In Morbidity and Mortality Weekly Reportthree new research describe elevated infections of parvovirus B19 detected in US industrial labs, with 5 worrisome circumstances in pregnant Minnesotans and infections in kids and teenagers 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 take a look at positivity and clusters of parvovirus B19–associated issues amongst pregnant girls and folks 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 way of transfusion of blood elements and sure plasma derivates,” the authors of the lab examine wrote. “Most individuals turn into contaminated with B19 throughout their faculty years. Immunity from an infection is considered lifelong.”
Nearly 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 take a look at positivity at Labcorp in 2024 from ranges within the 2018-19 respiratory virus season. Parvovirus B19 just isn’t a notifiable sickness in the US.
The investigators regarded for the presence of immunoglobulin (Ig) M antibodies, a marker of current an infection, in medical specimens from 359,445 kids and adults and carried out B19 nucleic acid amplification testing (NAAT) in plasma from a mean of 1,059 donor swimming pools every month.
Well being care suppliers caring for pregnant individuals must be significantly vigilant for indicators of decreased fetal motion or proof of hydrops [severe swelling] which could possibly be related to B19.
The share of IgM-positive medical specimens climbed to 9.9% in spring 2024, up from lower than 1.5% in 2020 to 2023, larger 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 medical specimens and wholesome plasma donors suggests larger group transmission in 2024, the researchers mentioned. “This enhance in group transmission is probably going because of decreased B19 transmission throughout the COVID-19 pandemic, ensuing from COVID-19 mitigation measures, resulting in larger numbers of individuals vulnerable 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 antagonistic 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 significantly vigilant for indicators of decreased fetal motion or proof of hydrops [severe swelling] which could possibly be related to B19,” they concluded.
4 pregnant girls had issues, together with a miscarriage
For the second examinea workforce 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 Might to August 2024.
Public well being officers ought to increase consciousness about parvovirus B19 exercise, together with amongst baby care and faculty suppliers.
The 5 sufferers did not stay in the identical group, however 4 had kids of their family, two of whom had sick kids. The fifth affected person was probably uncovered at her job as a childcare supplier at a facility wherein diseases characterised by fever and rash have 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 issues throughout a 3-month statement 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 issues.
MDH carried out metagenomic sequencing to generate full genomes utilizing amniotic fluid from two sufferers, and each samples have been genotype 1A, the commonest circulating genotype worldwide. Specimens did not look like associated by way of a current shared supply or transmission occasion.
“Public well being officers ought to increase consciousness about parvovirus B19 exercise, together with amongst baby care and faculty suppliers, and supply details about who could be at larger threat for extreme B19 illness and when contaminated kids and workers members can return to baby care or faculty after an infection,” the authors wrote.
Life-threatening anemia in kids
The ultimate examinecarried out by a Kids’s Healthcare of Atlanta–led analysis workforce, 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 issues of B19 an infection in kids with SCD and have a low threshold for testing when there may be medical 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 occasions larger 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 medical suspicion, throughout 2010 to 2023, a median of two.9% of all sufferers with SCD have 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 baby died unexpectedly at dwelling, however B19 was not confirmed in that case.
“Well being care suppliers ought to concentrate on the chance for issues of B19 an infection in kids with SCD and have a low threshold for testing when there may be medical suspicion of aplastic disaster,” the researchers wrote. “Kids and adolescents with SCD and B19 an infection must be monitored for issues; early crimson blood cell transfusion would possibly forestall critical antagonistic outcomes.”
