Further Outpatient Care

Patients with a resolved aplastic crisis or with a rash are no longer infectious.

Patients are no longer infectious after other symptoms resolve (usually by day 7 of illness). Thus, patients with a classic parvovirus B19 rash may return to school or daycare.^{[43, 9]}

Further Inpatient Care

Patients rarely require admission for parvovirus B19 (B19V) infections unless they have underlying disease.

Consider the following factors for purposes of infection control:

Parvovirus B19 is spread via small respiratory droplets.
The attack rate in susceptible populations approaches 60%.
Parvovirus B19 is contagious from 24-48 hours before developing the viral prodrome and until the rash appears. The appearance of serum immunoglobulin (IgM) coincides with the appearance of the rash.^[9]
See above for isolation precautions.

Transfer

Patients with an aplastic crisis may require transfer to centers that provide pediatric critical care and hematology services.

Deterrence/Prevention

Phase I clinical trials are currently evaluating vaccine candidates against parvovirus B19.^{[2, 8]}

The risk of contagion in typical erythema infectiosum in the community is the highest during the early stages of the infection when symptoms are least specific and the disease more difficult to diagnose. Little rationale warrants excluding children with Fifth disease exanthem from daycare centers and school and adults from work.^[43]

In addition to standard precautions, droplet precautions are recommended for hospitalized children with aplastic crises, children with the papular purpuric "gloves and socks" syndrome (PPGSS), and immunosuppressed patients with chronic infection and anemia for the duration of hospitalization.^[9]

Complications

Complications include hydrops fetalis, chronic anemia, aplastic crisis, and death.

Immunocompetent individuals with a prolonged course of rash, fatigue, and arthralgias caused by persistent viremia have been reported. Symptoms in some of these patients respond to intravenous immunoglobulin (IVIG) therapy.

Prognosis

Most patients recover without sequelae.

Patient Education

Parvovirus B19 infects only humans. Approximately 60% of adults aged 30 years are immune to parvovirus B19, although few recall having had the infection. Symptoms include a low-grade fever, myalgias, arthralgias, headache, nausea, and rhinorrhea. As the symptoms disappear, children often develop a bright red rash on the cheeks (as if they had been slapped). The infection is contagious in children for a few days before symptoms begin and until the symptoms disappear. When the rash appears, the infection is no longer contagious. The presence of the parvovirus B19 rash is not a reason to keep children home from daycare or school.

If a pregnant woman is not immune to parvovirus B19 becomes infected, the probability of hydrops fetalis developing in the neonate is small (2-5%). Any pregnant woman who is exposed to an individual in whom parvovirus B19 infection is suspected should immediately contact their obstetrician.

In healthy adults and children, parvovirus B19 is not a serious infection. Exceptions include patients with cancer who are receiving chemotherapy, as well as patients with HIV infection and/or acquired immunodeficiency syndrome (AIDS), organ transplants, and other immunodeficient states.

For patient education resources, see the Children's Health Center, as well as Fifth Disease.

Questions

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Media Gallery

Note the right side of this boy's face displaying signs of erythema infectiosum, or Fifth disease. Image courtesy of CDC.
Elementary school child with Fifth Disease. Image courtesy of CDC.

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Author

David J Cennimo, MD, FAAP, FACP, FIDSA, AAHIVS Associate Professor of Medicine and Pediatrics, Adult and Pediatric Infectious Diseases, Rutgers New Jersey Medical School

David J Cennimo, MD, FAAP, FACP, FIDSA, AAHIVS is a member of the following medical societies: American Academy of HIV Medicine, American Academy of Pediatrics, American College of Physicians, American Medical Association, HIV Medicine Association, Infectious Diseases Society of America, Medical Society of New Jersey, Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Coauthor(s)

Arry Dieudonne, MD Associate Professor of Pediatrics, Division of Pulmonology, Allergy, Immunology and Infectious Diseases, Rutgers New Jersey Medical School; Clinical Director, Francois-Xavier Bagnold Center for Children, University Hospital

Arry Dieudonne, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Joseph Domachowske, MD Professor of Pediatrics, Microbiology and Immunology, Department of Pediatrics, Division of Infectious Diseases, State University of New York Upstate Medical University

Joseph Domachowske, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American Society for Microbiology, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Phi Beta Kappa

Disclosure: Received research grant from: Pfizer;GlaxoSmithKline;AstraZeneca;Merck;American Academy of Pediatrics, Novavax, Regeneron, Diassess, Actelion<br/>Received income in an amount equal to or greater than $250 from: Sanofi Pasteur.

Chief Editor

Russell W Steele, MD Clinical Professor, Tulane University School of Medicine; Staff Physician, Ochsner Clinic Foundation

Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, Southern Medical Association

Disclosure: Nothing to disclose.

Additional Contributors

Glenn Fennelly, MD, MPH Director, Division of Infectious Diseases, Lewis M Fraad Department of Pediatrics, Jacobi Medical Center; Clinical Associate Professor of Pediatrics, Albert Einstein College of Medicine

Glenn Fennelly, MD, MPH is a member of the following medical societies: Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Acknowledgements

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous coauthor Dennis Cunningham, MD, to the original writing and development of this article.