Parvovirus
(Slapped Cheek, B19 or
Fifth Disease)
Information for Women In Pregnancy
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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 Check 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.
Older children and adults sometimes complain that the rash itches,
but most children with a rash do not look sick and no longer have
a 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.
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Parvovirus (Slapped Cheek, B19 or Fifth Disease)
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 than you think. It is
important to note that many people with Human Parvovirus show
no symptoms at all.
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.
Parvovirus (Slapped Cheek, B19 or Fifth Disease)
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The blood test will tell if:
ƒƒ
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)
ƒƒ
You
currently have Human Parvovirus infection
ƒƒ
You
have not had Human Parvovirus infection before and are
susceptible to infection.
ƒƒ
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.
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 your 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 your 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.
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Parvovirus (Slapped Cheek, B19 or Fifth Disease)
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.
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.
Parvovirus (Slapped Cheek, B19 or Fifth Disease)
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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.
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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)
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How to contact us:
Southmead Hospital Bristol
0117 950 5050
Assessment Unit
Southmead Hospital Bristol
0117 414 6906
Central Delivery Suite
Southmead Hospital Bristol
0117 414 6916 / 0117 414 6917
Cossham Birth Centre
0117 340 8460
Day Assessment Unit
St Michael’s Hospital, Bristol
0117 928 5395
Delivery Suite
St Michael’s Hospital, Bristol
0117 928 5214
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Day Assessment Unit
Royal United Hospital, Bath
01225 824 447
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or 01225 824 847
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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. This edition published January 2015. Review due January 2017. NBT002484