HPR volume 18 issue 5: news (16 May 2024)

Updated 16 May 2024

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Increasing levels of parvovirus B19 activity in England

Parvovirus B19 causes the common childhood illness, erythema infectiosum, also known as fifth disease (1) – also widely known as “slapped cheek” due to the typical presentation of erythematous cheeks which, together with rash and fever, are characteristic of this disease.

Accurate diagnosis on a clinical basis can be difficult, however, and parvovirus B19 infection cannot be clearly differentiated from other infections such as rubella.

Parvovirus B19 is seasonal with highest activity usually seen in Spring and early Summer and cyclical peaks every 3 to 4 years. There has been low activity since 2018 with an increase in reported cases of parvovirus B19 at the end of 2023 and beginning of 2024, although activity has not yet reached the levels seen in 2017 and 2018, the previous peak years (see figure).

The European Centre for Disease Prevention and Control (ECDC) has recently reported an increase in parvovirus B19 detections across five other European countries. This included France, which also independently reported increased activity.

Parvovirus B19 is not a notifiable disease and testing practice is likely to vary around the country. Except for women in contact with or presenting with a rash illness in pregnancy, there is no recommendation for routine laboratory testing for parvovirus B19. Confirmation of recent infection is by detection of parvovirus B19-specific IgM and/or a high parvovirus viral load (>10,000 IUs/ml) (1).

Infection in the first 20 weeks of pregnancy is associated with increased risk of intra-uterine death and hydrops fetalis. Infection usually presents as a mild febrile illness but, in patients with increased red blood cell turnover (that is, underlying haemolytic haemoglobulinopathies, such as sickle cell disease), infection can lead to transient aplastic crisis; and in patients who are immunocompromised, infection may lead to pure red cell aplasia and chronic anaemia. Both these groups of patients have very high levels of viraemia and should be considered infectious. Health Protection Teams and clinicians should be aware that there are NICE Clinical Knowledge Summaries (2) and national guidelines for managing the infection in healthcare settings, the community (3) and in pregnant women (4).