G541(P) Parvovirus infection in paediatric sickle cell patients: experience from a district general hospital during a recent community outbreak

Aim To describe the clinical presentations, complications and outcomes of a cohort of patients with acute parvovirus infection identified among children with sickle cell (SC) crisis episodes. Methods We retrospectively obtained demographic, clinical and laboratory information from electronic medical records. Results In a 2 year period (2016–2018), 93 children with SC crisis presented in our department, including 10 patients with confirmed parvovirus. Nine presented within 4 months (March – July 2018) and resided within a geographical area of 6 miles radius. Age range was 3–12 years (mean 9.2 years), and HbSS the commonest genotype. Fever was present initially only in 4 cases, but subsequently developed in 9. Severe pain requiring opiate analgesia was very common (80%). Severe headache was the only complaint of 2 patients and both underwent urgent neuroimaging. Two patients developed acute chest syndrome. Eight presented with reticulopenia. Three patients did not have significant anaemia initially, of whom 2 later developed anaemia (table 1). All required blood transfusion and 1 required exchange transfusion. Median length of stay was 4 days. Conclusion The cluster of cases within a distinct time and location is consistent with a parvovirus outbreak in our community. Parvovirus-associated complications among SC patients include severe vaso-occlusive and chest crises. Early reticulocyte count, even in the absence of significant anaemia, is recommended in all paediatric SC patients presenting with crisis. Targeted patient, family and healthcare professional education is paramount during outbreaks. Given the high morbidity of sickle-related complications, the development of a safe and effective Parvovirus vaccine should be prioritised for this population.