Abstract
The present study aimed to determine the role of human parvovirus В19 (B19V) as an aetiological agent in measles and rubella negative fever/rash patients from Bulgaria between 2004 and 2013. A total of 1,266 sera from all over the country were tested for B19V IgM antibodies and all positives were further investigated by polymerase chain reaction (PCR). Overall, 280 sera (22%) were B19V IgM positive and 227 of these (81%) were also PCR positive. The highest number of IgM positives was found among five to nine year-old children (27%). Eight infected women gave birth to healthy children; one fetus was aborted with hydrops fetalis. Of the 55 genetic sequences obtained, 54 belonged to genotype 1a and one grouped as a genotype 2 outlier. Phylogenetic analysis of all available genotype 2 sequences covering the 994 nucleotide non-structural protein 1(NS1)/capsid viral protein 1 (VP1) unique region junction, showed that only one other sequence grouped with the outlier strain, forming a clearly distinct and well-supported cluster of genotype 2 (between-group genetic distance: 3.32%). In accordance with B19V nomenclature, this cluster may represent a new subgenotype 2b. The study showed that B19V infections may be falsely identified as rubella or measles in ca 22% of cases, emphasising the need for laboratory confirmation.
Highlights
Human parvovirus В19 (B19V) belongs to the family Parvoviridae, subfamily Parvovirinae, genus Erythrovirus [1]
The viral genome consists of 5,596 nucleotides encoding among others the nonstructural protein 1 (NS1) and the capsid viral protein 1 (VP1)
The present study was based on samples collected during a ten-year period (2004–2013) throughout the country, providing a comprehensive overview of B19V infections during years with widely variable incidences of measles and rubella
Summary
Human parvovirus В19 (B19V) belongs to the family Parvoviridae, subfamily Parvovirinae, genus Erythrovirus [1]. B19V infections are associated with different clinical presentations and typically a mild, self-limiting disease, the infection can cause severe adverse outcomes in certain patients. The clinical presentation of B19V infection is sometimes mistakenly diagnosed as rubella or measles [3,4,5], which are both notifiable diseases in Bulgaria. An accurate diagnosis of fever/rash illness is necessary for case management and public health control activities [6], in particular in the context of the World Health Organization’s goal to eliminate measles and rubella in the European Region [7,8]. In outbreak situations many cases reported as measles or rubella are still not laboratory confirmed in Bulgaria. The laboratory diagnosis of В19V infection in fever (>38.5°C)/rash cases combining serological and molecular methods was introduced in Bulgaria in 2011
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