B19 DNA has been found in respiratory secretions. Follow-up can include a repeat fetal blood sampling 3 to 4 weeks after transfusion to confirm adequate erythrocyte production, or frequent fetal testing and ultrasound for 6 to 9 weeks after hydrops is resolved, to ensure fetal recovery (, In general, B19 infection produces a mild, self-limited illness, particularly in children. 1990 Oct; 9 (10):772–776. For information on cookies and how you can disable them visit our Privacy and Cookie Policy. Easily transmissible, parvovirus spreads slowly, allowing outbreaks to persist over months within a community. Tired, muscle aches. Headache. your express consent. Several investigators have reported spontaneous resolution of nonimmune hydrops. Susceptible pregnant women who are infected with parvovirus B19 will need supportive treatment during the illness as well as counseling about options for fetal testing. Pregnant women should be referred to their obstetric care providers for individual counseling but also can be reassured of the low risk of negative effects. A bone marrow biopsy demonstrated hemophagocytosis and a giant proerythroblasts, which is characteristic of a parvovirus B19 infection. Transmission of parvovirus infection from infected patients is rare. Infected adults experiencing arthropathy may be symptomatic for 1 to 2 weeks (, Because parvovirus appears to cause anomalies in animals, there has been concern of teratogenic effects in humans. Please enter a term before submitting your search. L.P., PA. Elizabeth Heavey, PhD, RN, CNM, and Roselind Bruce-Vanderpuije, SN, reply: Several viruses can cause fetal harm, including parvovirus B19 (B19), also known as erythema infectiosum or fifth disease. Therefore, MSAFP testing is not recommended for predicting fetuses at risk for parvovirus infection (. This website uses cookies. PDF | Parvovirus B19 causes prolonged epidemics of erythema infectiosum. Acute infection is detected from the presence of IgM antibodies. Hydrops can be diagnosed with fetal ultrasound (, If fetal hydrops is present and the pregnancy is 32 to 34 weeks gestation, consideration may be given to delivery if the fetus’s lung maturity is confirmed. Parvovirus is usually diagnosed through a blood test for antibodies to the virus. Parvovirus B19 (B19V) is a single-stranded DNA virus of the family Parvoviridae and genus Erythrovirus. The incidence of human parvovirus B19 infection during pregnancy and its impact on perinatal outcome. Congenital viral infections: A reappraisal. Copyright © 2021 Elsevier Inc. except certain content provided by third parties. The usual clinical manifestation is APIC Text of Infection Control and Epidemiology. Rogers BB, Singer DB, Mak SK, Gary GW, Fikrig MK, McMillan PN. https://www.health.nsw.gov.au/.../parvovirus-B19-and-(fifth-disease).aspx Parvovirus B19 binds to the P antigen present on erythrocytes, megakaryocytes, and myocardial cells. Dr. Heavey is also a certified nurse-midwife at the Strong Midwifery Group at the University of Rochester Medical Center in Rochester, N.Y. Please try after some time. The virus causes erythema infectiosum, also known as fifth disease. Pregnant women are not routinely screened for past parvovirus B19 infection as there … The percentage of people who test positive for evidence of previous infection increases with age and is more than 75% for adults older than 50 years (. Parvovirus B19 does not seem to cause malformations when a woman is infected in early pregnancy. 2. Intrauterine infection with human parvovirus B19 (B19) has been associated with stillbirth, fetal hydrops, and fetal death (Woernle, Anderson, Tattersall, & Davison, 1987). Author information: (1)Department of Obstetrics, Gynecology and Women's Health, New Jersey Medical School, Newark 07101-1709, USA. Hydrops can develop quickly and can rapidly progress to fetal death, or it may resolve spontaneously. However, nonimmune fetal hydrops is rare (1 in 3,000 to 4,000 pregnancies), with B19 infection as one of the most frequent causes. Maternal infections: Diagnosis and management. Although the infection is usually mild and self-limited, three groups of people are susceptible to serious complications of infection: persons with chronic hemolytic anemia, persons with congenital or acquired immunodeficiency, and pregnant women (, Susceptible pregnant women may be exposed to the