Prevalence and incidence of erythrovirus B19 infection in children with sickle cell disease: The impact of viral infection in acute clinical events

Abstract

B19V infection is common during childhood. It is self-limited in healthy individuals, but is often associated with transient aplastic crisis in children with sickle cell disease. The aim of this study was to estimate the prevalence and incidence of B19V infection in children with sickle cell disease screened by the Newborn Screening Program of Minas Gerais, Brazil, and followed-up at Fundação Hemominas. Serum or plasma samples from 278 patients were tested for anti-B19V IgG and IgM using commercial ELISA and for viral DNA using in-house real-time PCR assays; 127 negative-children were retested about 1 year later. The median age of children at first testing was 5.9 years (0.8-12.3). The estimated prevalence of B19V was 29.5 % (95%CI 24.1-34.9 %). The incidence of B19V in those 127 negative-children was 18.2 cases/100 patient-years. All DNA-positive samples were identified as genotype 1, except one sample, in which both genotypes 1 and 3 were identified. It was observed that the higher the child's age, the higher the probability of B19V infection. The analysis of clinical and hematological data showed a significant association of B19V infection with transient aplastic crisis and acute splenic sequestration, higher frequency of transfusions, and higher rate of hospitalization, but not with acute chest syndrome or stroke. These results emphasize the impact of B19V infection on the course of sickle cell disease. Strategies to prevent and monitor B19V infection in children with sickle cell disease should be considered to diminish its morbidity in this susceptible population.

Transient red cell aplasia in two brothers with sickle cell anemia and erythrovirus B19 infection

“…It is known that the vast majority of children with SCA who have serologic evidence of previous B19V infection had not developed symptomatic aplastic crisis, 10 as was also demonstrated by our recent cohort study 5 . Different degrees of baseline hemoglobin concentration, virus load, virus genotypes or other unknown factors could explain this observation, although genotype and virus load were the same in both children during a nosocomial B19V outbreak, one child with very severe manifestations and the other with an asymptomatic course 11 .…”

“…In a study of 278 children with sickle cell disease (SS or Sβ 0 -thalassemia, median age 5.8 years; range: 0.9–12.3 years), it has been shown that past or recent viral infection occurred in 29.5% (95% confidence interval: 24.1–34.9%) 5 . This report describes the clinical course and the laboratory tests of two siblings selected to participate in that cohort.…”

“…Many other complications may be associated with B19V infection, such as acute splenic sequestration4, 5 and acute chest syndrome 6 …”

Modeling the parvovirus B19 blood safety risk in Australia

“…The specific rate is unclear; therefore, risk was estimated for three values: 1%, 5%, and 10%. The number of red blood cells (RBCs) transfused to patients with hereditary hemolytic anemias (HHAs) per year is approximately equal to national hospital separations for these conditions with equivalent RBC use patterns to those reported in a 2011 South Australian study Transfusion‐dependent and sporadically transfused sickle cell disease (SCD) patients receive an average of 20 and 2 RBC components per year, respectively. The frequency of B19V‐attributable transient aplastic crisis (TAC) in patients with SCD is 40%, which is applicable to patients with other HHAs. …”

“…Owing to the long life span of erythrocytes, the clinical effect is usually minimal in immunocompetent individuals, although anemia and/or other cytopenias may occur . However, where there is preexisting high red cell turnover, increased hematopoietic demand, and/or impaired immunity, infection may be severe (Table ) . B19V infection may be associated with a wide range of other symptoms and clinical manifestations in immunocompetent individuals including encephalitis and cardiac diseases such as myocarditis …”