Parvovirus (Slapped Cheek, B19 or Fifth Disease) Information for Women In Pregnancy Exceptional healthcare, personally delivered
What is Parvovirus B19 (Human Parvovirus)? Parvovirus B19 is a virus that commonly infects children (similar to rubella). It is usually transmitted by respiratory droplets (coughing and sneezing). School teachers, child day care workers, and mothers of young children are particularly likely to be exposed to this virus. The human virus, 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. Parvovirus B19 is also known as Slapped Cheek Syndrome or Fifth Disease and the effects in children are known as Erythema Infectiosum. What are the symptoms of Parvovirus B19? Human Parvovirus commonly causes a slight fever, headache, and mild cold-like symptoms (a stuffy or runny nose). These symptoms pass, and the illness seems to be gone until a rash appears a few days later. The bright red rash usually begins on the face. This resembles a slapped cheek appearance, hence this disease is often referred to as slapped cheek syndrome. Several days later, the rash spreads and red blotches (usually lighter in colour) extend down to the trunk, arms, and legs. The rash usually spares the palms of the hands and soles of the feet. As the centres of the blotches begin to clear, the rash takes on a lacy net-like appearance. Children younger than 10 years old are most likely to get the rash. 2 Parvovirus (Slapped Cheek, B19 or Fifth Disease)
Older children and adults sometimes complain that the rash itches, but most children with a rash do not look sick and no longer have fever. Certain stimuli (including sunlight, heat, exercise, and stress) may reactivate the rash until it completely fades. It may take 1 to 3 weeks for the rash to completely clear, and during that time it may seem to worsen until it finally fades away entirely. Other symptoms that sometimes occur with Human Parvovirus infection include swollen glands, red eyes, sore throat, diarrhoea, and rarely, rashes that look like blisters or bruises. In some cases, especially in adults and older teenagers, infection with Human Parvovirus may be followed by joint swelling or pain, often in the hands, wrists, knees, or ankles. These symptoms are more common in adult women than in men.they usually last 2-4 weeks but may persist for several months. A person with parvovirus infection is most contagious before the rash appears either during the incubation period (the time between infection and the onset of symptoms) or when experiencing only mild respiratory symptoms. The incubation period ranges from 4 to 28 days, with the average being 16 to 17 days The rash is the result of an immune system reaction that occurs after the infection has passed, so children usually aren t contagious once it appears. Therefore infection with Human Parvovirus may have occurred earlier that you think. It is important to note that many people with Human parvovirus show no symptoms at all. Parvovirus (Slapped Cheek, B19 or Fifth Disease) 3
What happens if I think I may have been in contact with Human Parvovirus? Approximately 50-60% of adults have been infected with parvovirus at some time in the past and you are therefore immune to further infection. If you have think you have been in contact with Human parvovirus infection or if you have a rash you should report this to your midwife (or doctor) as you will need to have a blood test. Contact is defined as being in the same room as an infected person for a prolonged period (over 15 minutes) or face-to-face contact; the main risk of infection is from household contacts or prolonged occupational contact. The blood test will tell if: You have had Human Parvovirus infection before and are now immune (not at risk of infection as you have antibodies to protect you from infection) You currently have Human Parvovirus infection You have not had Human Parvovirus infection before and are susceptible to infection. The test for Rubella (German measles) will also be repeated to confirm your Rubella result performed on your booking blood. Human Parvovirus B19 and pregnancy Human Parvovirus affects about 1 in 400 pregnancies. The gestational period of risk is between 4 and 20 weeks gestation: under 4 weeks, there is no transmission of the virus to the baby and over 20 weeks there is a much lower risk of severe anaemia in the baby. 4 Parvovirus (Slapped Cheek, B19 or Fifth Disease)
9 out of 10 babies are unaffected by the virus. However, 1 in every 10 babies can be affected by exposure to this virus in pregnancy and this may result in serious harm to your baby as the infection can cause the baby to become anaemic (reduced level of red blood cells). Severe anaemia can lead to a condition known as fetal hydrops which may result in the baby having heart failure. If this occurs, this can lead to the baby dying. Fortunately, this tragic outcome is seen in only 3 in 100 babies of infected mothers and can be reduced by closely monitoring the baby for signs of fetal anaemia and treating as necessary. Human Parvovirus is not known to cause congenital abnormalities. What happens if I get Human Parvovirus infection whilst pregnant? If the results of your blood test confirm that you have the infection, your pregnancy will be monitored very closely. You will be referred to a specialist fetal medicine clinic (which will be either at Southmead or St. Michael s hospitals) and you will have frequent ultrasound scans for several weeks. The frequency of these scans will depend upon the stage of pregnancy and the findings at each scan. If the baby shows signs of anaemia, an intrauterine blood transfusion may be necessary. Intrauterine Blood Transfusion is a process where blood is given to the baby while it is still inside the womb in order to give the baby a better chance of survival. Blood is given via a needle inserted into the baby s umbilical cord. The blood given to the fetus increases the amount of healthy blood in the fetus and helps the fetus grow and develop normally. This treatment is usually successful in reversing the anaemia. Fortunately, the viral infection in the baby is usually short lived and after treatment the baby almost always continues to develop normally. Parvovirus (Slapped Cheek, B19 or Fifth Disease) 5
If I have had a blood test for Human Parvovirus how soon can I expect a result? If your midwife or doctor has taken a blood test for parvovirus the result should be available within 6 working days. Your midwife (or doctor) should contact you with the result as soon as they receive it,. If you do not hear from your midwife (or doctor) by 7 working days it is strongly advised that you contact them or their base (surgery, health centre) or the ante-natal clinic of the hospital stated on your Maternity hand held notes. If your blood test demonstrates antibodies to parvovirus in a sample taken before your presumed exposure date e.g. a booking blood sample, it indicates that you were immune prior to the exposure. If your blood test shows that you are parvovirus antibody negative you are susceptible to infection by Human Parvovirus and you will be required to be retested in 4 weeks time to see if you have developed antibodies to the virus. If your initial or follow-up blood test demonstrated the presence of Human parvovirus antibodies of recent origin or detectable virus it means you have been recently infected and your baby is at risk of infection. Your doctor and midwife will refer you to a specialist fetal medicine clinic for further follow-up promptly. 6 Parvovirus (Slapped Cheek, B19 or Fifth Disease)
References and sources of further information Parvovirus B19 Do you know your status? www. fifthdisease.org [Last Accessed April 2011] http://www.patient.co.uk/health/slapped-cheek-disease. htm [Last Accessed April 2011] Health Protection Agency ;Parvovirus general information June 2008 Parvovirus (Slapped Cheek, B19 or Fifth Disease) 7
How to contact us: Southmead Hospital Bristol 0117 323 5050 Assessment Unit Southmead 0117 323 6397 Central Delivery Suite (Southmead) 0117 323 5320 St Michael s Hospital, Bristol Day Assessment Unit 0117 928 5395 Delivery Suite (St Michael s) 0117 928 5214 Royal United Hospital, Bath Day Assessment Unit 01225 824 447 or 01225 824 847 www.nbt.nhs.uk/maternity If you or the individual you are caring for need support reading this leaflet please ask a member of staff for advice. North Bristol NHS Trust. First Published April 2011 NBT002484