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Concurrent outbreaks of influenza and parvovirus B19 in a boys' boarding school
E A Grilli1, M J Anderson, T W Hoskins
1Influenza Research Unit, Public Health Laboratory, St Luke's Hospital, Guildford.
Abstract:
In the spring term of 1985 there was a protracted outbreak of upper respiratory tract febrile illness consistent with a clinical diagnosis of influenza in a boys' boarding school, which lasted from 23 January to 29 March. Although influenza virus infection was confirmed in 89% of cases in the first half of the term, 53% of the cases which occurred in the second half of the term had no evidence of infection with influenza virus. Between 5 February and 31 March 28 boys presented with skin rashes consistent with a clinical diagnosis of erythema infectiosum; 68% of these were associated with parvovirus B19. Investigation of the cases of clinical influenza with no identified respiratory pathogen revealed a 58% infection rate with B19. B19 DNA was identified in either throat swabs or acute stage bloods of nine pupils with influenza-like symptoms. Cohort studies revealed that 44% of pupils aged 15-16 years were immune before the outbreak compared with only 17% of pupils aged 11-12 years. Infection in the younger group was common and was associated with influenza-like illnesses as well as rashes. Forty-eight per cent of those who did not report any symptoms were also infected with B19.
Insights
Parvovirus B19 caused widespread illness, mimicking influenza and causing rashes in a boarding school outbreak. Many infections occurred without symptoms, particularly in younger students, indicating B19
Area of Science:
- Virology
- Epidemiology
- Pediatrics
Background:
- A boys boarding school experienced a prolonged outbreak of febrile illness resembling influenza during the spring term of 1985.
- While influenza virus confirmed in the first half, later cases lacked viral evidence, suggesting other pathogens.
Purpose of the Study:
- To investigate the etiology of the prolonged febrile illness outbreak.
- To determine the role of parvovirus B19 in cases initially diagnosed as influenza or erythema infectiosum.
Main Methods:
- Clinical diagnosis of influenza and erythema infectiosum.
- Laboratory confirmation of influenza virus.
- Detection of parvovirus B19 DNA in throat swabs and blood samples.
- Cohort studies to assess age-related immunity.
Main Results:
- Parvovirus B19 was associated with 53% of later cases initially diagnosed as influenza and 68% of erythema infectiosum cases.
- B19 DNA was found in nine pupils with influenza-like symptoms and no identified respiratory pathogen.
- Younger students (11-12 years) had lower pre-outbreak immunity (17%) compared to older students (15-16 years, 44%).
- Infection in younger students was common, presenting with influenza-like illness and rashes; 48% of asymptomatic students were also infected.
Conclusions:
- Parvovirus B19 was a significant cause of illness during the outbreak, often presenting with influenza-like symptoms.
- The study highlights the varied clinical presentations of parvovirus B19, including asymptomatic infection and mimicry of other viral illnesses.
- Age-related differences in immunity influenced the susceptibility and presentation of parvovirus B19 infection within the school population.