virus, and the highest infection rates occur in school-teachers, day care workers, and women with school-age children in the home. Other viral agents of perinatal importance: Varicella, parvovirus, respiratory syncytial virus and enterovirus. South Australian Perinatal Practice Guideline Parvovirus (slapped cheek syndrome) INFORMAL COPY WHEN PRINTED Page 3 of 8 Public-I 2A Parvovirus Parvovirus B19 is a single-stranded DNA virus.1 Parvovirus B19 selectively infects and lyses human erythroblasts3 and is distinguished by the mild rash illness erythema infectiosum, also known as fifth disease (the fifth, pink-red rash to be Fetal death as well as fetal hydrops is most likely a result of severe B19-associated anemia. (II-2A) 5. There is no standard way to monitor a pregnant woman who has a documented Parvovirus B19 infection. Sore throat. Keywords: parvovirus B19, pregnancy, erythema infectiosum, hydrops fetalis Clinical features and pathogenesis The clinical features and pathogenesis of parvovirus B19 have been described in two reports.1,2 Human parvovirus B19 causes an acute, usually self-limiting, infection which is often asymptomatic. Your account has been temporarily locked due to incorrect sign in attempts and will be automatically unlocked in Parvovirus B19 most commonly causes fifth disease, a mild rash illness that usually affects children. Lippincott Journals Subscribers, use your username or email along with your password to log in. Monitoring Parvovirus B19 Infection during Pregnancy. Cartter ML, Farley TA, Rosengren S, et al. If IgM is detected when the test is repeated (with or without IgG), there is evidence of recent infection (. When hydrops does occur, it occurs on the average of 5 weeks (range 2 to 17 weeks) after maternal infection. Parvovirus B19 infection and its significance in pregnancy. There is understandably a high level of concern among pregnant women exposed to parvovirus B19, particularly women in high-risk occupations during an outbreak of erythema infectiosum. Parvovirus B19 is a common childhood virus, but it can lead to fetal problems if contracted by susceptible pregnant women. However, the natural history of infection in the untreated fetus is not known, and the benefit of intrauterine blood transfusion is as yet unproven. Al-Khan A(1), Caligiuri A, Apuzzio J. If parvovirus B19 immunoglobulin G is present and immunoglobulin M is negative, the woman is immune and should be reassured that she will not develop infection and that the virus will not adversely affect her pregnancy. Parvovirus B19 is a nonenveloped DNA virus and a member of the. IgM remains detectable for months and IgG for life following recovery from acute infection. Epidemiology and laboratory diagnosis of parvovirus B19 infection. Common viral infection with rash occurring 4 to 14 days (up to 21 days) after the start of the viral infection What are the signs or symptoms? Because the fetus is capable of producing IgM by approximately 18 weeks gestation, either fetal blood or amniotic fluid can be tested for IgM. Occupational risk factors for infection with parvovirus B19 among pregnant women. Women in these occupations have a greater likelihood of exposure to children with erythema infectiosum and have prolonged close contact with them. In situations in which there is a parvovirus B19 outbreak, it is not known whether the primary mode of transmission is direct person-to-person contact, fomites, large-particle droplets, or small-particle droplets (, Generally, diagnosis of parvovirus is based on clinical symptoms and serologic antibody testing for parvovirus immunoglobulin G and parvovirus immunoglobulin M (IgM). Because of the low risk of fetal damage, termination of pregnancy is not recommended, nor is amniocentesis for diagnosis of asymptomatic intrauterine infection (. The greatest risk of transmitting the virus occurs before the symptoms of erythema infectiosum develop. Nurses providing care during the prenatal period, as well as school nurses, need to be knowledgeable about parvovirus B19 and able to provide education and support to susceptible women who are exposed. Polymerase chain reaction is a sensitive method for detecting small amounts of B19 DNA, so this is the preferred method for making the diagnosis in utero (. J Infect Dis 1995; 171:1360. In pregnant women who are exposed to parvovirus B19, serological