parvovirus b19 pregnancy nursing actions

Parvovirus B19 infection is believed to be transmitted mainly through respiratory secretions. Lacy red rash on the cheeks, legs, belly, and neck. For information on cookies and how you can disable them visit our Privacy and Cookie Policy. Susceptibility to parvovirus B19 infection should be determined in selected pregnant women at high risk for exposure, and counseling should be provided regarding prevention, testing, and treatment options if exposed. APIC Text of Infection Control and Epidemiology. Because 30–60% will be seropositive, this will provide the basis for reassurance. However, parvovirus B19 infections during pregnancy can cause severe fetal anemia, occurring as a result of destruction of erythropoietic stem cells by the virus, which may in turn cause fetal heart failure and NIHF, and fetal death. Because the fetus is capable of producing IgM by approximately 18 weeks gestation, either fetal blood or amniotic fluid can be tested for IgM. By continuing you agree to the Use of Cookies. The authors have disclosed that they have no financial relationships related to this article. Preventing falls in hospitalized older adults, Managing delirium behaviors with one-to-one sitter, International public health emergencies: Lessons learned in West Africa, Keeping children with latex allergies safe, Calling on smartphones to enhance patient care, One hospital's journey to create a sustainable sepsis program, Implementing bedside shift report: Walking the walk and talking the talk, Improving language interpretation practices, Time taping an I.V. 2003;11(3):175-9. However, if a pregnant woman is in regular contact with children aged 4 to 11 or if she has been in contact with an affected child, she must tell her doctor and have a blood test to determine immunity. Women who are schoolteachers or day care workers are particularly at risk because they are more likely to be exposed and have close contact with children with fifth disease. Parvovirus infection is common throughout the world. Parvovirus B19 infection during pregnancy. 800-638-3030 (within USA), 301-223-2300 (international) Spontaneous resolution of nonimmune hydrops fetalis secondary to human parvovirus B19 infection. Wolters Kluwer Health, Inc. and/or its subsidiaries. School nurses or nurses on-site in day care centers may be involved in counseling during an outbreak of erythema infectiosum. Although the infection is usually mild and self-limited, three groups of people are susceptible to serious complications of infection: persons with chronic hemolytic anemia, persons with congenital or acquired immunodeficiency, and pregnant women (, Susceptible pregnant women may be exposed to the virus, and the highest infection rates occur in school-teachers, day care workers, and women with school-age children in the home. The Human 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 is usually diagnosed through a blood test for antibodies to the virus. As a result, it can cause anemia, thrombocytopenia, and myocarditis. Registered users can save articles, searches, and manage email alerts. Infections: Nursing action for a client who has Parvovirus B19 (Fifth Disease): -Monitor fetal well-being -Emphasize to the client the importance of compliance with prescribed treatment. Because B19 is cytotoxic to fetal red blood cell precursors, fetal infection may cause severe anemia, high cardiac output failure, and non-immune hydrops. For immediate assistance, contact Customer Service: Although perinatal transmission is uncommon and, therefore, often unrecognized, this potentially deadly infection should concern pregnant women and health professionals. Easily transmissible, parvovirus spreads slowly, allowing outbreaks to persist over months within a community. In situations in which there is a parvovirus B19 outbreak, it is not known whether the primary mode of transmission is direct person-to-person contact, fomites, large-particle droplets, or small-particle droplets (, Generally, diagnosis of parvovirus is based on clinical symptoms and serologic antibody testing for parvovirus immunoglobulin G and parvovirus immunoglobulin M (IgM). Other providers may increase the frequency of office visits and perform blood tests and ultrasound examinations to monitor the health of the unborn baby. The virus is effectively transmitted after close contact exposures, however. The greatest risk of transmitting the virus occurs before the symptoms of erythema infectiosum develop. In pregnant women exposed to parvovirus B19, obtain IgG and IgM serology as soon as possible following exposure - Negative IgG and IgM results indicate that the mother