# Measles (Rubeola) - Category: infectious - Review status: reviewed (every claim checked against a document named on this page) - Sources: MSF Essential Drugs 2024 (retinol = vitamin A oral monograph), Treatment of vitamin A deficiency and the two-dose measles regimen in Remarks · WHO Guideline for Epidemic Measles Management 2020 · GAMASTAN (immune globulin (human)) injection US prescribing information, section 1 Indications and Usage and section 2 Dosage and Administration (DailyMed SetID 561f48de-2697-4a35-8233-bd1cdb73438f) · Measles - disease-level clinical article (measles-full.txt) - Verified date: 2026-08 ## Verified against - MSF Essential Drugs 2024 (retinol = vitamin A oral monograph), Treatment of vitamin A deficiency and the two-dose measles regimen in Remarks - WHO Guideline for Epidemic Measles Management 2020 - Measles - disease-level clinical article (measles-full.txt) - MSF Essential Drugs 2024 - paracetamol (oral) - GAMASTAN (immune globulin (human)) injection US prescribing information, section 1 Indications and Usage and section 2 Dosage and Administration (DailyMed SetID 561f48de-2697-4a35-8233-bd1cdb73438f) ## Treatment metadata - Paracetamol — 500 mg — oral.solid - Vitamin A — oral.solid - Referral & safety-netting (no drug therapy) - Immunoglobulin — injection ## Complete treatment card ```text MEASLES (RUBEOLA) Sources: MSF Essential Drugs 2024 (retinol = vitamin A oral monograph), Treatment of vitamin A deficiency and the two-dose measles regimen in Remarks · WHO Guideline for Epidemic Measles Management 2020 · GAMASTAN (immune globulin (human)) injection US prescribing information, section 1 Indications and Usage and section 2 Dosage and Administration (DailyMed SetID 561f48de-2697-4a35-8233-bd1cdb73438f) · Measles - disease-level clinical article (measles- full.txt) Review status: REVIEWED against MSF Essential Drugs 2024 (retinol = vitamin A oral monograph), Treatment of vitamin A deficiency and the two-dose measles regimen in Remarks, WHO Guideline for Epidemic Measles Management 2020, Measles - disease-level clinical article (measles-full.txt), MSF Essential Drugs 2024 - paracetamol (oral), GAMASTAN (immune globulin (human)) injection US prescribing information, section 1 Indications and Usage and section 2 Dosage and Administration (DailyMed SetID 561f48de-2697-4a35-8233-bd1cdb73438f) (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (5) - The WHO case definition is fever with a widespread blotchy rash, cough, runny nose, or conjunctivitis [cough · fever · rash · runny nose] - Koplik spots - small white spots inside the cheeks - show up 1 to 2 days ahead of the rash and are diagnostic on their own [rash] - Fever comes before the rash, which starts around the hairline and face and then spreads downward [fever · rash] - The rash clears in the same order it appeared, about a week after onset, often followed by skin peeling [rash] - Modified measles in previously immunized patients is milder and the rash may start on the trunk or limbs instead of the usual pattern [rash] TESTS (5) - CBC often shows low white cells, especially low lymphocytes, and low platelets - Within the first 3 days of rash, RT-PCR is most reliable, though viral RNA can still be picked up for up to 10 days afterward - Measles-specific IgM confirms the diagnosis but can be falsely negative in up to 25% of cases if drawn within 3 days of rash onset - IgM levels rise to a peak by one to three weeks post-rash, then fade below detection somewhere between 4 and 8 weeks - False-positive IgM results can occur with rheumatoid factor or with rubella, parvovirus, or human herpesvirus 6 infection IF NOT THIS - what else fits (7) - Kawasaki disease - Rubella in children - Scarlet fever - Multisystem inflammatory syndrome in children - Parvovirus B19 infection - Dengue is a differential diagnosis for measles - Meningococcemia Source StatPearls "Measles" - disease-level clinical article Status traced to the source above Rx: Fever and discomfort | Vitamin A - WHO, all children | Main treatment | Post-exposure prophylaxis for a contact who cannot have the vaccine - intramuscular only FEVER AND DISCOMFORT 1. PARACETAMOL [1st line] Adult 1 g 3 or 4 times daily (max. 4 g daily) x 3-5 days Peds 10-15 mg/kg/dose [child max 500 mg] (Child 1 month and over: 15 mg/kg 3 or 4 times daily (max. 60 mg/kg daily). Child under 1 month: 10 mg/kg 3 or 4 times daily (max. 40 mg/kg daily).) 