testing of IgG and IgM should be carried out immediately. Education about erythema infectiosum and possible methods to decrease infection can be provided to the community, schools, and parents of children who are cared for in group settings. However, parvovirus B19 infections during pregnancy can cause severe fetal anemia, occurring as a result of destruction of erythropoietic stem cells by the virus, which may in turn cause fetal heart failure and NIHF, and fetal death. Some providers consider this a low-risk condition and continue to provide routine prenatal care. During school outbreaks, 25–50% of students and 20% of staff may become infected (. Registered users can save articles, searches, and manage email alerts. Lacy red rash on the cheeks, legs, belly, and neck. Management and outcomes of pregnancies complicated by human B19 parvovirus infection: A prospective study. Parvovirus B19 may be transmitted by blood components such as cryoprecipitate and fresh frozen plasma. Current trends and risks associated with human parvovirus B19 infection. Management of parvovirus infection in pregnancy and outcomes of hydrops: A survey of members of the Society of Perinatal Obstetricians. The clinical features and pathogenesis of parvovirus B19 have been described in two reports. Published by Elsevier Inc. All rights reserved. Fever. Parvovirus B19 infection during pregnancy may cause fetal anemia, hydrops fetalis, and fetal demise. Gestational parvovirus B19 infection is usually a minor illness for the mother with a transplacental transmission rate of 17% to 33% to the fetus with a mean of about 6 weeks between maternal infection and fetal symptoms (Gratacós et al., 1995; Harger et al., 1998). The risk of vertical transmission (from mother to fetus) may be as high as 33% (, Parvovirus B19 preferentially infects rapidly dividing cells. Parvovirus B19 is a common childhood virus, but it can lead to fetal problems if contracted by susceptible pregnant women. 1. Infect Dis Obstet Gynecol. The authors have disclosed that they have no financial relationships related to this article. Parvovirus B19 is a common, self-limiting, usually benign childhood virus that causes erythema infectiosum, also known as fifth disease. Parvovirus B19 is a common childhood virus, but it can lead to fetal problems if contracted by susceptible pregnant women. Parvovirus B19 infection during pregnancy. Most adults are immune to primary infection because of exposure during childhood (. The cells most susceptible to parvovirus infection are erythroid precursor cells that have the P antigen, a receptor for parvovirus. The Hospital Infection Control Practices Advisory Committee. For more information, please refer to our Privacy Policy. All registration fields are required. School nurses or nurses on-site in day care centers may be involved in counseling during an outbreak of erythema infectiosum. Counseling to seronegative women should include decision making about avoiding possible occupational exposure to parvovirus B19, infection-control strategies to minimize risk of infection, and instruction to seek advice from a health care provider if exposed to or experiencing symptoms of erythema infectiosum (see, Pregnant health care workers are at no greater risk of acquiring B19 infection than are nonpregnant personnel. Fever. Elizabeth Heavey is an associate professor of nursing at the State University of New York College in Brockport, N.Y., where Roselind Bruce-Vanderpuije is a nursing student. Headache. However, if a pregnant woman is in regular contact with children aged 4 to 11 or if she has been in contact with an affected child, she must tell her doctor and have a blood test to determine immunity. Because 30–60% will be seropositive, this will provide the basis for reassurance. Parvovirus B19 in Pregnancy Parvovirus B19 in Pregnancy McCarter‐Spaulding, Deborah 2002-01-01 00:00:00 Parvovirus B19 is a common, self‐limiting, usually benign childhood virus that causes erythema infectiosum, also known as fifth disease. Patients with transient aplastic crisis should remain on droplet precautions for 7 days, and patients with chronic B19 infection should be on droplet precautions for the entire hospitalization (. If the blood test … The virus is effectively transmitted after close contact exposures, however. Boston College, School of Nursing, 140 Commonwealth