Morbidity and Mortality Weekly Report

Notes from the Field

Human Parvovirus B19 Infections Among Patient A had fetal hydrops and experienced fetal demise at
Pregnant Persons — Minnesota, January– 20 weeks’ gestation before fetal transfusion could be performed.
September 2024 Patient B was evaluated weekly for 3 months and did not expe-
Stephen Contag, MD1,*; Elizabeth M. Dufort, MD2,*; rience complications; patients C and D developed severe fetal
Sarah Lim, MBBCh2; Tyler Winkelman, MD3; Jennifer Zipprich, PhD2; anemia requiring fetal transfusion; and patient E developed
Lindsey Erickson, PhD2; Mel Anacker, PhD2; Nayanjot Kaur Rai, MPH4; severe fetal anemia with hydrops (severe edema) requiring two
Kristen Ojo, MHS2; Danielle Kvasager, MS2; Henry D. Kunerth, PhD2;
R. Adams Dudley, MD5; Pamala Gahr, MPH2; Kelly R. Bergmann, DO6;
fetal transfusions. Patients B, C, D, and E delivered full-term
Alanna M. Chamberlain, PhD7; Summer Martins, PhD8; infants with no birth or neonatal complications identified
Stephen Waring, PhD9; Bjorn Westgard, MD10; Kristin Sweet, PhD2; (Supplementary Table, https://stacks.cdc.gov/view/cdc/170371).
Paul Drawz, MD4,†; Ruth Lynfield, MD2,† The MDH Public Health Laboratory performed metage-
Human parvovirus B19 (B19) commonly causes asymptom- nomic sequencing to generate full genomes using amniotic
atic infection or mild illness in healthy children and nonpreg- fluid from two patients. Both samples were genotype 1A, the
nant adults, but infection during pregnancy can lead to severe most commonly circulating genotype worldwide. Specimens
perinatal sequelae, particularly when infection occurs before differed by at least 35 single nucleotide polymorphisms and
20 weeks’ gestation. In July 2024, the Minnesota Department did not appear to be related through a recent shared source
of Health (MDH) was notified by a maternal-fetal medicine or transmission event. Comparisons to sequences available in
specialist of an increase in B19 infections among pregnant the National Center for Biotechnology Information (https://
persons associated with fetal complications. Although increased www.ncbi.nlm.nih.gov/) database revealed no closely related
circulation of B19 had not been described in the United States sequences based on single nucleotide polymorphisms or clus-
at that time, review of the literature revealed that European tering on a phylogenetic tree.
surveillance indicated increases in B19 in late 2023 and 2024 No routine surveillance for B19 exists in the United States.
identified through laboratory, clinical, and blood donation It is not a notifiable condition, and it is not a reportable
screening data (1,2). disease in Minnesota. To evaluate overall B19 trends and fre-
quency of pregnancy-associated complications, the Midwest
Investigation and Outcomes Analytics and Disease Modeling Center§ analyzed electronic
health record data from 10 health systems provided through
Five cases of B19 infection among women aged 20–40 years
the Minnesota Electronic Health Record Consortium, among
who were evaluated during May–August 2024 were reported
Minnesota residents during January 2019–September 2024
to MDH. No known epidemiologic links among the patients
(Figure). This analysis identified an increase in parvovirus
were identified, and the patients did not live in the same com-
testing, positive tests, percentage of positive test results, and
munities. Four patients had children in the household, includ-
diagnoses in 2024 compared with 2019–2023, with the largest
ing two who had ill children (one with B19-associated anemia
increases among children. During the 10-month period from
requiring transfusion) and one who reported B19 circulating
January through September 2024, procedure and diagnosis
at her child’s school. The fifth patient had presumed exposure
codes identified 19 B19-associated pregnancy complications
as a provider at a child care facility where febrile rash illnesses
within 60 days of a B19 diagnosis or positive test result, includ-
were circulating among attendees.
ing hydrops fetalis, fetal anemia and thrombocytopenia, fetal
Three patients had signs and symptoms consistent with B19
transfusion, or stillbirth. In comparison, during a 60-month
infection, including fever, rash, malaise, fatigue, arthralgias,
period (2019–2023), 28 B19-associated pregnancy compli-
and lymphadenopathy. All five patients had B19 infection
cations occurred. No increase in non–B19-associated fetal
at 13–20 weeks’ gestation, laboratory-confirmed by immu-
complications was identified during January–September 2024
noglobulin M or polymerase chain reaction (PCR) testing,
compared with January 2019–December 2023.
including three who received positive B19 PCR amniotic fluid
test results. None had immunocompromising conditions or § Midwest Analytics and Disease Modeling Center is a CDC Center for
blood disorders. Forecasting and Outbreak Analytics–funded partnership among the University
of Minnesota, the Minnesota Department of Health, and the Minnesota
Electronic Health Records Consortium (a collaboration among the 11 largest
* These authors contributed equally to this report. health systems that collectively care for >90% of Minnesotans). https://www.
† These senior authors contributed equally to this report.
sph.umn.edu/research/centers/midwest-analytics-and-disease-modeling/

