Parvovirus B19

At a glance

Parvovirus B19 from the Infection Control in Healthcare Personnel: Epidemiology and Control of Selected Infections Transmitted Among Healthcare Personnel and Patients (2025) guideline.

Recommendations

  1. For asymptomatic healthcare personnel who have an exposure to parvovirus B19:
  • Work restrictions are not necessary.
  • Wear source control through the 14th day after last exposure.
  1. For healthcare personnel known or suspected to have the early symptoms (i.e., prodrome) of parvovirus B19 infection:
  • Exclude from work until:
    • At least 5 days have passed from symptom onset, AND
    • They are fever free for at least 24 hours without the use of antipyretics, AND
    • Symptoms are improving
  • Wear source control upon return to work until resolution of their respiratory symptoms.

For recommendations about healthcare personnel who are pregnant or intending to become pregnant, please see the Pregnant HCP 
(https://www.cdc.gov/infection-control/hcp/healthcare-personnel-epidemiology-control/pregnant-hcp.html) section.

Background

Parvovirus B19 most commonly causes erythema infectiosum, or Fifth Disease, a common, mild rash illness that usually affects children but can also cause a mild rash and/or joint pains in adults in addition to other potential complications. 1Transmission of parvovirus B19 from infected patients to healthcare personnel (HCP), from HCP to HCP, and to patients (potentially from HCP) during nosocomial outbreaks is rare, but has been reported. 2345678910 HCP have been reported to acquire infection during the care of patients with parvovirus B19-associated sickle-cell aplastic crises. 21112 Investigations of HCP exposures to parvovirus B19 have reported mixed findings, with some reporting higher rates of HCP infections after exposures, and others not. 131415Based on serologic surveys in seronegative HCP, community-based exposures, including in childcare/daycare settings, tend to be more common sources of parvovirus B19 infection than healthcare settings, and community risk factors for exposure (e.g., living with an infectious child) likely pose a higher risk for transmission than working in healthcare. 1617

Prevention of transmission of parvovirus B19 in healthcare settings involves using infection prevention and control practices as recommended by CDC (https://www.cdc.gov/infection-control/hcp/isolation-precautions/appendix-a-type-duration.html#P). 18

Occupational Exposures

Transmission of parvovirus B19 occurs through deposition of respiratory, oral, or nasal secretions from an infected source person onto the mucous membranes of a susceptible host. Parvovirus B19 can also spread through exposure to blood or blood products, including sharps injuries. 119 Concern for occupational exposures typically occurs when unprotected HCP (i.e., not wearing recommended personal protective equipment) provide care for patients with chronic parvovirus B19 infection or parvovirus B19-associated aplastic crisis who have not been placed in recommended Transmission-Based Precautions and are likely to be contagious. 19

Clinical Features

Most persons with parvovirus B19 infection are asymptomatic or exhibit mild, nonspecific, cold-like symptoms that spontaneously resolve. 120 The facial rash that characterizes erythema infectiosum can be an intense red color with a "slapped cheek" appearance but is rare in adults. Most persons are diagnosed with parvovirus B19 infection clinically, due to the appearance of the "slapped cheek" rash, and most are past their period of infectiousness to others once the rash appears. Development of painful or swollen joints (i.e., polyarthropathy) can be a more common presentation of parvovirus B19 infection in adults and occurs more often in females than males. Complications, such as a transient severe anemia, are rare in healthy adults. 1

Immunodeficient persons, such as those with leukemia, cancer, or HIV infection, or those who are organ transplant recipients, may become chronically infected with parvovirus B19 and develop a chronic anemia (i.e., chronic erythroid hypoplasia). 2122Persons with sickle cell disease, similar types of long-lasting anemias, or problems producing red blood cells may also experience additional complications such as a transient aplastic crisis. 23 Those who develop aplastic crises are contagious from before onset of symptoms through at least the week after onset. 19

A pregnant woman infected with parvovirus B19 can pass the virus to the fetus, and the risk of fetal death (e.g., fetal hydrops, spontaneous abortion, and stillbirth) is increased, especially in the first half of pregnancy. 16192224 The presence of protective antibodies in a pregnant woman offers protection from infection. 19

There is very limited information available on viral shedding of parvovirus B19 by infected persons, as well as the potential for asymptomatic and presymptomatic shedding or transmission. The incubation period, defined as the time between parvovirus B19 exposure and onset of initial symptoms, varies according to the clinical manifestation of disease and is between 4 and 14 days, but can be up to 21 days. 19 A human parvovirus challenge study in adults demonstrated parvovirus excretion in respiratory secretions that correlated with onset of prodromal symptoms (e.g., fever, malaise), roughly between days 7 and 11 post-inoculation. Hence, there was a period of roughly 5 days where subjects may have been contagious to others. 25 Persons who develop the slapped-cheek rash of erythema infectiosum or polyarthropathy after resolution of their prodromal respiratory symptoms are, for the most part, not considered as being contagious to others. Those with aplastic crises can be contagious to others for as long as 7 days after its onset, and persons with chronic disease could be contagious to others for much longer. 42627

