1887

Abstract

In Europe, fetal loss due to Parvovirus B19 (B19V) is under-reported and a poorly addressed occupational risk to pregnant women. This is exemplified internationally, where it was unmentioned in the last two European Centre for Disease Prevention and Control (ECDC) annual surveillance reports or its 2009 special report on infections in pregnancy. To assess this potential for underestimating B19V fetal loss in pregnancy, we undertook a systematic review of practice in Northern Ireland in the management and reporting of B19V infections over a 12-month period of heightened transmission, one of six observed in a span of 9 years. Pregnant and non-pregnant women presented with symptomatic infection in 24 and 93 % of confirmed B19V infections, respectively, with no difference in viral loads. There was underinvestigation of viral causes of fetal loss, with only 143/2739 (5 %) tested for B19V, and a failure to follow up most non-immune women tested following rash contact. Occupational exposure was recorded in 31/60 (51.6 %) of pregnancies audited following rash exposure, the majority teachers or day care workers. Against a background seroprevalence of 66.5 % immunity in women of child-bearing years, two patterns of infection were identified. Firstly, pregnant women investigated for a rash or exposure to slapped cheek syndrome, where an infection incidence of 18 % was observed, resulted in 42 confirmed infections, all proceeding to healthy term deliveries. Secondly, pregnant women with unsuspected infection had six cases of confirmed B19V fetal loss, including four of 22 (18 %) diagnosed at autopsy, of which three were non-hydropic. While many studies have reported B19V fetal loss in pregnancy, there are no robust public health surveillance figures to draw on. That all six confirmed fetal losses came from the small number of miscarriages/stillbirths investigated, 143 out of 2739, suggests inadequate follow-up of those pregnancies where B19V-related fetal loss may be most common, and supports the need for enhanced surveillance pilots to address this significant gap in public health knowledge.

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2013-01-01
2024-03-28
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References