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U.S. Department of Health and Human Services | Centers for Disease Control and Prevention | MMWR | November 28, 2024 | Vol. 73 | No. 47
 Morbidity and Mortality Weekly Report

FIGURE. Number of human parvovirus B19 immunoglobulin M and polymerase chain reaction tests performed and percentage of tests with
positive results* among persons of all ages (A), among females aged 15–49 years (B), and percentage of positive results by age group (C) —
Minnesota, January 2019–September 2024†,§
Options A. All ages
de = 7.5”
ats = 5.0” 100
s = 4.65” No. of tests Percentage positive
n = 3.57” 1,000 25
o bottom 900
title and

Percentage positive
800 20
otes) = 9”
No. of tests

700
600 15
500
400 10
300
200 5
100
0 0
Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3
2019 2020 2021 2022 2023 2024
Year and quarter
B. Females aged 15–49 years
Dog 100
Cat No. of tests Percentage positive
Human 1,000 25
900
800 20

Percentage positive
Dog
No. of tests

Cat 700
Human 600 15
500
400 10
300
200 5
100
0 0
Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3
2019 2020 2021 2022 2023 2024
Year and quarter
C. Percentage of positive test results, by age group
100

25 0–14 yrs 15–49 yrs ≥50 yrs

Percentage positve

20

15

10

0
Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3
2019 2020 2021 2022 2023 2024
Year and quarter
Abbreviation: Q = quarter.
* One-year moving average.
† Q1 = January–March; Q2 = April–June; Q3 = July–September; Q4 = October–December.
§ A total of 10 health systems reported human parvovirus B19 test results through the Minnesota Electronic Health Record Consortium during January 2019–September
2024. Two health systems had data through June 2024. The remaining eight health systems had data through August 31, 2024; however, data from September 2024
is incomplete.
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U.S. Department of Health and Human Services | Centers for Disease Control and Prevention | MMWR | November 28, 2024 | Vol. 73 | No. 47
 Morbidity and Mortality Weekly Report

All authors have completed and submitted the International

Summary Committee of Medical Journal Editors form for disclosure of
What is already known about this topic? potential conflicts of interest. Ruth Lynfield reports serving
Human parvovirus B19 (B19) infection during pregnancy can as an executive officer for the Council of State and Territorial
have serious consequences for the pregnancy and the fetus. Epidemiologists (CSTE), a former executive officer for the National
What is added by this report? Foundation for Infectious Diseases (NFID), an associate editor of
An increased frequency of B19 infections, including severe and infectious diseases program committee member for the American
sequelae among pregnant women in Minnesota, was identified Academy of Pediatrics (AAP), and receipt of travel support to attend
in 2024 through clinician reporting and evaluation of electronic meetings from CSTE, NFID, AAP, and the Infectious Diseases
health data. Society of America; a fee for work as an associate editor for the AAP
What are the implications for public health practice? Red Book was donated to the Minnesota Department of Health.
Jennifer Zipprich reports that her spouse is employed by Pfizer. Tyler
Health care providers should have a high index of suspicion for
Winkelman reports support from the National Institutes of Health,
B19 in pregnant persons, offer counseling, and provide
appropriate monitoring and care. the Minnesota Department of Health, and the Substance Abuse and
Mental Health Services Administration, to Hennepin County and
payment from the Louisiana Center for Children’s Rights for expert
Preliminary Conclusions and Actions testimony. Elizabeth M. Dufort received consulting fees for service as
MDH alerted CDC and both agencies released health advi- a public health physician consultant with Hutton Health Consulting
sories (3,4). Health care providers should educate patients with for a CSTE project related to congenital infections but not related
suspected or confirmed B19 infection to inform exposed con- to parvovirus. No other potential conflicts of interest were disclosed.
tacts who are pregnant and others at risk (such as those who are
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Romieu, CDC; Minnesota Electronic Health Record Consortium.
Corresponding author: Elizabeth M. Dufort, [email protected].
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