Testing and Diagnosis

Typically, neither asymptomatic nor symptomatic HCP are routinely tested for parvovirus B19 infection or immunity. If erythema infectiosum is present, a clinical diagnosis can be made without laboratory testing. 20 When laboratory testing is performed, parvovirus B19-specific antibody testing and viral DNA testing are available and may be used. 20 Testing for parvovirus B19 is not typically performed by Occupational Health Services (OHS).

Routine testing for parvovirus B19 is not indicated in pregnant women. 20 Guidance for submitting specimens to CDC for testing is available online (https://www.cdc.gov/laboratory/specimen-submission/list.html). 28

Additional considerations

There is no postexposure prophylaxis (PEP) for exposures to parvovirus B19. Because erythema infectiosum is usually mild in healthy adults, treatment typically consists of relieving symptoms, such as fever, itching, and joint pain and swelling. 29 Since symptoms of parvovirus B19 infection can be non-specific (e.g., fever and respiratory symptoms), other causes are typically considered when symptomatic HCP are evaluated after parvovirus B19 exposure. Additionally, if symptoms persist, further clinical evaluation is often performed in collaboration with their primary medical provider. When pregnant HCP or those intending to become pregnant are exposed to parvovirus B19 or develop signs and symptoms compatible with parvovirus B19 infection, OHS will typically refer them to their obstetric provider (see Pregnant HCP section) for counseling and to discuss the need for further diagnostic testing and management. 16