  1. Adler S. P., Manganello A. M., Koch W. C., Hempfling S. H., Best A. M. 1993; Risk of human parvovirus B19 infections among school and hospital employees during endemic periods. J Infect Dis 168:361–368 [View Article][PubMed]
    [Google Scholar]
  2. Beigi R. H., Wiesenfeld H. C., Landers D. V., Simhan H. N. 2008; High rate of severe fetal outcomes associated with maternal parvovirus B19 infection in pregnancy. Infect Dis Obstet Gynecol 2008:524601 [View Article][PubMed]
    [Google Scholar]
  3. CEMACH (2007). Saving Mothers’ Lives: Reviewing Maternal Deaths to Make Motherhood Safer - 2003-2005. The Seventh Report on Confidential Enquiries into Maternal Deaths in the United Kingdom. Edited by G. Lewis. London: CEMACH
  4. de Villemeur A. B., Gratacap-Cavallier B., Casey R., Baccard-Longère M., Goirand L., Seigneurin J. M., Morand P. 2011; Occupational risk for cytomegalovirus, but not for parvovirus B19 in child-care personnel in France. J Infect 63:457–467 [View Article][PubMed]
    [Google Scholar]
  5. Doherty L. 2008 Parvovirus B19 Infection in Pregnant Women http://www.dhsspsni.gov.uk/hss-md-11-2008.pdf
  6. Duckitt K., Qureshi A. 2011 Recurrent miscarriage. Clin Evid (Online) 2011, pii: 1409
  7. ECDC 2009a Annual Epidemiological Report on Communicable Diseases in Europe 2009 http://ecdc.europa.eu/en/publications/Publications/0910_SUR_Annual_Epidemiological_Report_on_Communicable_Diseases_in_Europe.pdf Stockholm: ECDC
  8. ECDC 2009b Special Issue: Pregnancy and Infectious Diseases. Eurosurveillance 14, Issue 1–12, Jan–Mar 2009 http://www.eurosurveillance.org/images/dynamic/EQ/V14N01/V14N01.pdf
  9. ECDC 2011 Annual Epidemiological Report 2011. Reporting on 2009 Surveillance Data and 2010 Epidemic Intelligence Data http://www.ecdc.europa.eu/en/publications/Publications/1111_SUR_Annual_Epidemiological_Report_on_Communicable_Diseases_in_Europe.pdf Stockholm: ECDC
  10. Enders M., Klingel K., Weidner A., Baisch C., Kandolf R., Schalasta G., Enders G. 2010; Risk of fetal hydrops and non-hydropic late intrauterine fetal death after gestational parvovirus B19 infection. J Clin Virol 49:163–168 [View Article][PubMed]
    [Google Scholar]
  11. Gärtner B., Enders M., Luft-Duchow C., Bocharov G., Modorow S. 2007; [Parvovirus B-19 infections in pregnant women in day care facilities: health economic analysis of prohibition to employ seronegative women]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 50:1369–1378 (in German) [PubMed] [CrossRef]
    [Google Scholar]
  12. Gilbert G. L. 2000; Parvovirus B19 infection and its significance in pregnancy. Commun Dis Intell 24:Suppl.69–71[PubMed]
    [Google Scholar]
  13. Gillespie S. M., Cartter M. L., Asch S., Rokos J. B., Gary G. W., Tsou C. J., Hall D. B., Anderson L. J., Hurwitz E. S. 1990; Occupational risk of human parvovirus B19 infection for school and day-care personnel during an outbreak of erythema infectiosum. JAMA 263:2061–2065 [View Article][PubMed]
    [Google Scholar]
  14. Harger J. H., Adler S. P., Koch W. C., Harger G. F. 1998; Prospective evaluation of 618 pregnant women exposed to parvovirus B19: risks and symptoms. Obstet Gynecol 91:413–420 [View Article][PubMed]
    [Google Scholar]
  15. Miller E., Fairley C. K., Cohen B. J., Seng C. 1998; Immediate and long term outcome of human parvovirus B19 infection in pregnancy. Br J Obstet Gynaecol 105:174–178 [View Article][PubMed]
    [Google Scholar]
  16. Mitchell E. 2009; Increase in Parvovirus B19 Infection – Advice on Management of Suspected Infections in Pregnancy. http://www.dhsspsni.gov.uk/hss-md-12-2009.pdf. Northern Ireland: Department of Health, Social Services and Public Safety. .
  17. Mossong J., Hens N., Friederichs V., Davidkin I., Broman M., Litwinska B., Siennicka J., Trzcinska A., VAN Damme P. other authors 2008; Parvovirus B19 infection in five European countries: seroepidemiology, force of infection and maternal risk of infection. Epidemiol Infect 136:1059–1068 [View Article][PubMed]
    [Google Scholar]
  18. NCCWCH 2008 Antenatal Care: Routine Care for the Healthy Pregnant Woman London: RCOG Press;
    [Google Scholar]
  19. Nicolay N., Cotter S. 2009; Clinical and epidemiological aspects of parvovirus B19 infections in Ireland, January 1996-June 2008. Euro Surveill 14:19249[PubMed]
    [Google Scholar]
  20. Oliveira S. A., Camacho L. A., Pereira A. C., Faillace T. F., Setubal S., Nascimento J. P. 2002; Clinical and epidemiological aspects of human parvovirus B19 infection in an urban area in Brazil (Niterói city area, State of Rio de Janeiro, Brazil). Mem Inst Oswaldo Cruz 97:965–970 [View Article][PubMed]
    [Google Scholar]
  21. Rash Guidance Working Group 2011 Guidance on Viral Rash in Pregnancy: Investigation, Diagnosis and Management of Viral Rash Illness, or Exposure to Viral Rash Illness, in Pregnancy London: Health Protection Agency;
    [Google Scholar]
  22. Regan L., Backos, Rai R. 2011 The Investigation and Treatment of Couples with Recurrent First-Trimester and Second-Trimester Miscarriage Green-Top Guideline No. 17 London: Royal College of Obstetricians and Gynaecologists;
    [Google Scholar]
  23. Simpson J. L. 1990; Incidence and timing of pregnancy losses: relevance to evaluating safety of early prenatal diagnosis. Am J Med Genet 35:165–173 [View Article][PubMed]
    [Google Scholar]
  24. Skjöldebrand-Sparre L., Tolfvenstam T., Papadogiannakis N., Wahren B., Broliden K., Nyman M. 2000; Parvovirus B19 infection: association with third-trimester intrauterine fetal death. BJOG 107:476–480 [View Article][PubMed]
    [Google Scholar]
  25. Stelma F. F., Smismans A., Goossens V. J., Bruggeman C. A., Hoebe C. J. 2009; Occupational risk of human Cytomegalovirus and Parvovirus B19 infection in female day care personnel in the Netherlands; a study based on seroprevalence. Eur J Clin Microbiol Infect Dis 28:393–397 [View Article][PubMed]
    [Google Scholar]
  26. The Council Of The European Communities 1992; . Council Directive 92/85/EEC of 19 October 1992 on the Introduction of Measures to Encourage Improvements in the Safety and Health at Work of Pregnant Workers and Workers who Have Recently Given Birth or Are Breastfeeding pp. 1–8 EUR-Lex;
    [Google Scholar]
  27. UK National Screening Committee 2010 Infectious Diseases in Pregnancy Screening Programme: Programme Standards UK: NHS;
    [Google Scholar]
  28. Valeur-Jensen A. K., Pedersen C. B., Westergaard T., Jensen I. P., Lebech M., Andersen P. K., Aaby P., Pedersen B. N., Melbye M. 1999; Risk factors for parvovirus B19 infection in pregnancy. JAMA 281:1099–1105 [View Article][PubMed]
    [Google Scholar]
  29. Watt A., Coyle P., Parris C., Vizzard C. 2011; Audit of the management of susceptible pregnant women following exposure to parvovirus B19. Bulletin of the Royal College of Pathologists 156:277–281
    [Google Scholar]
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