What is the recommended screening and management for parvovirus B19 (Fifth disease) in a patient trying to get pregnant?

From the Research

Routine screening for parvovirus B19 (Fifth disease) is not recommended for women trying to conceive. If a woman planning pregnancy has been exposed to parvovirus B19, serologic testing can be performed to determine immunity status, as suggested by 1. The test measures IgG and IgM antibodies to parvovirus B19. A positive IgG with negative IgM indicates past infection and immunity, meaning the woman can safely proceed with pregnancy attempts without concern for parvovirus complications.

Key Considerations

• If testing shows susceptibility (negative IgG), women should consider avoiding high-risk exposure settings like elementary schools during outbreaks.
• For susceptible women with known exposure, waiting one menstrual cycle (about 4-6 weeks) before attempting conception is reasonable to avoid potential infection during early pregnancy, as implied by the management strategies discussed in 1.
• If a woman becomes infected while trying to conceive, delaying pregnancy for 3 months after symptom resolution is prudent, given the potential risks associated with parvovirus B19 infection during pregnancy, particularly the risk of fetal hydrops and fetal loss, as noted in 1.

Prevention Strategies

• No specific antiviral treatment or vaccine exists for parvovirus B19, so prevention through hand hygiene and avoiding known exposures remains the primary strategy.
• The detection of parvovirus B19 IgM by antibody capture enzyme immunoassay, as discussed in 2, can be useful in diagnosing recent infection, but the primary approach should focus on prevention and careful management of exposure risks.

Management Approach

• The management of parvovirus B19 infection, especially in pregnant women, involves close monitoring and potentially includes serial ultrasounds to rule out fetal anemia and hydrops fetalis, as outlined in 1.
• The use of intravenous immunoglobulin (IVIG) may be considered in certain cases, as mentioned in 3, but this is more relevant to immunocompromised hosts rather than the general management of parvovirus B19 in pregnancy.