CDC HAN Advisory: Increase in Human Parvovirus B19 Activity in the United States

Credit CDC

 #18,240

Outbreaks of parvovirus B19 - sometimes called `Fifth disease' or `slapped check syndrome (erythema infectiosum)' - tend to occur every 3 to 5 years, and most commonly affect school-aged children (although adults can be infected).  Epidemics tend to occur mostly in late winter or the spring, although cases can occur year-round. 

Parvovirus B19 infection is usually mild and self-limiting, although infection during pregnancy can increase the risk of miscarriage, and some people with underlying blood disorders or weakened immune system can experience more serious illness. 

 While most infections are asymptomatic, those who do experience symptoms generally report:

• Fever
• Headache
• Cough
• Sore throat
• Rashes
• Joint pain

The CDC notes that `. . . severe outcomes from parvovirus B19 disease, such as myocarditis, hepatitis, or encephalitis, are rare. No vaccine or specific treatment is recommended for parvovirus B19 infection.'

With schools just now starting their fall semester, yesterday the CDC released the following HAN Advisory on recent increases of Parvovirus around the nation.  After the break, I'll have a brief update on AFM (acute flaccid myelitis) and Enterovirus EV-D68 activity around the nation.

Increase in Human Parvovirus B19 Activity in the United States
 


Distributed via the CDC Health Alert Network
August 13, 2024, 2:30 PM ET
CDCHAN-00514


Summary

The Centers for Disease Control and Prevention (CDC) is issuing this Health Alert Network (HAN) Health Advisory to notify healthcare providers, public health authorities, and the public about current increases in human parvovirus B19 activity in the United States. Parvovirus B19 is a seasonal respiratory virus that is transmitted through respiratory droplets by people with symptomatic or asymptomatic infection. 

In the first quarter of 2024, public health authorities in 14 European countries observed unusually high numbers of cases of parvovirus B19. In the United States, there is no routine surveillance for parvovirus B19, and it is not a notifiable condition.

Recently, CDC has received reports indicating increased parvovirus B19 activity in the United States. Data include increased test positivity for parvovirus B19 in clinical specimens and pooled plasma from a large commercial laboratory, and reports of clusters of parvovirus B19-associated complications among pregnant people and people with sickle cell disease. The proportion of people with IgM antibodies, an indicator of recent infection, increased among all ages from <3% during 2022–2024 to 10% in June 2024; the greatest increase was observed among children aged 5–9 years, from 15% during 2022–2024 to 40% in June 2024. Among plasma donors, the prevalence of pooled samples with parvovirus B19 DNA >104 IU/mL increased from 1.5% in December 2023 to 19.9% in June 2024.

          (SNIP)

 Recommendations for Healthcare Providers

1. Have increased suspicion for parvovirus B19 among people presenting with compatible symptoms (i.e., fever, rash, arthropathy, or unexplained anemia with low reticulocyte count).
2. Provide preventive counseling and have a low threshold to test people who present with compatible signs and symptoms if they are at higher risk of severe parvovirus B19 disease, including:
   1. Pregnant people
   2. People with severely immunocompromising conditions, including leukemia or other cancers, organ transplant, HIV infection, or who are receiving chemotherapy.
   3. People with chronic hemolytic blood disorders, including sickle cell disease, thalassemia, and hereditary spherocytosis.
3. When treating people with suspected or confirmed parvovirus B19, inform them or their caregivers about high-risk groups and advise any exposed contacts in those groups (e.g., who may be pregnant) to consult with their healthcare providers.
4. Follow standard of care (e.g., professional society guidelines) for testing pregnant people reporting exposure to parvovirus B19 infection or who present with compatible signs and symptoms of maternal or fetal parvovirus B19 disease.
5. Promote CDC recommendations for core prevention strategies to prevent respiratory illness, including practicing good hand hygiene and taking steps for cleaner air to reduce spread of parvovirus B19 and other respiratory viruses.
   1. People at higher risk of severe outcomes or complications who work in settings with higher risk of parvovirus B19 exposure should practice hand hygiene, avoid sharing food or drinks, and consider wearing a respirator or mask while at work. There is no proven benefit to removing someone from work in settings with higher risk of parvovirus B19 exposure.
6. Follow recommended infection control precautions for persons with parvovirus B19 in healthcare settings.

Recommendations for Health Departments

1. Ensure that healthcare providers are aware of increasing parvovirus B19 activity and identify people at higher risk of severe parvovirus B19 outcomes. Parvovirus B19 is not nationally notifiable.
2. Promote measures to prevent respiratory illness and share information about complications of parvovirus B19 with people at high risk of severe disease.
3. Raise awareness of parvovirus B19 activity among daycare and school providers, including who may be at higher risk of severe parvovirus B19 disease and when children and staff can return to school following an infection.

Recommendations for the Public

1. Learn about parvovirus B19 symptoms and who may be at higher risk of severe disease.
2. Seek medical care if you:
   1. are pregnant and have been exposed to a person with suspected or confirmed parvovirus B19 or you have signs and symptoms of parvovirus B19.
   2. have a weakened immune system or a chronic hemolytic blood disorder including sickle cell disease, thalassemia, and hereditary spherocytosis, and you have signs and symptoms of parvovirus B19.
3. Follow general respiratory precautions to prevent spread of parvovirus B19 and other respiratory viruses. People at higher risk of severe parvovirus B19 can consider using additional prevention strategies such as wearing a mask when around others.
4. Know that children and adults with parvovirus B19 are no longer contagious once the characteristic facial rash appears.

(Continue . . . . )

Ten years ago this month the United States reported a nationwide epidemic caused by a rarely seen EV-D68 virus, which caused hundreds of thousands of `flu-like' illnesses, along with dozens of polio-like AFM cases, mostly in children (see EID Journal: Association of EV-D68 with Acute Flaccid Myelitis, Philadelphia, PA, USA, 2009–2018). 

This epidemic returned in 2016, and again in 2018, increasing in intensity each time (see chart below).  This biannual pattern was disrupted in 2020, likely due to the pandemic precautions in place, and also failed to return in 2022. 

Since the winding down of most pandemic restrictions in 2022, we've have seen a number of alerts (both domestically, and internationally) on increased summer/fall viral outbreaks, including: 

CDC HAN #00498: Increased Respiratory Syncytial Virus (RSV) Activity in Parts of the Southeastern United States

WHO Update: Enterovirus-Echovirus 11 Infection - the European Region

Denmark SSI Reports Sharp Increase In Pertussis (Whooping Cough) Since May

CDC HAN #00473: Severe Respiratory Illnesses Associated with Rhinoviruses and/or Enteroviruses Including EV-D68 – Multistate, 2022

CDC HAN Advisory: Recent Reports of Human Parechovirus (PeV) in the United States—2022

The good news so far, is we're not seeing any evidence of a resurgence AFM in 2024.