Thalassemia Patients and Friends
Discussion Forums => Thalassemia Major => Topic started by: Sharmin on March 08, 2009, 01:25:46 AM
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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
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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
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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.
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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.
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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
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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
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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
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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.
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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
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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
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Sharmin,
I am glad that Little A is safe from fifth disease :hugfriend take care of your daughter too.
Zaini.
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First time to hear about this fifth disease :huh :huh and seems scary for me :wah :wah but i am glad that little A is doing fine now. Sharmin, i feel for you :hugfriend
manal
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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
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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
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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 :grin ....
Best Regards
Take Care
Umair
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Thank you all :hugfriend I am also glad that little A is safe.
We took Andy's advice and decided to not have the sleepover last night. As Andy mentioned, little A has had issues with hemolysis when he has been sick, he has had rituximab etc. so it is probably best to avoid something like this in the first place. We also take comfort in the fact that he has had ivig so we are not too concerned in case he had exposure - because as Andy said he is probably in the clear even if he is exposed. And Zaini, you are right - I should keep an eye on my daughter in case she gets sick from it. Manal and Dore thank you for your support :hugfriend
Andy, the ped told us that Little A will begin his rituximab again within a week even though his hg is good - just to make sure that problems do not take place before we give him the rituximab.
Thanks again all :hugfriend :hugfriend
Sharmin
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Manal,
As I mentioned - you may wish to ask you doctor about fifth disease because our doc said that intermedias can run into trouble with it because it would cause transient aplastic anemia and in that case a transfusion and ivig would be required.
Sharmin
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Andy,
Do you know of other viruses that are particularly risky to patients having anemia - such as fifth disease? Perhaps we can list them so that patients know to avoid them or seek medical advise if they contract them. I did not know of this connection in the past.
Sharmin
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The parvoviruses especially, can pose a threat to thals by causing hemolysis and even minors can have some harsh effects as a result. I learned about this some time ago with someone who contacted me about an unexplained instance of low Hb. Her doctor had mentioned she had a parvovirus and that led me to research the connection between parvoviruses and anemia. I believe the issue eventually resolved on its own (the woman did not seem to believe the connection, but I think her doctor had some inkling that it was involved) but I did learn that parvoviruses are implicated in cases of suuden anemia where origin is not clear and that this should always be checked in patients who already have anemia that has suddenly gotten much worse. In cases where thal minors and non-transfused intermedias have sudden hemoglobin drops, the parvovirus should be investigated as a cause.
http://www.ncbi.nlm.nih.gov/pubmed/3020978
Human parvovirus and aplastic crisis in chronic hemolytic anemias: a study of 24 observations.
Lefrère JJ, Couroucé AM, Bertrand Y, Girot R, Soulier JP.
From March 1984 through November 1985, 24 children and adults with aplastic crises were admitted in several Parisian hospitals. Twelve patients had known hemolytic anemia. Aplastic crisis revealed hemolytic anemia in the remaining patients. The detection of human parvovirus antigen was performed by counter-immunoelectrophoresis, and specific IgM antibodies were detected by IgM-antibody-capture-radioimmunoassay, in order to establish the incidence of human parvovirus infection in the genesis of the aplastic crisis. Twenty-one patients had acute infection with human parvovirus. In the three remaining patients, no marker of human parvovirus infection was found. The features of the human parvovirus linked aplastic crisis are described. We consider that human parvovirus infection, and unknown hemolytic anemia, must be systematically researched in any case of unexplained acute aplastic anemia.
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Thanks Sharmin, definetly i will and let you know. Luckly i will be at the clinic in half an hour
manal
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Just when I thought I heard it all then come the "fifth disease" now I have another illness to worry about ??? ??? ??? ??? ??? ??? ??? ???
Thank-you Andy :biggrin :biggrin :biggrin I bet you if one doesnt kill us the other will,
Life is never boring on this forum that is for certain.
Kathy
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Oh ! Now wht is a fifth disease. I have not heard about this.
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Puja,
Check this http://www.fifthdisease.org/ .
Zaini.
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Hi
I asked the doctor whether this virus is spread here and how to avoid but the summary of her answer was that nothing can be made. It is just there :huh :-\ :-\
manal
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:huh :huh
Is there no vaccination or even precaution against it?
Zaini.
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Just when I thought I heard it all then come the "fifth disease" now I have another illness to worry about
Life is never boring on this forum that is for certain.
:agree life is full of new stuff here. BTW u should try this sometime: :lalala it works for me :biggrin
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Zaini
Unfortunatly there is no vaccine, may be because for healthy it is no ig deal :dunno
manal
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Tariq
You are right sometimes you don't have any other option
manal
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The development of a parvovirus B19specific serologic test led to the first report of symptomatic infection in humans. This report, published in 1980, described two soldiers who had a brief febrile illness.2 Subsequently, the simultaneous reports of parvovirus B19 as the etiologic agent for transient aplastic crisis among patients with sickle cell disease and for erythema infectiosum among schoolchildren established the association between parvovirus infection and these two disorders.
http://www.aafp.org/afp/991001ap/1455.html
Parvovirus B19 has been associated with persistent chronic anaemia and with transient aplastic crisis in children with sickle cell disease. A study involving a cohort of Jamaican patients with sickle cell disease showed that almost all cases of transient aplastic crisis were caused by Parvovirus B19 infection.(1,2)
Reports suggests that Parvovirus B19 can be transmitted through blood transfusions and plasma-derived products.(3,4) B19 is a non-enveloped virus and is resistant to high temperatures and most solvent-detergent treatments.
Despite this fact, routine screening of blood products for B19 DNA does not occur. However, many manufacturers carryout B19 PCR on plasma mini-pools to reduce high B19 viral load.
http://www.biotrin.ie/Blood.transfusions.html
My suggestion: forget about it. I dont want to worry about this. I mean, the piece of information I give you. In Sharmin's situation I would be worried too. Anyway, today I went with my niece to the blood bank. She had a hgb of 8.4 ml/l so she was able to give blood!!! :cheer Last time she was not allowed to give because of a low hgb. Woman are allowed to give three times blood a year. I asked the nurse thousands of questions about it and she really like it to met a receiver and ofcourse to answer the questions. We were very lucky, because she has worked in the lab in the past. I never knew that you could work there actually without working ever in the lab. Btw all donors are voluntary workers in the Netherlands.
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Zaini havent you had enough injections???????????????? :rotfl :rotfl :rotfl :rotfl :rotfl :rotfl
Really girl :rotfl :rotfl :rotfl :rotfl :rotfl more needles I'm running :rotfl :rotfl :rotfl :rotfl
Love Kathy
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:shy :shy :noway :grin :grin
Zaini.