is not immune and that no evidence of acute infection is noted. The Signs and symptoms of the Fifth disease while pregnant can include: Soreness in your joints which could last for several days or weeks. In fetuses at less than 32 weeks gestation or with immature lungs, intrauterine blood transfusions can be considered. Some error has occurred while processing your request. Parvovirus B19 most commonly causes fifth disease, a mild rash illness that usually affects children. In pregnant women who are exposed to parvovirus B19, serological testing of IgG and IgM should be carried out immediately. Pregnant women are not routinely screened for past parvovirus B19 infection as there … Data is temporarily unavailable. Several investigators have reported spontaneous resolution of nonimmune hydrops. There is understandably a high level of concern among pregnant women exposed to parvovirus B19, particularly women in high-risk occupations during an outbreak of erythema infectiosum. Past infection can be confirmed by the presence of IgG antibodies. The percentage of people who test positive for evidence of previous infection increases with age and is more than 75% for adults older than 50 years (. This disease is usually not a problem for pregnant women and their babies. Al-Khan A(1), Caligiuri A, Apuzzio J. Occupational risk factors for infection with parvovirus B19 among pregnant women. Susceptible pregnant women who are infected with parvovirus B19 will need supportive treatment during the illness as well as counseling about options for fetal testing. Viral serology for parvovirus B19 was positive. Török TJ. Elizabeth Heavey is an associate professor of nursing at the State University of New York College in Brockport, N.Y., where Roselind Bruce-Vanderpuije is a nursing student. Therefore, MSAFP testing is not recommended for predicting fetuses at risk for parvovirus infection (. Intrauterine infection with human parvovirus B19 (B19) has been associated with stillbirth, fetal hydrops, and fetal death Woernle, Anderson, Tattersall, & Davison, 1987 Woernle C.H. Routine screening for parvovirus is not recommended. Fifth disease is a mild rash illness caused by parvovirus B19. Sore throat. In studies of human volunteers, serum and respiratory secretions were positive for B19 DNA during the prodromal illness, but the specimens were negative by the time of onset of rash or arthralgia. The usual clinical manifestation is Nurses providing care during the prenatal period, as well as school nurses, need to be knowledgeable about parvovirus B19 and able to provide education and support to susceptible women who are exposed. Hydrops can develop quickly and can rapidly progress to fetal death, or it may resolve spontaneously. Parvovirus B19 is a common childhood virus, but it can lead to fetal problems if contracted by susceptible pregnant women. However, nonimmune fetal hydrops is rare (1 in 3,000 to 4,000 pregnancies), with B19 infection as one of the most frequent causes. The usual clinical manifestation is erythema infectiosum (fifth disease), characterised by a mild prodrome - mild fever, malaise, myalgia - followed by a biphasic rash. However, the natural history of infection in the untreated fetus is not known, and the benefit of intrauterine blood transfusion is as yet unproven. Women who are schoolteachers or day care workers are particularly at risk because they are more likely to be exposed and have close contact with children with fifth disease. Because of the low risk of fetal damage, termination of pregnancy is not recommended, nor is amniocentesis for diagnosis of asymptomatic intrauterine infection (. 1,2 Human parvovirus B19 causes an acute, usually self-limiting, infection which is often asymptomatic. Most adults are immune to primary infection because of exposure during childhood (. The virus causes erythema infectiosum, also known as fifth disease. Baseline serologic testing and counseling of women in high-risk occupations, particularly those who will be pregnant in the winter months, should be offered by either primary care or obstetric care providers. However, there is no evidence that the rate of congenital anomalies differs from background rates (, During outbreaks of B19 infection, it is difficult to prevent the spread of infection. However, 35–53% of pregnant women have existing immunoglobulin G (IgG), which indicates that they are immune because of a previous infection (, The mode of transmission of parvovirus B19 is not entirely clear. Human parvovirus B19 infections in pregnancy. Association for Professionals in Infection Control and Epidemiology, We use cookies to help provide and enhance our service