Outbreaks caused by parvovirus B19 in three Portuguese schools

Abstract

This paper reports the study of outbreaks of an acute exanthematous disease among children of three schools in the municipality of Braga (Portugal). Laboratory tests were performed for five cases, showing that the disease was not due to infection by measles or rubella virus, and infection with parvovirus B19 was confirmed. There were 41 cases in children: 12 in the kindergarten, 17 in the secondary school and 12 in the primary school. There was only one case in a staff member, who worked in the kindergarten. Eight cases were identified among household contacts; two of them were brothers, one from the kindergarten and another from the secondary school, where the outbreak occurred after the kindergarten outbreak. The estimated values of the basic reproduction number R0 were very low and it is very likely that asymptomatic infectious cases have occurred. The local health authority produced written documents and met with staff members and parents. Primary healthcare facilities and the obstetric department of the local hospital were also informed. As we are approaching the elimination of measles in Portugal and the rest of Europe, with very high vaccine coverage, it is very likely that a high proportion of infectious non-vesicular exanthemas will be due to B19 infections. This is to be taken into account in the design and conduct of surveillance activities, in the context of measles and rubella elimination programmes.

Human parvovirus B19 surveillance in patients with rash and fever from Belarus

“…The single large outbreak detected during the 4 years of observation seems to be in agreement with the previously described increased incidence of B19V every 3–5 years [Mossong et al, 2008; Kooistra et al, 2011]. Similar to other reports [Anderson, 1987; Davidkin et al, 1998; Sabella and Goldfarb, 1999; Zaaijer et al, 2004; Goncalves et al, 2005; Servey et al, 2007; Nicolay and Cotter, 2009; Kooistra et al, 2011] the outbreak in Minsk city occurred in the winter–spring period, with an incidence peak in April, while the small cluster cases were observed in early winter.…”

Clinical and epidemiological aspects of parvovirus B19 infections in Ireland, January 1996-June 2008

“…Commercial tests for the serological diagnosis of parvovirus B19 are available, but none are validated for use on oral fluid samples. Such a diagnostic tool would be invaluable, particularly when investigating fever/rash illnesses in young children [2] who are not so ill as to require hospitalisation but are usually seen by general practitioners (GPs) in the community. Anecdotal reports indicate that Irish GPs are reluctant to undertake phlebotomy in such paediatric cases and hence accurate laboratory confirmation of fever illness is often not done.…”

“…An accurate diagnosis of fever/rash illness is necessary not only for case management but also for public health control activities, particularly in outbreak situations in which measles or rubella is suspected [2]. As Europe seeks to eliminate measles as part of the World Health Organization's European strategy it is important that fever/rash illnesses are accurately diagnosed and that parvovirus B19 infection is not mistakenly reported as measles or rubella [3,4].…”

Gianotti-Crosti Syndrome, Pityriasis Rosea, Asymmetrical Periflexural Exanthem, Unilateral Mediothoracic Exanthem, Eruptive Pseudoangiomatosis and Papular-Purpuric Gloves and Socks Syndrome: A Brief Review and Arguments for Diagnostic Criteria

“…Asymptomatic virus shedding is common. 201 Its significance might be lower for Caucasian populations. For populations with high prevalence of congenital hemoglobinopathies, namely thalassemias, sickle-cell disease, or congenital spherocytosis, a rise in the incidence of PPGSS might signify escalating prevalence of HB19EV infection in the community 202 and, therefore, actions might have to be taken to detect and prevent aplastic anemia.…”