Fifth disease

Andy,

My daughter has a friend staying over - when her mom dropped her of she told us that her daughter carpooled with a girl the week of Feb 23 - 27th who had fifth disease.  My daughter's friend has not shown any of the symptoms of the illness - and she will be sleeping over tonight.  What are the risks to little A from my daughter having this friend over? 

Thank you very kindly,

Sharmin

Little A had IVIG Wednesday morning - can this provide some protection for him from the disease?  I am thinking that the risk of him becoming infected is very very low - but in case there were to be any exposure. 

Is there anything that I should watch for?  He still has a few lingering symptoms from the recent cold that he had, so I won't know if he gets a new cold. 

Sharmin

Sharmin,

Little A should not be exposed to fifth disease. In most people it is no problem but with anemias it can cause a serious problem.

http://www.cdc.gov/NCIDOD/DVRD/revb/respiratory/parvo_b19.htm

Fifth disease is usually a mild illness that resolves on its own among children and adults who are otherwise healthy. Joint pain and swelling in adults usually resolve without long-term disability.

Parvovirus B19 infection may cause a serious illness in persons with sickle-cell disease or similar types of chronic anemia. In such persons, parvovirus B19 can cause an acute, severe anemia. The ill person may be pale, weak, and tired, and should see his or her physician for treatment. (The typical rash of fifth disease is rarely seen in these persons.) Once the infection is controlled, the anemia resolves. Furthermore, persons who have problems with their immune systems may also develop a chronic anemia with parvovirus B19 infection that requires medical treatment.

I would suggest keeping him away from the sleepover girls. If your daughter is exposed, he will also need to avoid her until it clears up.

Is fifth disease contagious?     
Yes. A person infected with parvovirus B19 is contagious during the early part of the illness, before the rash appears. By the time a child has the characteristic "slapped cheek" rash of fifth disease, for example, he or she is probably no longer contagious and may return to school or child care center. This contagious period is different than that for many other rash illnesses, such as measles, for which the child is contagious while he or she has the rash.

Parvovirus B19 has been found in the respiratory secretions (e.g., saliva, sputum, or nasal mucus) of infected persons before the onset of rash, when they appear to "just have a cold." The virus is probably spread from person to person by direct contact with those secretions, such as sharing drinking cups or utensils. In a household, as many as 50% of susceptible persons exposed to a family member who has fifth disease may become infected. During school outbreaks, 10% to 60% of students may get fifth disease.

Altough IVIG does at least in theory give protection against many illnesses because it is the antibodies of thousands of people, in light of little A's ongoing battles, it is best if he is not exposed.

I want to also point out what it says about the contagious period. It is contagious only during the early part of the illness and usually before the rash appears.

Thank you Andy,

I will do my best to keep him away from the her.  Gosh, there is always something to worry about! 

The mom of the girl who is sleeping over is certain that her daughter does not have it because she has not had any symptoms since she  carpooled with the girl having fifth disease 8 or 9 days ago - but you never know she could still be carrying it.  I think that I will call little A's pediatrician as well to let him know. 

Thanks again Andy,  I am pretty nervous now...

Sharmin

Andy,

I have tried to page the pediatrician but he has not gotten back to me.  Can it be that fifth disease is bad for people having thalassemia or sickle cell anemia because it shuts down production of red blood cells - requiring them to have immediate transfusions - but perhaps not for a transfused thal because they receive transfusions anyway and they do not need to produce red blood cells? 

I am a bit of a wreck right now...I don't know what to think. 

Sharmin

Andy,

We decided to take the little girl home, but if she was carrying the disease there is a chance that my children may have become exposed.

What should we watch for?  Should the children have a blood test to see if they were exposed?

Sharmin

I don't think you should worry too much about it. Yes, the girl could be infected and not know it and the normal incubation period is 4-14 days, but as it turns out, IVIG is the first line of treatment against this parvovirus, so little A may have some protection. Talk to your doctor about this and see if there is any reason to test him for parvovirus antibodies. He may be in the clear, even if exposed.

Thank you Andy.  I am glad that he had his ivig on Wednesday.  He is do for his next ivig in 3 weeks but we may schedule it to be sooner so that he is fully covered.  Maybe it would be helpful to give him IVIm as well - is that typically given?  I think I read that it is the igM that produces antibodies against parvovirus - expect in little a his igM is suppressed somewhat with the ritux and is not replaced (only the IGg is replaced).  What do you think Andy?  His ped hasn't called back but I will try him again in the morning. 

Thank you very much Andy - it is during times like this when I thank god that we have you - times when we can't contact doctors and we are freaking out. 

Sharmin

The Ped called - Andy you were right the ivig will protect him from fifths disease.  Although the virus is fairly common - as you said Andy thals (particularly thal intermedias), sickle cell anemia patients, and those with other anemias need to be particularly careful if they come into contact with this disease because it can interfere with the production of premature red blood cells causing aplastic anemia - and can become potentially fatal.  Also, anyone having ritux can run into trouble if their IGg is not being replaced - because they would not be able to fight off the virus and would eventually become severely anemic.  Transfused thal majors have protection because they are transfused and they do not need the premature rbcs. 

Andy, the research you did for fifth's disease can be life saving for thal intermedias and sickle cell patients who think they may have been exposed to fifth disease - and the treatment would be IVIg. 

Sharmin

Sharmin,

I am glad that Little A is safe from fifth disease  take care of your daughter too.

Zaini.

First time to hear about this fifth disease  and seems scary for me but i am glad that little A is doing fine now. Sharmin, i feel for you

manal

Hi Sis ,
Glad to hear that Little-A is safe , but i think he need a little care and to be a little cautious to every kind of infection . May GOD bless him To the better than the best of life and super good health ..

A lots of Wishes
Best Regards
Take cAre
Umair

Hi,

I have never ever heard fith disease before. So I learnt at least an other thing today. I am glad Little Mister A is safe for this.
I wish you a nice weekend.

Dore

these r a few quotes to a site , is for complete article please visit the link , written below : http://kidshealth.org/parent/infections/bacterial_viral/fifth.html

Especially common in kids between the ages of 5 and 15, fifth disease typically produces a distinctive red rash on the face that makes the child appear to have a "slapped cheek." The rash then spreads to the trunk, arms, and legs. Fifth disease is actually just a viral illness that most kids recover from quickly and without complications.

Contagiousness
A person with parvovirus infection is most contagious before the rash appears — either during the incubation period (the time between infection and the onset of symptoms) or during the time when he or she has only mild respiratory symptoms. Because the rash of fifth disease is due to an immune reaction (a defense response launched by the body against foreign substances like viruses) that occurs after the infection has passed, a child is usually not contagious once the rash appears.

Parvovirus B19 spreads easily from person to person in fluids from the nose, mouth, and throat of someone with the infection, especially through large droplets from coughs and sneezes.

In households where a child has fifth disease, another family member who hasn't previously had parvovirus B19 has about a 50% chance of also getting the infection. Children with fifth disease may attend childcare or school, since they are no longer contagious. Once infected with parvovirus B19, a person develops immunity to it and won't usually become infected again.

Prevention
There is no vaccine for fifth disease, and no real way to prevent spreading the virus. Isolating someone with a fifth disease rash won't prevent spread of the infection because the person usually isn't contagious by that time.
Practicing good hygiene, especially frequent hand washing, is always a good idea since it can help prevent the spread of many infections.

i hope it is helpful ....

Best Regards
Take Care
Umair