and tailor content and ads. About half of pregnant women are immune to parvovirus B19, so they and their babies are usually protected from getting the virus and fifth disease. Some studies have noted that several women infected with parvovirus B19 were found to have elevated maternal serum alpha-fetoprotein (MSAFP) levels and have suggested that women with high MSAFP levels be screened for B19 infection. Education about erythema infectiosum and possible methods to decrease infection can be provided to the community, schools, and parents of children who are cared for in group settings. Fifth Disease Outbreaks in the Workplace & Pregnancy. Epidemiology and laboratory diagnosis of parvovirus B19 infection. One exception would be patients with chronic B19 infection or patients in aplastic crisis from B19. Serology needs to be repeated within 2 to 4 weeks. Acute infection during pregnancy can be transmitted to the fetus via the placenta. If you're not a subscriber, you can: You can read the full text of this article if you: Institutional members Parvovirus B19 is a common childhood virus, but it can lead to fetal problems if contracted by susceptible pregnant women. -Psychosocial history (a client’s emotional response to pregnancy, adolescent pregnancy, spouse, support system, history of depression, domestic violence issues). The association between MSAFP and B19 infection is weak, however, and elevated MSAFP can be caused by other conditions. AWHONN Journals Article Collection on COVID-19, Racism, Disparities, and Social Determinants of Health, JOGNN Health Care Improvement and Evaluation, Diagnosis and Treatment of Herpes Simplex Infection During Pregnancy, Guide to Interpreting Parvovirus B19 IgG and IgM Serology Values. Management of parvovirus infection in pregnancy and outcomes of hydrops: A survey of members of the Society of Perinatal Obstetricians. If IgM is detected when the test is repeated (with or without IgG), there is evidence of recent infection (. Parvovirus B19 may be transmitted by blood components such as cryoprecipitate and fresh frozen plasma. There is no standard way to monitor a pregnant woman who has a documented Parvovirus B19 infection. A survey of perinatal obstetricians in the United States and Canada reported that 34% of the cases of nonimmune hydrops resulting from parvovirus infection resolved spontaneously, the majority within 8 weeks (. Infect Dis Obstet Gynecol. Parvovirus B19 does not seem to cause malformations when a woman is infected in early pregnancy. Fever. Fetal death as well as fetal hydrops is most likely a result of severe B19-associated anemia. (II-2A) 5. Susceptible household contacts have about a 50% attack rate. Your account has been temporarily locked due to incorrect sign in attempts and will be automatically unlocked in Parvovirus B-19 infection during pregnancy. Women in these occupations have a greater likelihood of exposure to children with erythema infectiosum and have prolonged close contact with them. If parvovirus B19 immunoglobulin G is present and immunoglobulin M is negative, the woman is immune and should be reassured that she will not develop infection and that the virus will not adversely affect her pregnancy. Current trends and risks associated with human parvovirus B19 infection. Some providers consider this a low-risk condition and continue to provide routine prenatal care. You may be trying to access this site from a secured browser on the server. Management and outcomes of pregnancies complicated by human B19 parvovirus infection: A prospective study. Because testing for MSAFP is performed between 15 and 18 weeks gestation, its use would be limited to cases of women infected during the late 1st or early 2nd trimester. IgM can be detected approximately 10 days after exposure and just before the onset of symptoms and is present in more than 90% of patients at the onset of rash (, A pregnant woman exposed to parvovirus or with a new rash or arthralgia should be tested for parvovirus B19. This article addresses the issues concerning parvovirus infection and pregnancy. Detection of human parvovirus B19 in early spontaneous abortuses using serology, histology, electron microscopy, in situ hybridization, and the polymerase chain reaction. Fetal hydrops usually resolves within 2 weeks after adequate intrauterine therapy. IgM remains detectable for months and IgG for life following recovery from acute infection. 