Emergency Department Management of Measles, Mumps, Rubella, and Varicella in Pediatric Patients (Infectious Disease CME and Pharmacology CME)

Delivery Method:	Online
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Publication Date: November 2025 (Volume 22, Number 11)

CME Credits: 4 AMA PRA Category 1 Credits™, 4 ACEP Category I Credits, 4 AAP Prescribed Credits, 4 AOA Category 2-B Credits. CME expires 11/01/2028.

Specialty CME Credits: Included as part of the 4 credits, this CME activity is eligible for 4 Infectious Disease CME credits and 1 Pharmacology CME credit, subject to your state and institutional approval.

Author

Peer Reviewers

Abstract

Public health programs have helped decrease the prevalence and sequelae of measles, mumps, rubella, and varicella; however, misinformation regarding vaccinations and recent disruptions to vaccination programs have caused outbreaks to occur. Emergency clinicians must be able to readily identify the characteristic presentations of measles, mumps, rubella, and varicella, with the goals of optimizing supportive care, limiting the spread of disease, and giving appropriate precautionary advice for complications to patients and their families. This issue provides a review of the clinical features, differential diagnoses, potential complications, and treatment options for measles, mumps, rubella, and varicella.

Case Presentations

A mother brings in her 3-month-old son, who has been fussy and has had a runny nose, cough, and fever for the past 5 days...

• The mother also tells you that the infant developed a red, raised rash on his face that spread to his abdomen and extremities over the course of a day. The mother reports that her son is eating less and has been breathing rapidly. The boy was born full-term in the United States and has no past medical history. He has had 1 vaccination visit at his primary care physician, at 2 months of age.
• The infant’s vital signs are: rectal temperature, 40°C; heart rate, 175 beats/min; blood pressure, 81/54 mm Hg; respiratory rate, 45 breaths/min; and oxygen saturation, 91% on room air. The physical examination is significant for rhinorrhea, lesions on the buccal mucosa, and bilateral conjunctival injection without purulent drainage. You note cervical lymphadenopathy and a blanching maculopapular exanthem on his face, trunk, extremities, palms, and soles. Upon auscultation, he has rales at both lung bases.
• You consider: What is the etiology for this patient’s fever and rash? What are the possible complications of his illness? Does this patient need diagnostic testing or specialty consultation? Should this patient be isolated in the ED, and should contacts be isolated or treated? What treatments are indicated? Should this patient be admitted?

A 6-month-old girl, who was born full-term, is brought into the ED by her mother for fever and rash for 3 days…

• The mother tells you the rash began on the infant’s face as “water blisters.” The mother also states that it seems as though her daughter has not felt well for the last 2 days, has had decreased urine output, decreased activity, and has been irritable. According to the mother, the girl is up-to-date with recommended vaccinations for her age. There are no sick contacts in the family; however, the patient’s grandmother has a painful rash on her back.
• The infant’s vital signs are: rectal temperature, 38.5°C; heart rate, 170 beats/min; blood pressure, 100/64 mm Hg; respiratory rate, 40 breaths/min; and oxygen saturation, 98% on room air. The physical examination is significant for vesicles on an erythematous base on the girl’s face, trunk, extremities, and back, as well as many excoriated and scabbed lesions. There are erythematous papules on the anterior buccal mucosa and the posterior pharynx. The infant’s mucous membranes are dry, her lungs are clear, and her skin is warm. The infant is crying and her mother is having difficulty consoling her.
• Similar to your previous patient, you wonder: What is the etiology for this patient’s fever and rash? What are the possible complications of her illness? Does this patient need diagnostic testing or specialty consultation? Should this patient be isolated in the ED, and should contacts be isolated or treated? What treatments are indicated? Should this patient be admitted?

Accreditation:

EB Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.