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| |    Parvovirus B19 Infections: The Risks by Lynn Cates, M.D., F.A.A.P. reviewed by Laura Jana, M.D., F.A.A.P. In the vast majority of cases, parvovirus B19 causes only a mild case of fifth disease. However, a few individuals with certain underlying conditions are at risk of developing serious complications from this virus. Underlying conditions Parvovirus B19 can cause severe illness in people with sickle cell anemia, thalassemia, hereditary spherocytosis, HIV/AIDS, and some other conditions that can suppress the immune system (such as chemotherapy for certain kinds of cancer). Complications include a decrease in red blood cell production (anemia), as well as decreased production of other blood cells needed to fight infections (white blood cells) and initiate blood clotting (platelets). These problems may be persistent and these individuals are highly contagious while they are infected. People with known increased susceptibility to these manifestations of parvovirus infections should try to avoid exposure to children who have fifth disease whenever possible, and they should let their healthcare providers know if they are exposed so that they can be monitored appropriately. Pregnant women About 1.5 percent of women of childbearing age become infected with parvovirus B19 infections each year. Most pregnant women who develop this infection deliver normal babies; however, in about a quarter to a third of these pregnancies, the fetus also becomes infected--sometimes severely. The highest risk appears to be in the second trimester, but the infection has been reported to cause serious fetal disease at any time in gestation. Parvovirus B19 does not cause birth defects, but it can be responsible for other problems. When the mother is infected during pregnancy, about 2 to 6 percent of fetuses die, usually from a condition known as hydrops fetalis, which is characterized by severe anemia and resulting decreased oxygen delivery to vital organs and heart failure. Sometimes fetal blood transfusions can successfully treat this condition. Because fifth disease is so common among children, parvovirus B19 infection is considered to be an occupational hazard of daycare workers and teachers. Since the infection is so commonplace in this setting, it is not realistic, or routinely recommended, for pregnant women to be excluded from work when fifth disease is circulating. However, certain hospitalized patients with parvovirus B19 infections are highly contagious, putting pregnant healthcare personnel at greater risk of exposure to the virus. For that reason, such workers should be advised of the potential risks to the fetus and should either practice strict infection control or avoid caring for these patients. It is recommended that pregnant women consult with their obstetrical practitioner if they learn that they have been exposed to parvovirus B19. Sometimes blood antibody tests can be performed to determine whether or not the woman has already had the infection. If infection is diagnosed, weekly ultrasound imaging for the next month or two can check the baby for signs of hydrops fetalis. If hydrops fetalis develops, it should be managed by a high-risk obstetrical specialist experienced in the care of babies with this condition.
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