1990 Oct; 9 (10):772–776. A bone marrow biopsy demonstrated hemophagocytosis and a giant proerythroblasts, which is characteristic of a parvovirus B19 infection. Fetal Parvovirus infection has been associated with aplastic anaemia and myocarditis that may present with hydrops fetalis and death, usually within the first 20 weeks of pregnancy although it has rarely been reported at later gestations. Pediatr Infect Dis J. doi: 10.1097/01.NURSE.0000399598.59294.af, The item(s) has been successfully added to ", This article has been saved into your User Account, in the Favorites area, under the new folder. In rare cases, some of these symptoms can persist for a long time. Acute infection in pregnancy can cause B19 infection in the fetus, leading to nonimmune fetal hydrops or fetal loss, depending on gestational age at the time of infection. Parvovirus B19 and Pregnancy Usually there is no serious complication for a pregnant woman or her unborn baby following exposure to a person with parvovirus B19. Patients with transient aplastic crisis should remain on droplet precautions for 7 days, and patients with chronic B19 infection should be on droplet precautions for the entire hospitalization (. During school outbreaks, 25–50% of students and 20% of staff may become infected (. South Australian Perinatal Practice Guideline Parvovirus (slapped cheek syndrome) INFORMAL COPY WHEN PRINTED Page 3 of 8 Public-I 2A Parvovirus Parvovirus B19 is a single-stranded DNA virus.1 Parvovirus B19 selectively infects and lyses human erythroblasts3 and is distinguished by the mild rash illness erythema infectiosum, also known as fifth disease (the fifth, pink-red rash to be This website uses cookies. The risk of vertical transmission (from mother to fetus) may be as high as 33% (, Parvovirus B19 preferentially infects rapidly dividing cells. Parvovirus B19 is a common, self-limiting, usually benign childhood virus that causes erythema infectiosum, also known as fifth disease. PDF | Parvovirus B19 causes prolonged epidemics of erythema infectiosum. Parvovirus B19 binds to the P antigen present on erythrocytes, megakaryocytes, and myocardial cells. J Infect Dis 1995; 171:1360. Wolters Kluwer Health https://www.health.nsw.gov.au/.../parvovirus-B19-and-(fifth-disease).aspx B19 DNA has been found in respiratory secretions. Copyright © 2021 Elsevier Inc. except certain content provided by third parties. Headache. Monitoring Parvovirus B19 Infection during Pregnancy. Published by Elsevier Inc. All rights reserved. L.P., PA. Elizabeth Heavey, PhD, RN, CNM, and Roselind Bruce-Vanderpuije, SN, reply: Several viruses can cause fetal harm, including parvovirus B19 (B19), also known as erythema infectiosum or fifth disease. 2. These patients may transmit the virus to susceptible health care workers or patients. The cells most susceptible to parvovirus infection are erythroid precursor cells that have the P antigen, a receptor for parvovirus. Your message has been successfully sent to your colleague. 30 mins. For more information, please refer to our Privacy Policy. By continuing you agree to the, Deborah McCarter-Spaulding, RNC, MS, IBCLC, https://doi.org/10.1111/j.1552-6909.2002.tb00029.x, Pryde, Nugent, Pridjian, Barr, & Faix, 1992, View Large If the blood test … The Hospital Infection Control Practices Advisory Committee. Evidence of acute/recent infection with B19. 10 In addition, it has been reported that day-care … This is a case report of a 31-year-old primigravida who was diagnosed with an asymptomatic acute parvovirus B19 infection in the second trimester of pregnancy and its suspected association with an increased nuchal translucency (NT) measurement. Tired, muscle aches. Although fetal death and nonimmune hydrops are of concern, the risk is actually quite low. 1. About 50 per cent of women are already immune to this infection, and these women and their unborn babies are … Acute infection in pregnancy can cause B19 infection in the fetus, leading to nonimmune fetal hydrops or fetal loss, depending on gestational age … Hydrops can be diagnosed with fetal ultrasound (, If fetal hydrops is present and the pregnancy is 32 to 34 weeks gestation, consideration may be given to delivery if the fetus’s lung maturity is confirmed. For women who are seronegative, serologic testing will offer baseline information, should they be exposed to parvovirus during the pregnancy. Rogers BB, Singer DB, Mak SK, Gary GW, Fikrig MK, McMillan PN. Intrauterine infection with human parvovirus B19 (B19) has been associated with stillbirth, fetal hydrops, and fetal death (Woernle, Anderson, Tattersall, & Davison, 1987). access full text with Ovid®. Image, Infection most likely within last 2 to 3 months. Cartter ML, Farley TA, Rosengren S, et al. Boston College, School of Nursing, 140 Commonwealth Ave., Chestnut Hill, MA 02467-3812. We use cookies to help provide and enhance our service and tailor content and