3kg -> 30-45 mg/dose 4kg -> 40-60 mg/dose 5kg -> 50-75 mg/dose 6kg -> 60-90 mg/dose 7kg -> 70-105 mg/dose 8kg -> 80-120 mg/dose 9kg -> 90-135 mg/dose 10kg -> 100-150 mg/dose 11kg -> 110-165 mg/dose 12kg -> 120-180 mg/dose 13kg -> 130-195 mg/dose 14kg -> 140-210 mg/dose 15kg -> 150-225 mg/dose 16kg -> 160-240 mg/dose 17kg -> 170-255 mg/dose 18kg -> 180-270 mg/dose 19kg -> 190-285 mg/dose 20kg -> 200-300 mg/dose 21kg -> 210-315 mg/dose 22kg -> 220-330 mg/dose 23kg -> 230-345 mg/dose 24kg -> 240-360 mg/dose 25kg -> 250-375 mg/dose 26kg -> 260-390 mg/dose 27kg -> 270-405 mg/dose 28kg -> 280-420 mg/dose 29kg -> 290-435 mg/dose 30kg -> 300-450 mg/dose 31kg -> 310-465 mg/dose 32kg -> 320-480 mg/dose 33kg -> 330-495 mg/dose 34kg -> 340-500 mg/dose (upper capped) 35kg -> 350-500 mg/dose (upper capped) 36kg -> 360-500 mg/dose (upper capped) 37kg -> 370-500 mg/dose (upper capped) 38kg -> 380-500 mg/dose (upper capped) 39kg -> 390-500 mg/dose (upper capped) 40kg -> 400-500 mg/dose (upper capped) 41kg -> 410-500 mg/dose (upper capped) 42kg -> 420-500 mg/dose (upper capped) 43kg -> 430-500 mg/dose (upper capped) 44kg -> 440-500 mg/dose (upper capped) 45kg -> 450-500 mg/dose (upper capped) 46kg -> 460-500 mg/dose (upper capped) 47kg -> 470-500 mg/dose (upper capped) 48kg -> 480-500 mg/dose (upper capped) 49kg -> 490-500 mg/dose (upper capped) 50kg -> 500 mg/dose (capped) Source MSF Essential Drugs 2024 - paracetamol (oral) Why Antipyretic and analgesic for symptomatic relief of fever and discomfort in measles; supportive care only, with no effect on the virus itself. Caution Report respiratory distress, altered consciousness, or otitis media. Paracetamol is supportive therapy; isolate the patient to prevent airborne spread. Do not exceed maximum daily dose. 500 mg is the per-dose ceiling used here for a child. 1000 mg is the adult dose and does not belong in a weight calculation - the daily 60 mg/kg limit is the one that binds first in any case. Egypt FEBRIMOL 500 MG 20 TAB. PHARCO 3.50 EGP (0.17/unit) CETAMOL 500 MG 20 TABS. MEMPHIS 8.00 EGP (0.40/unit) PARACETAMOL-MUP 500MG B.P. 20 TABS. MUP 13.00 EGP (0.65/unit) CETAL 500 MG 20 TABS. EIPICO 24.00 EGP (1.20/unit) ARKADOLOW 500 MG 30 F.C. TABS. UTOPIA 42.00 EGP (1.40/unit) PARAMOL 500MG 20 TAB. MISR 38.00 EGP (1.90/unit) ADOL 500MG 24 CAPLETS JULPHAR 32.00 EGP AUGICETAMIDE 500 MG 20 SACHETS AUG PHARMA 50.00 EGP FEBRIMOL ORAL DROPS 20 ML PHARCO 4.00 EGP -> ? strength differs, ? different route - not oral solid THERA-LO 3.2G/100ML ORAL SUSP. 100 ML PHAROPHARMA 5.00 EGP -> ? strength differs, ? different route - not oral solid VITAMIN A - WHO, ALL CHILDREN 2. VITAMIN A [1st line] Adult 200000 IU once daily for 2 consecutive days x 2 days Peds Under 6 months: 50000 IU daily for 2 days 6 to 11 months: 100000 IU daily for 2 days 12 months and over: 200000 IU daily for 2 days (Infants <6 months: 50000 IU daily; 6-11 months: 100000 IU daily; >=12 months: 200000 IU daily for 2 days) Source MSF Essential Drugs 2024 (retinol = vitamin A oral monograph), Treatment of vitamin A deficiency and the two-dose measles regimen in Remarks Why WHO-recommended supplementation given during acute measles in children to reduce disease severity and complications, addressing the vitamin A depletion that measles itself provokes. Caution Reduces mortality and complications in childhood measles. High-dose Vitamin A is teratogenic; avoid in pregnant adults. Sold as oral drops or capsule contents in primary care. Egypt A-VITON 50.000 I.U. 20 CAPS. KAHIRA 5.00 EGP (0.25/unit) VITAMIN A 10 000 IU 100 SOFTGELS (ILLEGAL IMPORT) PURITANS PRIDE 63.00 EGP MAIN TREATMENT 3. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY) [1st line] Adult Source Measles - disease-level clinical article (measles-full.txt) Why Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen. Caution RED FLAG - Infection control measures, including appropriate isolation, are named as part of the mainstay of therapy, and institutional infection control/public health notification should be consulted promptly for suspected cases. RED FLAG - Specialist referral (infectious disease, neurology, pulmonology, critical care) is needed for severe cases or measles complications. POST-EXPOSURE PROPHYLAXIS FOR A CONTACT WHO CANNOT HAVE THE VACCINE - INTRAMUSCULAR ONLY 4. IMMUNOGLOBULIN [2nd line] Adult 0.25 mL/kg intramuscularly. US label verbatim, from its dosing table: "0.25 mL/kg" with the instruction "Administer to a susceptible person within 6 days of exposure." For an immunocompromised contact the label doubles it: "0.5 mL/kg Immediately administer (maximum dose, 15 mL) to an immunocompromised child." Route is not a choice - "For intramuscular use only." and "Do not administer intravenously." Large volumes are split: "Divide and inject doses greater than 