Severe complicated measles needs urgent referral
For every child with measles, the Integrated Management of Childhood Illness (IMCI) chart checks for eye and mouth complications. The classification severe complicated measles applies when the child has any general danger sign, clouding of the cornea, or deep or extensive mouth ulcers. It needs urgent referral. This child is alert, drinking well, and has no general danger signs, so the decision rests on the eye and mouth findings. Hazy clouding over the cornea makes it severe complicated measles, because corneal damage can lead to blindness.
Why the cornea is so important
Measles damages the surface of the eye, and in children with low vitamin A stores the cornea can ulcerate and scar quickly, causing permanent blindness. Clouding of the cornea is a sign that this process has begun. The child needs vitamin A, the first dose of an appropriate antibiotic as directed by the chart, protective eye treatment, and urgent transfer to a hospital. Measles itself is also a reason to give vitamin A to every child with the illness.
| Finding | IMCI classification | Action |
|---|
| General danger sign, clouding of the cornea, or deep or extensive mouth ulcers | Severe complicated measles | Urgent referral after pre-referral treatment |
| Pus draining from the eye or mouth ulcers not deep or extensive | Measles with eye or mouth complications | Treat at home, follow up |
| Measles now or within the last 3 months, no complications | Measles | Vitamin A, home care |
Why the other findings do not require urgent referral
A few shallow ulcers inside the cheeks are mouth ulcers that are not deep or extensive; they are treated at home, for example with gentian violet, and followed up. Pus draining from both eyes is an eye complication treated at home with tetracycline eye ointment and follow-up. A respiratory rate of 38 per minute in a 4-year-old is below the fast-breathing cut-off of 40 per minute for children aged 12 months up to 5 years, and with no chest indrawing it does not indicate pneumonia. Watch out! Pus from the eye looks dramatic, but in IMCI it is a home-treatment complication; corneal clouding is the sight-threatening sign.
Exam takeaway
In measles, look at the cornea and the depth of mouth ulcers: corneal clouding or deep or extensive ulcers mean urgent referral. The nurse should also report the case for surveillance, since measles is a notifiable disease, check the measles vaccination status of other children in the household and community, and counsel the family on feeding, fluids, and danger signs to watch for.