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©iStockphoto.com/pascalgenest
by Heidi Green
June 14, 2009
When my son developed an unusual widespread rash, I first attributed it to contact with a strange plant of some kind. After all, several of his classmates had developed poison ivy after a recent class hike, and I had heard that several others in his class had a rash. It took a couple of days for me to suspect that it was caused by an outbreak of fifth disease—and to wonder if I should be concerned about my unborn child, too.
What is it?
Fifth disease is a common, viral illness caused by the human parvovirus B19. It occurs most commonly among children between the ages of 4 and 14. According to the Centers for Disease Control and Prevention (CDC), it is estimated that 50 percent of all adults have been infected with the virus sometime during their lives—and are, therefore, immune to further infection.
It may be that fifth disease waxes and wanes over time; one source from the United Kingdom says that researchers there have noticed a pattern: two years of parvovirus epidemic followed by two years of low incidence.
What are the symptoms?
Fifth disease is usually a mild illness. It is estimated that between 20–30 percent of children and adults who contract the virus may not experience any symptoms at all.
For children, symptoms tend to include:
Adults may experience any of these symptoms, as well as joint pain and swelling. Some reports indicate that the joint pain can last as long as a couple of months.
How does it spread?
Fifth disease is highly contagious. The time between infection and development of the illness varies greatly, ranging from 4 to 21 days. Worse news—in terms of trying to identify and avoid risk—is that people with fifth disease are most infectious before the onset of symptoms. Once the rash and other symptoms develop, they are not contagious.
In short, by the time you become aware that someone close to you (a family member or friend) is sick, they may have already unknowingly passed the virus to you.
What can pregnant women do to prevent exposure?
Not much. The usual “staying healthy” tips about washing your hands and practicing good hygiene apply, but for those of us who have small children or whose work involves small children, prevention is more challenging. Just ask any parent who has ever been bombarded with kisses from a snuffly preschooler or handed a half-chewed snack from a distracted child or… you get the picture. Frankly, the risk of infection for a non-immune mother with an infected child is estimated to be between 50–90 percent. Compare that with just 20–30 percent risk for a child who attends day care with an infected peer.
What can pregnant women do to identify their risk?
Some experts suggest that all pregnant women be screened for parvovirus B19 during their initial prenatal bloodwork so that they know their risk from the outset. Since no vaccine yet exists for fifth disease, others are comfortable waiting after a suspected exposure for test results. Pregnant women are encouraged to discuss their concerns with their health care providers.
What are the risks for the baby?
Many pregnant women who become infected with fifth disease will deliver healthy babies. The scary part is that the virus can cross the placenta, and does so about 33 percent of the time. In some cases, the virus will infect the unborn baby and lead to serious consequences.
In some cases, miscarriage or stillbirth will result. This is more likely for women who are infected during the first 20 weeks of pregnancy. The miscarriage risk attributable to fifth disease is estimated to be about 10 percent.
In utero infection can also lead to inflammation of the heart (myocarditis) and can damage the bone marrow so that red blood cells cannot be made. This can ultimately result in anemia. In severe cases of heart damage or anemia, excess fluid can build up in fetal tissue (hydrops) and cause death.
What treatment is available to pregnant women?
Sadly, there is no treatment for fifth disease. However, women who are diagnosed with fifth disease during pregnancy require special care. Typically, this includes:
Unfortunately, women in their first trimester of pregnancy when they contract the virus are left without options until they reach their second trimester. Even weekly ultrasounds will typically not be prescribed until their baby has reached a gestational age at which treatment (blood transfusions, delivery) can help.
A ray of hope
It’s worth repeating that most women who contract parvovirus B19 while pregnant will not pass the virus to their children. These women will deliver healthy children. In addition, treatment is often possible when anemia or hydrops is recognized in utero.
Finally, experts tend to agree that the risk period for transmission of the virus across the placenta is 10 weeks. So even those of us who are unlucky enough to contract the virus before the golden second trimester of treatment options will—hopefully—be out of the woods before the day our baby arrives in our eager arms.
Heidi Green has been researching and writing about women’s and children health since she moved to Pittsburgh more than 10 years ago. She is also a children’s book reviewer in her spare time. She is mom to Ben, Katie, Sam, and Max.
Copyright ©2012 baby gooroo, inc.
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