ads. Guideline for infection control in health care personnel. Primate erythroparvovirus 1, generally referred to as B19 virus, parvovirus B19 or sometimes erythrovirus B19, was the first (and until 2005 the only) known human virus in the family Parvoviridae, genus Erythroparvovirus; it measures only 23–26 nm in diameter. Parvovirus B19 infection during pregnancy may cause fetal anemia, hydrops fetalis, and fetal demise. Erythema infectiosum can occur at any time, but in the United States outbreaks are common in winter and spring. Polymerase chain reaction is a sensitive method for detecting small amounts of B19 DNA, so this is the preferred method for making the diagnosis in utero (. The virus causes erythema infectiosum, also known as fifth disease. Women who are schoolteachers or day care workers are particularly at risk because they are more likely to be exposed and have close contact with children with fifth disease. All registration fields are required. Although rare, acute B19 infection in pregnancy may lead to hydrops fetalis (fetal hydrops) or fetal loss. If IgG is positive and IgM negative then there is no risk to the fetus as the mother was infected by B19 in the past with no recent infection and already has B19 antibodies present in the sera. Hand washing has not been studied as a means to prevent transmission of infection, but it is certainly recommended as a measure that is most likely effective (, Women who are pregnant and who are at high risk for exposure to B19 infection, such as schoolteachers, day care workers, and women living with school-age children or children in group day care, may benefit from baseline serologic testing to determine their susceptibility to infection. The name is derived from Latin, parvum meaning small, reflecting the fact that B19 ranks among the smallest DNA viruses. The overall risk of a fetus acquiring hydrops after maternal B19 infection is low, approximately 1% (, Intrauterine blood transfusion has been proposed as a treatment for the fetus with severe B19-induced anemia and hydrops. Guidelines for preconceptional conseling. Follow-up can include a repeat fetal blood sampling 3 to 4 weeks after transfusion to confirm adequate erythrocyte production, or frequent fetal testing and ultrasound for 6 to 9 weeks after hydrops is resolved, to ensure fetal recovery (, In general, B19 infection produces a mild, self-limited illness, particularly in children. Common viral infection with rash occurring 4 to 14 days (up to 21 days) after the start of the viral infection What are the signs or symptoms? The risk of hydrops is 3% with a mortality of 50%. Please enable scripts and reload this page. The patient experienced fever and pancytopenia. 800-638-3030 (within USA), 301-223-2300 (international). Parvovirus B19 infection and its significance in pregnancy. Because B19 also can infect myocardial cells, myocardial injury may contribute to the hydrops and fetal death (, Infection resulting in fetal loss is more likely to occur in the first 20 weeks, and most losses occur within 4 to 6 weeks of exposure (. Easily transmissible, parvovirus, respiratory syncytial virus and enterovirus infectiosum, also known fifth. That causes erythema infectiosum and have prolonged close contact exposures, however contracted by susceptible women! To parvovirus during the pregnancy management of parvovirus infection from infected patients is rare women these... Less than 32 weeks gestation or with immature lungs, intrauterine blood transfusions be. To use this website you are giving consent to cookies being parvovirus b19 pregnancy nursing actions in these occupations have a likelihood! 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The third trimester can induce severe congenital hypoplastic anemia in the infant is. The average of 5 weeks ( range 2 to 17 weeks ) after maternal infection ( international [... Prolonged close contact exposures, however has been successfully sent to your colleague have... Clinical features and pathogenesis of parvovirus B19 infection is believed to be to... Hydrops are of concern, the risk is actually quite low lungs, intrauterine blood transfusions can be transmitted through! And IgG for parvovirus b19 pregnancy nursing actions following recovery from acute infection is weak, however, and myocarditis neck... Environmental surfaces has not been studied cookies and how you can disable them visit our Privacy and Cookie.... Is infected in early pregnancy most susceptible to parvovirus during the third trimester induce... A receptor for parvovirus infection in the infant impact on perinatal outcome Privacy and Cookie.. 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