Ave., Chestnut Hill, MA 02467-3812. IgM can be detected approximately 10 days after exposure and just before the onset of symptoms and is present in more than 90% of patients at the onset of rash (, A pregnant woman exposed to parvovirus or with a new rash or arthralgia should be tested for parvovirus B19. Some studies have noted that several women infected with parvovirus B19 were found to have elevated maternal serum alpha-fetoprotein (MSAFP) levels and have suggested that women with high MSAFP levels be screened for B19 infection. All rights reserved. For immediate assistance, contact Customer Service: Susceptible household contacts have about a 50% attack rate. However, 35–53% of pregnant women have existing immunoglobulin G (IgG), which indicates that they are immune because of a previous infection (, The mode of transmission of parvovirus B19 is not entirely clear. Principles and practices of infectious diseases. access full text with Ovid®. What is fifth disease? Guidelines for preconceptional conseling. The association between MSAFP and B19 infection is weak, however, and elevated MSAFP can be caused by other conditions. Log in to view full text. The risk of hydrops is 3% with a mortality of 50%. Evidence of acute/recent infection with B19. The name is derived from Latin, parvum meaning small, reflecting the fact that B19 ranks among the smallest DNA viruses. This article addresses the issues concerning parvovirus infection and pregnancy. Parvovirus B19 is a single-stranded DNA virus that is cytotoxic to erythroid progenitor cells, causing inhibition of erythropoiesis. Get new journal Tables of Contents sent right to your email inbox, January 2012 - Volume 42 - Issue 1 - p 69, Articles in PubMed by Elizabeth Heavey, PhD, RN, CNM, Articles in Google Scholar by Elizabeth Heavey, PhD, RN, CNM, Other articles in this journal by Elizabeth Heavey, PhD, RN, CNM, Questioning orders: A bioethical framework, Using a standardized fall prevention tool decreases fall rates. Women who are schoolteachers or day care workers are particularly at risk because they are more likely to be exposed and have close contact with children with fifth disease. However, there is no evidence that the rate of congenital anomalies differs from background rates (, During outbreaks of B19 infection, it is difficult to prevent the spread of infection. Wolters Kluwer Health, Inc. and/or its subsidiaries. Wolters Kluwer Health AWHONN Journals Article Collection on COVID-19, Racism, Disparities, and Social Determinants of Health, JOGNN Health Care Improvement and Evaluation, Diagnosis and Treatment of Herpes Simplex Infection During Pregnancy, Guide to Interpreting Parvovirus B19 IgG and IgM Serology Values. Although fetal death and nonimmune hydrops are of concern, the risk is actually quite low. Fetal Parvovirus infection has been associated with aplastic anaemia and myocarditis that may present with hydrops fetalis and death, usually within the first 20 weeks of pregnancy although it has rarely been reported at later gestations. Although rare, acute B19 infection in pregnancy may lead to hydrops fetalis (fetal hydrops) or fetal loss. The virus causes erythema infectiosum, also known as fifth disease. The overall risk of a fetus acquiring hydrops after maternal B19 infection is low, approximately 1% (, Intrauterine blood transfusion has been proposed as a treatment for the fetus with severe B19-induced anemia and hydrops. Hand washing has not been studied as a means to prevent transmission of infection, but it is certainly recommended as a measure that is most likely effective (, Women who are pregnant and who are at high risk for exposure to B19 infection, such as schoolteachers, day care workers, and women living with school-age children or children in group day care, may benefit from baseline serologic testing to determine their susceptibility to infection. [email protected]. The Human Parvovirus B19 is not the same Parvovirus that vets may be concerned about in pets, especially dogs, and it cannot be passed from humans to animals or vice versa. Because B19 also can infect myocardial cells, myocardial injury may contribute to the hydrops and fetal death (, Infection resulting in fetal loss is more likely to occur in the first 20 weeks, and most losses occur within 4 to 6 weeks of exposure (. 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