• Notification is not required
• School exclusion is not required

Infectious agent Clinical features:

• Human parvovirus B19 infection causes a mild illness with little or no fever but a striking redness of the cheeks (hence "slapped face disease"), followed one to four days later by a lacy pink rash on the trunk and limbs which fades but may recur over several weeks on exposure to heat. The illness may also cause headache, itch and upper respiratory tract symptoms.
• In adults the rash is often atypical or absent, but pain, inflammation and swelling of joints may occur, and, rarely, persist for months
• Asymptomatic infection is common.
• Several groups of people are at particular risk from the effects of Parvovirus infection on developing red blood cells.
• Persons with chronic haemolytic diseases (eg. sickle cell disease) may develop transient aplastic crises after Parvovirus infection and immunosuppressed persons may develop severe chronic anaemia. Adverse effects from Parvovirus infection during pregnancy are uncommon. but infection of the foetus may cause foetal anaemia hydrops foetalis and foetal death (in fewer than 10% of cases of maternal infection). Parvovirus infection has been associated with spontaneous abortion, but does not appear to cause congenital abnormalities

Public Health Significance and Occurrence:

• Human parvovirus infection occurs worldwide and is a common childhood disease. Outbreaks occur during winter and spring. Up to 50 percent of susceptible household contacts and 10 to 60 percent of child care or school contacts may be infected during outbreaks.

Method of Diagnosis:

• The diagnosis can usually be made an clinical grounds.
• Serological tests for lgG and lgM antibodies can be performed on serum and amniotic fluid.
• PCR can be used for confirmation of the above
• Electron microscopy can also be performed on beta tissue.
• Other diagnostic techniques may be available in some specialised centres-

Reservoir:

• Humans

Incubation Period:

• 1 to2weeks

• Infection is transmitted by contact with infected respiratory secretions. it may be spread vertically from mother to foetus and, rarely by transfusion of blood or blood products.

Period of Communicability:

• Children with erythema infectiosum are most infectious before rash, and are probably not infectious after the rash appears. Persons with aplastic crises are infectious for a week after the onset of the symptoms.
• Immunosuppressed persons with chronic infection and anaemia may excrete virus for years.

Susceptibility and Resistance:

• Five to 10 percent of pre-school children and more than 50% of adults have serological evidence of infection. Infection confers immunity.

Method of Control

Control of Case:

• Persons with Parvovirus infection need not be excluded from child care or schools
• There is no specific treatment for erythema infectiosum. Seek specialist advice if a person with immunodeficiency or a blood disorder suffers Parvovirus infection. The risk of transmission to staff should be considered when immunosuppressed persons are hospitalised with anaemia associated with Parvovirus infection.

Pregnant women:

• A pregnant woman who believes she has been in contact with a case of Parvovirus infection should consult the doctor supervising her pregnancy. Antibody testing is available at VIDRL and this may assist doctors advising women who are pregnant or contemplating pregnancy, of the risk, if any, which Parvovirus infection poses.
• There is no risk to women who have antibodies due to previous infection.

Preventive and Outbreak Measures:

• Non-immune persons who are immunosuppressed (due to illness and/or
• treatment), have chronic haemolytic disorders? or are pregnant are at risk of
• potentially serious outcomes from Parvovirus infection.
• "At risk" persons in close contact with children or siblings where Parvovirus infection may occur (schools, child care centres, health care facilities etc.) should be advised of the risk which Parvovirus infection may pose and warned of school and child care centre outbreaks.