In Morbidity and Mortality Weekly Report, three new research describe elevated infections of parvovirus B19 detected in US business labs, with 5 worrisome circumstances in pregnant Minnesotans and infections in kids and youths with sickle cell illness in Georgia.
In August, the Facilities for Illness Management and Prevention (CDC) issued a Well being Alert Community advisory on the rise in circumstances of the seasonal respiratory viral illness after receiving stories of lab check positivity and clusters of parvovirus B19–associated problems amongst pregnant girls and other people with sickle cell illness. A number of European nations had noticed vital will increase in B19 exercise early in 2024.
The sickness, which may enhance the chance of miscarriage early in being pregnant, is characterised by a “slapped-cheek” rash in kids and joint ache in adults. Whereas most circumstances are asymptomatic or gentle, individuals with an underlying blood illness or a weakened immune system can expertise extra critical outcomes.
“B19 an infection might be transmitted from a mom to the fetus throughout being pregnant and, hardly ever, by transfusion of blood elements and sure plasma derivates,” the authors of the lab research wrote. “Most individuals turn into contaminated with B19 throughout their college years. Immunity from an infection is considered lifelong.”
Virtually 10% positivity, up from 1.5%
Within the first of the three research, researchers from North Carolina’s Labcorp and the CDC investigated an uptick in parvovirus B19 check positivity at Labcorp in 2024 from ranges within the 2018-19 respiratory virus season. Parvovirus B19 is just not a notifiable sickness in america.
The investigators seemed for the presence of immunoglobulin (Ig) M antibodies, a marker of current an infection, in scientific specimens from 359,445 kids and adults and carried out B19 nucleic acid amplification testing (NAAT) in plasma from a median of 1,059 donor swimming pools every month.
Well being care suppliers caring for pregnant individuals must be notably vigilant for indicators of diminished fetal motion or proof of hydrops [severe swelling] which might be related to B19.
The proportion of IgM-positive scientific specimens climbed to 9.9% in spring 2024, up from lower than 1.5% in 2020 to 2023, increased than peaks in the identical interval of 2018 (3.8%) and 2019 (5.1%). The prevalence of B19–NAAT-positive plasma-donor swimming pools (512 donations per pool) rose to twenty% in June, up from lower than 2% in 2020 to 2023 and better than peaks in spring 2018 (6.7%) and 2019 (7.3%).
Elevated parvovirus B19 positivity in each scientific specimens and wholesome plasma donors suggests higher neighborhood transmission in 2024, the researchers mentioned. “This enhance in neighborhood transmission is probably going attributable to decreased B19 transmission through the COVID-19 pandemic, ensuing from COVID-19 mitigation measures, resulting in increased numbers of individuals inclined to B19,” they wrote.
The authors urged healthcare suppliers to advertise measures to stop an infection and, together with public well being officers, to trace opposed B19-related outcomes to cut back extreme illness in pregnant girls and different high-risk sufferers. “Well being care suppliers caring for pregnant individuals must be notably vigilant for indicators of diminished fetal motion or proof of hydrops [severe swelling] which might be related to B19,” they concluded.
4 pregnant girls had problems, together with a miscarriage
For the second research, a group led by investigators from the College of Minnesota and the Minnesota Division of Well being (MDH) detailed parvovirus B19 infections in 5 pregnant girls from Could to August 2024.
Public well being officers ought to increase consciousness about parvovirus B19 exercise, together with amongst little one care and faculty suppliers.
The 5 sufferers did not reside in the identical neighborhood, however 4 had kids of their family, two of whom had sick kids. The fifth affected person was seemingly uncovered at her job as a childcare supplier at a facility wherein diseases characterised by fever and rash had been circulating in kids.
All sufferers skilled B19 infections at 13 to twenty weeks’ gestation, none of whom had a weakened immune system or blood dysfunction. One affected person skilled a miscarriage at 20 weeks’ gestation after fetal hydrops, one had no problems throughout a 3-month remark interval, two fetuses developed extreme anemia requiring fetal transfusion, and one fetus developed extreme anemia and hydrops, requiring two fetal transfusions. The 4 latter sufferers delivered full-term infants with out problems.
MDH performed metagenomic sequencing to generate full genomes utilizing amniotic fluid from two sufferers, and each samples had been genotype 1A, the most typical circulating genotype worldwide. Specimens did not seem like associated by a current shared supply or transmission occasion.
“Public well being officers ought to increase consciousness about parvovirus B19 exercise, together with amongst little one care and faculty suppliers, and supply details about who could be at increased danger for extreme B19 illness and when contaminated kids and workers members can return to little one care or college after an infection,” the authors wrote.
Life-threatening anemia in kids
The ultimate research, performed by a Kids’s Healthcare of Atlanta–led analysis group, concerned 55 kids contaminated with sickle cell illness (SCD) and parvovirus B19 an infection from December 2023 to September 2024.
Well being care suppliers ought to concentrate on the chance for problems of B19 an infection in kids with SCD and have a low threshold for testing when there’s scientific suspicion of aplastic disaster.
The incidence of B19 an infection related to aplastic disaster—or life-threatening anemia that happens when the bone marrow stops making crimson blood cells—amongst all kids with SCD was 35.6 per 1,000 patient-years, 3.6 instances increased than that from 2010 to 2023 (7.78 per 1,000 patient-years).
Elevated numbers of B19-associated aplastic disaster circumstances and incidence occurred in 2014 (34 circumstances; 19.2 per 1,000 patient-years) and 2019 (30 circumstances; 14.7 per 1,000 patient-years). Based mostly on scientific suspicion, throughout 2010 to 2023, a median of two.9% of all sufferers with SCD had been examined for B19 annually from 2010 to 2023, rising to six.8% in 2024.
Problems of SCD included acute chest syndrome (27%), splenic sequestration (11%), stroke (3.6%), and nephrotic syndrome (1.8%). Forty-three sufferers (78%) got transfusions. One little one died unexpectedly at house, however B19 was not confirmed in that case.
“Well being care suppliers ought to concentrate on the chance for problems of B19 an infection in kids with SCD and have a low threshold for testing when there’s scientific suspicion of aplastic disaster,” the researchers wrote. “Kids and adolescents with SCD and B19 an infection must be monitored for problems; early crimson blood cell transfusion would possibly forestall critical opposed outcomes.”
