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Infection Control of Parvovirus in Healthcare Personnel

Background

Human parvovirus B19 is the cause of erythema infectiosum (fifth disease), a common rash illness that is usually acquired in childhood. Immunocompetent persons infected with B19 may have an acute, self-limited arthropathy, with or without a rash or anemia of short duration. However, patients with preexisting anemia (e.g., patients with sickle-cell anemia or thalassemia) may have aplastic crisis occur. Immunodeficient patients (e.g., patients with leukemia or AIDS) may become chronically infected with B19 and have chronic anemia.

Transmission of B19 to health care personnel from infected patients appears to be rare but has been reported. In two investigations of health care personnel exposures to B19, the rate of infection among exposed nurses was not higher than the rate among unexposed control subjects. In another investigation of health care personnel exposed to a patient with undetected chronic B19 infection, none of the susceptible employees became infected.. Personnel have acquired infection while working in laboratories or during the care of patients with B19-associated sickle-cell aplastic crises.

B19 may be transmitted through contact with infected persons, fomites, or large droplets. The incubation period is variable, depending on the clinical manifestation of disease, and ranges from 6 to 10 days. The period of infectivity also varies, depending on the clinical presentation or stage of disease. Persons with erythema infectiosum are infectious before the appearance of the rash, those with infection and aplastic crises for as long as 7 days after onset of illness, and persons with chronic infection for years.

Pregnant personnel are at no greater risk of acquiring B19 infection than are nonpregnant personnel; however, if a pregnant woman does acquire B19 infection during the first half of pregnancy, the risk of fetal death (fetal hydrops, spontaneous abortion, and stillbirth) is increased. Because of the serious nature of the consequences for the fetus, female personnel of childbearing age need to be counseled regarding the risk of transmission of B19 and appropriate infection control precautions.

Isolation precautions are not indicated for most patients with erythema infectiosum because they are past their period of infectiousness at the time of clinical illness. However, patients in aplastic crisis from B19 or patients with chronic B19 infection may transmit the virus to susceptible health care personnel or other patients; therefore, patients with preexisting anemia who are admitted to the hospital with febrile illness and transient aplastic crises should remain on droplet precautions for 7 days and patients with known or suspected chronic infection with B19 should be placed on droplet precautions on admission and for the duration of hospitalization. Work restrictions are not necessary for personnel exposed to B19.

Recommendations

a. Ensure that pregnant personnel are aware of the risks associated with parvovirus infection and of infection control procedures to prevent transmission when working with high-risk patient groups (Table 6). Category IB

b. Do not routinely exclude pregnant personnel from caring for patients with B19. Category IB

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