles
- Other viral exanthems (e.g., Rubella, Dengue, Enterovirus)
- Kawasaki disease
- Drug reaction
- Severe Vitamin A deficiency (corneal signs)
- Herpetic stomatitis (mouth ulcers)
Complications
- Blindness (from corneal ulceration/scarring)
- Severe Pneumonia
- Encephalitis
- Severe Diarrhoea and Dehydration
- Severe Stomatitis leading to poor intake/malnutrition
- Otitis Media, Mastoiditis
- Sepsis
- Subacute Sclerosing Panencephalitis (SSPE - late complication)
- Death
Prevention
- Measles vaccination (2 doses as per national schedule).
- Vitamin A supplementation (routine).
- Good nutrition.
- Prompt treatment of uncomplicated measles.
- Isolation of cases to prevent spread.
References
IMCI Chart Booklet - Page 4, Pages 1, 12, 18 (eye ointment), 20 (Vit A)