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Management guidelines for pregnant health care workers exposed to infectious dermatoses. Int J Womens Dermatol 2020; 6:142-151. [PMID: 32313827 PMCID: PMC7165119 DOI: 10.1016/j.ijwd.2020.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 04/14/2020] [Accepted: 04/14/2020] [Indexed: 01/08/2023] Open
Abstract
Exanthematous diseases are frequently of infectious origin, posing risks, especially for pregnant health care workers (HCWs) who treat them. The shift from cell-mediated (Th1 cytokine profile) to humoral (Th2 cytokine profile) immunity during pregnancy can influence the mother’s susceptibility to infection and lead to complications for both mother and fetus. The potential for vertical transmission must be considered when evaluating the risks for pregnant HCWs treating infected patients because fetal infection can often have devastating consequences. Given the high proportion of women of childbearing age among HCWs, the pregnancy-related risks of exposure to infectious diseases are an important topic in both patient care and occupational health. Contagious patients with cutaneous manifestations often present to dermatology or pediatric clinics, where female providers are particularly prevalent; a growing number of these physicians are female. Unfortunately, the risks of infection for pregnant HCWs are not well defined. To our knowledge, there is limited guidance on safe practices for pregnant HCWs who encounter infectious dermatologic diseases. In this article, we review several infectious exanthems, their transmissibility to pregnant women, the likelihood of vertical transmission, and the potential consequences of infection for the mother and fetus. Additionally, we discuss recommendations with respect to avoidance, contact, and respiratory precautions, as well as the need for treatment after exposure.
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Romero Starke K, Kofahl M, Freiberg A, Schubert M, Groß ML, Schmauder S, Hegewald J, Kämpf D, Stranzinger J, Nienhaus A, Seidler A. Are Daycare Workers at a Higher Risk of Parvovirus B19 Infection? A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E1392. [PMID: 30999694 PMCID: PMC6517978 DOI: 10.3390/ijerph16081392] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 04/13/2019] [Accepted: 04/15/2019] [Indexed: 11/20/2022]
Abstract
Objective: In this systematic review, we aimed to summarize the evidence on the association between being a daycare educator working with children and the possible increased risk of parvovirus B19 infection compared to the general population. Methods: The Medline and Embase databases were searched using a defined search to find studies published since 2000. Two reviewers evaluated the search hits using predefined inclusion and exclusion criteria. The resulting studies were extracted and were assessed in eight domains of bias. A pooled relative risk (RR) of parvovirus infection for daycare workers compared to the general population was calculated. Results: After evaluating the 7781 search hits and manual search, four methodologically-adequate studies were identified: three cross-sectional studies and one retrospective cohort study. Of the three studies investigating the risk of infection, one evaluated parvovirus B19 seroconversion rates for daycare workers. There was an indication for an increased risk for daycare workers compared to the unexposed population (RR = 1.12, 95% CI 0.98-1.27) using prevalence estimators. Furthermore, daycare workers had a higher seroconversion rate compared to the unexposed population (RR = 2.63, 95% 1.27-5.45) in the low risk of bias study. Conclusions: Our findings suggest a higher risk of parvovirus B19 infection for daycare workers compared to an unexposed comparison population, which necessitate preventative efforts. Considering the underestimation of the occupational seroconversion risk by prevalence-based estimators, parvovirus B19 infections among daycare workers might mostly be occupationally acquired.
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Affiliation(s)
- Karla Romero Starke
- Institute and Policlinic of Occupational and Social Medicine (IPAS), Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany.
| | - Marlen Kofahl
- Institute and Policlinic of Occupational and Social Medicine (IPAS), Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany.
| | - Alice Freiberg
- Institute and Policlinic of Occupational and Social Medicine (IPAS), Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany.
| | - Melanie Schubert
- Institute and Policlinic of Occupational and Social Medicine (IPAS), Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany.
| | - Mascha Luisa Groß
- Institute and Policlinic of Occupational and Social Medicine (IPAS), Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany.
| | - Stefanie Schmauder
- Institute and Policlinic of Occupational and Social Medicine (IPAS), Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany.
| | - Janice Hegewald
- Institute and Policlinic of Occupational and Social Medicine (IPAS), Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany.
| | - Daniel Kämpf
- Institute and Policlinic of Occupational and Social Medicine (IPAS), Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany.
| | - Johanna Stranzinger
- Section Occupational Health, Basic Principles of Prevention and Rehabilitation, Institution for Statutory Social Accident Insurance and Prevention in the Health Care and Welfare Services (BGW), 22089 Hamburg, Germany.
| | - Albert Nienhaus
- Section Occupational Health, Basic Principles of Prevention and Rehabilitation, Institution for Statutory Social Accident Insurance and Prevention in the Health Care and Welfare Services (BGW), 22089 Hamburg, Germany.
- Competence Centre for Epidemiology and Health Services Research for Healthcare Professionals (CVcare), University Medical Centre Hamburg-Eppendorf (UKE), 20251 Hamburg, Germany.
| | - Andreas Seidler
- Institute and Policlinic of Occupational and Social Medicine (IPAS), Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany.
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Abstract
Parvovirus B19 (B19V) and human bocavirus 1 (HBoV1), members of the large Parvoviridae family, are human pathogens responsible for a variety of diseases. For B19V in particular, host features determine disease manifestations. These viruses are prevalent worldwide and are culturable in vitro, and serological and molecular assays are available but require careful interpretation of results. Additional human parvoviruses, including HBoV2 to -4, human parvovirus 4 (PARV4), and human bufavirus (BuV) are also reviewed. The full spectrum of parvovirus disease in humans has yet to be established. Candidate recombinant B19V vaccines have been developed but may not be commercially feasible. We review relevant features of the molecular and cellular biology of these viruses, and the human immune response that they elicit, which have allowed a deep understanding of pathophysiology.
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Affiliation(s)
- Jianming Qiu
- Department of Microbiology, Molecular Genetics and Immunology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | | | - Neal S Young
- Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
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