Travellers should start one of the above regimes if they develop a fever of greater than 38 degrees seven or more days after arriving in a malarious area and where no medical assistance is available. Not only is it important that cases of Parvovirus are recognised for what they are, but also the effectiveness of MMR will be underestimated if cases are wrongly notified as rubella. As noted in Issue 2, Parvovirus infection of the fetus can result in haemolytic anaemia in the fetus. Fetal loss appears to be largely a second trimester phenomenon. Incubation is generally in the range 4-14 days.
Transmission is respiratory.
The disease is not reliably differentiable, by clinical means, from rubella. Tetanus is becoming rare - there were 10 cases in England and Wales in 1992 and 116 cases between 1984 and 1991 in the distribution graphed below. Persons born after 1961 will not have received tetanus immunisation in infancy and so may be at risk. Giving boosters to persons already immune confers no benefit and is attended by a much higher risk of severe reaction. Although the risk of varicella pneumonia complicating infection is higher in pregnant women than in others, there was no increased mortality observed in the 1992 cohort compared with the varicella-infected population at large.