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Content Source:
National Center for Emerging and Zoonotic Infectious Diseases (NCEZID)
  1. Centers for Disease Control and Prevention; National Center for Immunization and Respiratory Diseases; Division of Viral Diseases. About Parvovirus B19. Updated November 26, 2024. Accessed July 10, 2025. https://www.cdc.gov/parvovirus-b19/about/index.html
  2. Bell LM, Naides SJ, Stoffman P, Hodinka RL, Plotkin SA. Human parvovirus B19 infection among hospital staff members after contact with infected patients. The New England journal of medicine. Aug 24 1989;321(8):485-91. doi:10.1056/nejm198908243210801
  3. Harrison J, Jones CE. Human parvovirus B19 infection in healthcare workers. Occupational medicine (Oxford, England). Apr 1995;45(2):93-6.
  4. Lui SL, Luk WK, Cheung CY, Chan TM, Lai KN, Peiris JS. Nosocomial outbreak of parvovirus B19 infection in a renal transplant unit. Transplantation. Jan 15 2001;71(1):59-64.
  5. Miyamoto K, Ogami M, Takahashi Y, et al. Outbreak of human parvovirus B19 in hospital workers. The Journal of hospital infection. Jul 2000;45(3):238-41. doi:10.1053/jhin.2000.0771
  6. Pillay D, Patou G, Hurt S, Kibbler CC, Griffiths PD. Parvovirus B19 outbreak in a children's ward. Lancet (London, England). Jan 11 1992;339(8785):107-9.
  7. Rosenstein RK, Rosenstein PK, Kramer N, Rosenstein ED. Healthcare-Associated Transmission of Parvovirus B19 Arthropathy. Bull Hosp Jt Dis (2013). Jun 2020;78(2):140-143.
  8. Seng C, Watkins P, Morse D, et al. Parvovirus B19 outbreak on an adult ward. Epidemiology and infection. Oct 1994;113(2):345-53.
  9. Shishiba T, Matsunaga Y. An outbreak of erythema infectiosum among hospital staff members including a patient with pleural fluid and pericardial effusion. Journal of the American Academy of Dermatology. Aug 1993;29(2 Pt 1):265-7.
  10. Sungkate S, Phongsamart W, Rungmaitree S, et al. Human parvovirus B19 nosocomial outbreak in healthcare personnel in a paediatric ward at a national tertiary referral centre in Thailand. The Journal of hospital infection. Jun 2017;96(2):163-167. doi:10.1016/j.jhin.2017.03.014
  11. Anderson LJ, Gillespie SM, Torok TJ, Hurwitz ES, Tsou CJ, Gary GW. Risk of infection following exposures to human parvovirus B19. Behring Institute Mitteilungen. Aug 1990;(85):60-3.
  12. Evans JP, Rossiter MA, Kumaran TO, Marsh GW, Mortimer PP. Human parvovirus aplasia: case due to cross infection in a ward. British medical journal (Clinical research ed). Mar 3 1984;288(6418):681.
  13. Dowell SF, Torok TJ, Thorp JA, et al. Parvovirus B19 infection in hospital workers: community or hospital acquisition? The Journal of infectious diseases. Oct 1995;172(4):1076-9.
  14. Koziol DE, Kurtzman G, Ayub J, Young NS, Henderson DK. Nosocomial human parvovirus B19 infection: lack of transmission from a chronically infected patient to hospital staff. Infection control and hospital epidemiology. Jun 1992;13(6):343-8.
  15. Ray SM, Erdman DD, Berschling JD, Cooper JE, Torok TJ, Blumberg HM. Nosocomial exposure to parvovirus B19: low risk of transmission to healthcare workers. Infection control and hospital epidemiology. Feb 1997;18(2):109-14.
  16. Committee on Practice Bulletins - Obstetrics; The American College of Obstetricians and Gynecologists. Practice bulletin no. 151: Cytomegalovirus, parvovirus B19, varicella zoster, and toxoplasmosis in pregnancy. Obstetrics and gynecology. Jun 2015;125(6):1510-25. doi:10.1097/01.Aog.0000466430.19823.53
  17. Harger JH, Adler SP, Koch WC, Harger GF. Prospective evaluation of 618 pregnant women exposed to parvovirus B19: risks and symptoms. Obstetrics and gynecology. Mar 1998;91(3):413-20. doi:10.1016/s0029-7844(97)00701-1
  18. Siegel JD, Rhinehart E, Jackson M, Chiarello L, the Healthcare Infection Control Practices Advisory Committee. Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings (2007): Type and Duration of Precautions Recommended for Selected Infections and Conditions: Parvovirus B19 (Erythema infectiosum). Updated February 7, 2025. Accessed July 10, 2025. https://www.cdc.gov/infection-control/hcp/isolation-precautions/appendix-a-type-duration.html#P
  19. Committee on Infectious Diseases, American Academy of Pediatrics, Kimberlin DW, Barnett ED, Lynfield R, Sawyer MH. Parvovirus B19 (Erythema Infectiosum, Fifth Disease). Red Book: 2021–2024 Report of the Committee on Infectious Diseases. American Academy of Pediatrics,; 2021:562-566:chap Section 3.
  20. Servey JT, Reamy BV, Hodge J. Clinical presentations of parvovirus B19 infection. American family physician. Feb 1 2007;75(3):373-6.
  21. Anderson LJ, Torok TJ. The clinical spectrum of human parvovirus B19 infections. Current clinical topics in infectious diseases. 1991;11:267-80.
  22. Torok TJ. Parvovirus B19 and human disease. Advances in internal medicine. 1992;37:431-55.
  23. Centers for Disease Control and Prevention; National Center for Immunization and Respiratory Diseases; Division of Viral Diseases; Division of Viral Diseases. About Parvovirus B19: Complications. Updated November 26, 2024. Accessed July 10, 2025. https://www.cdc.gov/parvovirus-b19/about/index.html#cdc_disease_basics_compli-complications
  24. Torok TJ. Human parvovirus B19 infections in pregnancy. The Pediatric infectious disease journal. Oct 1990;9(10):772-6.
  25. Anderson MJ, Higgins PG, Davis LR, et al. Experimental parvoviral infection in humans. The Journal of infectious diseases. Aug 1985;152(2):257-65. doi:10.1093/infdis/152.2.257
  26. Frickhofen N, Abkowitz JL, Safford M, et al. Persistent B19 parvovirus infection in patients infected with human immunodeficiency virus type 1 (HIV-1): a treatable cause of anemia in AIDS. Ann Intern Med. Dec 15 1990;113(12):926-33. doi:10.7326/0003-4819-113-12-926
  27. Frickhofen N, Young NS. Persistent parvovirus B19 infections in humans. Microbial Pathogenesis. 1989/11/01/ 1989;7(5):319-327. doi:https://doi.org/10.1016/0882-4010(89)90035-1
  28. Centers for Disease Control and Prevention NCfEaZID. Infectious Diseases Laboratories, Submitting Specimens to CDC: Test Directory. Updated July 7, 2025. Accessed July 10, 2025. https://www.cdc.gov/laboratory/specimen-submission/list.html
  29. Centers for Disease Control and Prevention; National Center for Immunization and Respiratory Diseases; Division of Viral Diseases. About Parvovirus B19: Treatment. Updated November 26, 2024. Accessed July 10, 2025. https://www.cdc.gov/parvovirus-b19/about/index.html#cdc_disease_basics_treatment-treatment