Infections In Pregnancy /

Parvovirus (Slapped Cheek Disease)

01 In Brief

Infection with Parvovirus B19 causes a minor illness in children associated with a red rash on the cheeks and by adulthood 50-60% of people have already acquired the infection. In pregnancy if the infection occurs for the first time before 20 weeks gestation it is associated with a 10% chance of miscarriage and in a surviving fetus a 3% chance of  development of severe anaemia and myocarditis resulting in Hydrops fetalis, where the infant accumulate excessive fluid in their tissues . This may resolve spontaneously or lead to fetal death. It can be treated with in-utero blood transfusions.

02 What Do I Need To Know?

ClINICAL CHARACTERISTICS OF SLAPPED CHEEK DISEASE

• Infection with Parvovirus B19 is common and causes a mid flu like illness. It has several other names i.e. as Slapped Cheek Disease, Erythema Infectiosum or Fifth Disease. Fifth disease because it was the fifth disease to be described as the cause of erythema (red rash) in children after measles, scarlet fever, rubella, dukes disease (now known not to exist ) and the sixth being roseola or baby measles;  The "Fourth Disease" of Childhood: Reevaluation of a Nonexistent Disease

• It causes a relatively mild disease in children between the ages of 5-15 years starting with a mild fever, sore throat and typically a week later, development of a bright red rash on the cheeks hence its name slapped cheek disease. A typical red, bumpy, lacy rash develops on the extremities and lasts about 7-10 days. The rash may recur for some weeks when exposed to heat or sunlight.

• Adults often are asymptomatic and are often unaware that they have been infected by the virus.  About 50-60 % of women have protective antibodies (indicating previous infection). It may cause flu like symptoms and joint symptoms affects the hands, wrists, ankles and knees  in 60% of adults and 10% of children. Joint symptoms may last up to 1-3 weeks but can occasionally  persist for months.

• It is highly contagious and can be spread by secretions from the nasal passages and lungs as well as the blood. The incubation period is 4 - 21 days. The period before the rash develops is the most infectious. Most women who work in occupational settings with children have usually been exposed to the virus and are immune. To prevent spread of infection careful hand washing and avoidance of sharing of food implements is advised.

INFECTION IN PREGNANCY

• Infection in non immune pregnant women results in an infection rate in their unborn child of 30%. Most babies are born unaffected and Parvovirus is not teratogenic i.e. does not cause major defects. Fetal loss is greatest in the first trimester and infection less than 20 weeks gestation miscarriage is estimated to be about 10 %.  In the second trimester in 3% of cases it can be associated with myocarditis and severe anaemia causing Hydrops fetalis where the baby accumulates excessive fluid in the tissues . This may resolve spontaneously or lead to fetal demise.  

• Immunity to Parvovirus may not be routinely tested for in pregnancy and in high risk women it ay be useful o discuss this with your doctor.

• If a pregnant woman is concerned that she may have been infected with parvovirus she should contact her doctor. If testing is indicated and the tests indicate that the infection is active it is recommended that  fetal well being is monitored  by Ultrasound every 1-2 weeks. Fetal blood transfusions are sometimes used to treat severe Hydrops fetalis. Tests on the amniotic fluid are not usually performed because of the risk of fetal loss. 

03 What Others Say

• Fact sheet from Infectious diseases : Victorian Government Health Information

Slapped cheek infection information sheet for pregnant women

04 I Want To Know More

• A thorough well written review on Parvovirus B-19 infection during pregnancy Authors: Anthony Al-Khan, Andrew Caligiuri and Joseph Apuzzio from the  Division of Maternal Fetal Medicine, Department of Obstetrics, Gynecology and Women’s Health, New Jersey Medical School, Newark, NJ ;published Infect Dis Obstet Gynecol 2003;11:175–179

Parvovirus B-19 infection during pregnancy

Last updated: 10/08/2011 by Dr Elizabeth Hallam*

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