Fifth disease

What is fifth disease? 

Fifth disease, also known as erythema infectiosum, is a mild to moderately contagious infection caused by the virus parvovirus B19. The most common symptom is a rash. It can appear as bright red patches across your child's cheeks, giving them a "slapped cheeks" appearance, or as a lace-like pattern on the child's torso. The virus may also cause cold-like symptoms but is rarely serious. However, cause for concern arises when the virus infects pregnant women, as well as children and adults with anemia or a compromised immune system.

The condition is called fifth disease because it was fifth in a list of historical classifications of common skin rash illnesses in children; the others included rubella, measles, scarlet fever, chicken pox, and roseola infantum.

What are fifth disease symptoms? 

While the “slapped cheek” rash is fifth disease’s signature symptom, it typically appears several days after your child begins to complain of other symptoms, including:

  • sore throat
  • mild fever
  • upset stomach
  • headache
  • fatigue
  • itching

These cold-like symptoms usually appear 4-14 days after exposure to the virus. When the rash surfaces, at the end of the illness, it begins on the cheeks but may extend to the arms, trunk, thighs, and buttocks. On these body parts, the rash is usually pink, lacy, and slightly raised. The rash may come and go for up to three weeks, and it may be more noticeable if children are in the sun or exposed to extreme temperatures (such as after a bath). 

Some adults infected with the parvovirus are more likely to complain of sore joints (hands, wrists, knees, ankles) lasting for days or weeks, and never experience a rash or cold symptoms. 

How do children get fifth disease? 

Like the common cold and many other viruses, fifth disease spreads through contact with respiratory secretions (such as saliva and nasal mucus) when an infected person sneezes or coughs. Children are most contagious when they have cold-like symptoms and before a rash appears, meaning they are likely infecting others without knowing they have the disease. Once the rash surfaces, your child is no longer contagious.

How is fifth disease treated? 

As with most viruses, parents of an otherwise healthy child should focus on relieving their child’s symptoms until the parvovirus runs its course. Children showing symptoms should get plenty of rest and drink lots of fluids. Your child’s physician may also recommend acetaminophen or ibuprofen (over-the-counter medications) to ease fever and pain. Do not give aspirin to children under the age of 12 or to teens under the age of 19 with a viral illness.

A child with anemia who shows signs of fifth disease may need to be hospitalized and receive blood transfusions, while a child with a compromised immune system may receive antibodies (through immune globulin injections) to treat the infection. For more information on fifth disease complications, visit the Mayo Clinic’s website.

How can Fifth Disease be prevented? 

Frequent handwashing is the best way to reduce your child’s chances of getting fifth disease and other childhood viruses. Though there’s no vaccine for fifth disease, once you’ve been infected, you become immune to it. In many cases, people are immune to the disease (due to an unknown childhood bout with the illness) but don’t know it. If you or your child is at risk for parvovirus complications, talk to your doctor about blood tests that can help determine if someone is immune to the parvovirus or if he or she has recently become infected.

When should I call a doctor? 

Parents should make an appointment with their child’s pediatrician if the child has sickle cell anemia or an impaired immune system and is exhibiting signs of fifth disease. Pregnant women exposed to fifth disease should contact their health care provider, as the infection can cause complications for the fetus. 

Learn more about the dangers of parvovirus during pregnancy here

Last updated March 22, 2020

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