10 mL into several muscle sites to reduce local pain and discomfort." - One dose, tied to the exposure rather than to symptoms. The label's window is six days from contact, and an immunocompromised child is dosed "Immediately". Peds This is mostly a paediatric prescription and the volume is per kilogram: 0.25 mL/kg for a susceptible child within six days of exposure, and 0.5 mL/kg to a maximum of 15 mL, given immediately, for an immunocompromised child. The vaccine schedule then shifts. US label verbatim: "Do not give GAMASTAN and measles vaccine at the same time. If a child is older than 12 months and has received GAMASTAN, give measles vaccine about five months later when the measles antibody titer will have disappeared." Source GAMASTAN (immune globulin (human)) injection US prescribing information, section 1 Indications and Usage and section 2 Dosage and Administration (DailyMed SetID 561f48de-2697-4a35-8233-bd1cdb73438f) Why StatPearls names the step and the drug: give the MMR vaccine as post-exposure prophylaxis within 72 hours of exposure, and where a patient cannot be vaccinated because they are immunocompromised, consider immune globulin instead. The US label's licensed use names the same disease and patient group: it is especially suited to susceptible household contacts of a measles case, particularly those under 1 year old, who carry the highest complication risk; an immunocompromised child exposed to measles should get it right away; and it also covers pregnant women with no evidence of immunity. Measles outbreaks in Cairo reach infants too young to be vaccinated and children on chemotherapy or steroids, and for both groups the vaccine is not the answer. Egypt registers an intramuscular human immunoglobulin, Y-GLOBULIN KGCC vial at 37 EGP, among several intravenous preparations. Caution RED FLAG - boxed warning, thrombosis. US label verbatim: "Thrombosis may occur with immune globulin products, including GAMASTAN. Risk factors may include: advanced age, prolonged immobilization, hypercoagulable conditions, history of venous or arterial thrombosis, use of estrogens, indwelling central vascular catheters, hyperviscosity, and cardiovascular risk factors. Thrombosis may occur in the absence of known risk factors." and "For patients at risk of thrombosis, do not exceed the recommended dose of GAMASTAN. Ensure adequate hydration in patients before administration." Never intravenously. US label verbatim: "Do not administer intravenously because of the potential for serious reactions (e.g., Renal Dysfunction/Failure/Hemolysis, Transfusion- Related Acute Lung Injury [TRALI])." and, on the injection site, "Do not use the gluteal region as an injection site because of the risk of injury to the sciatic nerve." The millilitre-per-kilogram figure belongs to a 16.5% intramuscular preparation. US label verbatim: "GAMASTAN is a sterile, 16.5% protein solution supplied in 2 mL and 10 mL single-dose vials." A 5% intravenous immunoglobulin is a different product at a different concentration by a different route, and the volume does not carry across - check the vial before drawing anything up. Most of the Egyptian register under this ingredient is intravenous 5% or 10% product; the intramuscular ones are Y-GLOBULIN KGCC I.M VIAL at 37 EGP and HUMAN GAMMA GLOBULIN 16% ampoule. Live vaccines wait afterwards. US label verbatim: "Antibodies in GAMASTAN may interfere with the response to live virus vaccines such as measles, mumps, polio, rubella, and varicella. Defer live vaccine administration for up to 6 months after GAMASTAN administration." Contraindicated in two groups. US label verbatim: "Anaphylactic or severe systemic hypersensitivity reactions to Immune Globulin (Human)" and "IgA deficient patients with antibodies against IgA and a history of hypersensitivity". The vaccine still comes first where it can be given: the disease article recommends the MMR as post-exposure prophylaxis, given within 72 hours of the exposure. Immunoglobulin is for the contact who cannot have it. Egypt Y-GLOBULIN KGCC I.M VIAL KORIA GREEN C... 37.00 EGP I.V-GLOBULIN 50MG/ML 0.5G VIAL KORIA GREEN C... 360.00 EGP INTRAGLOBIN F 50MG/ML (20ML=1G) I.V.INFUSION BIOTEST PHARMA GERMANY > EG... 600.00 EGP INTRAGLOBIN F 50MG/ML (50ML=2.5G) I.V.INFUSION BIOTEST PHARMA GERMANY > ... 1450.00 EGP VIGAM-S 5 %W/V (100ML) INJ. BPL BIO PRO... 2200.00 EGP GAMUNEX-C 10% I.V. VIAL 100 ML GRIFOLS THERA... 6000.00 EGP GAMUNEX-C 10% I.V. VIAL 25 ML GRIFOLS THERA... 10000.00 EGP GAMUNEX-C 10% I.V. VIAL 50 ML GRIFOLS THERA... 20000.00 EGP Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)