ABOUT CAUSES DIAGNOSIS TREATMENT NEXT STEPS
Fifth disease is a viral illness that causes a rash (exanthem). Fifth disease is also called erythema infectiosum. And it’s known as "slapped cheek" disease. This is because the rash can cause a child's cheeks to become very red. Fifth disease is spread from one child to another through direct contact with fluid from the nose and throat. It can also be spread through contact with infected blood. It is somewhat contagious.
Fifth disease is caused by human parvovirus B19. It occurs most often in the winter and spring.
It is most common in young school-age children. Children often get it at school or other places where children gather. Adults can get fifth disease, too, but most infections are in children.
Symptoms usually show up 4 to 14 days after a child is exposed to the disease. About 4 in 5 infected children have very mild symptoms for about a week before getting the rash. About 1 in 5 will have no symptoms at all before the rash appears. Children are most contagious before the rash occurs, before they know they have the disease.
Early symptoms are usually very mild. These may include:
- Low fever
- Headache
- Runny nose
- Sore throat
- Itching
- Nausea or vomiting
- Diarrhea
A rash is usually the main symptom of fifth disease. The rash:
- Starts on the cheeks and is bright red.
- Spreads to the trunk, arms, and legs, and lasts 2 to 4 days. It often has a "lacey" appearance.
- May come back when the child is exposed to sunlight, heat or cold, or injury to the skin. This may continue for several days.
The symptoms of fifth disease can be like other health conditions. Make sure your child sees his or her healthcare provider for a diagnosis.
The healthcare provider will ask about your child’s symptoms and health history. He or she will give your child a physical exam. The physical exam will include inspecting the rash. The rash is unique to fifth disease, and may be enough to diagnose your child. In some cases, your child may also have blood tests.
Treatment will depend on your child’s symptoms, age, and general health. It will also depend on how severe the condition is. The illness is caused by a virus. Antibiotics won't help your child.
The goal of treatment is to help ease symptoms. Treatment may include:
- Having your child drink plenty of fluids
- Giving acetaminophen or ibuprofen for fever and discomfort
- Giving an antihistamine medicine for itching
Talk with your child’s healthcare providers about the risks, benefits, and possible side effects of all medicines. Don't give ibuprofen to a child younger than 6 months old, unless your healthcare provider tells you to. Don't give aspirin to children. Aspirin can cause a serious health condition called Reye syndrome.
Fifth disease is usually a mild illness. In some cases, it may cause acute severe anemia in a child with sickle-cell disease or a weak immune system. In a pregnant woman with fifth disease, there is a small risk of death of the baby in the womb.
The best ways to keep fifth disease from spreading include:
- Washing hands well with soap and warm water
- Covering the mouth and nose when coughing or sneezing
Call the healthcare provider if your child has:
- Symptoms that don’t get better, or get worse
- New symptoms
Key points about fifth disease in children
- Fifth disease is a viral illness that causes a bright red rash on the cheeks. The rash can then spread to the body, arms, and legs. The rash lasts 2 to 4 days.
- Other symptoms can include runny nose, sore throat, and low fever.
- Fifth disease is spread from one child to another through direct contact with fluid from the nose and throat. It can also be spread through contact with infected blood.
- Treatment may include medicine to reduce fever and discomfort.
Tips to help you get the most from a visit to your child’s healthcare provider:
- Know the reason for the visit and what you want to happen.
- Before your visit, write down questions you want answered.
- At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you for your child.
- Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are.
- Ask if your child’s condition can be treated in other ways.
- Know why a test or procedure is recommended and what the results could mean.
- Know what to expect if your child does not take the medicine or have the test or procedure.
- If your child has a follow-up appointment, write down the date, time, and purpose for that visit.
- Know how you can contact your child’s provider after office hours. This is important if your child becomes ill and you have questions or need advice.
Fifth disease is a virus that causes a bright red rash to appear on the cheeks. It's most commonly seen in school-aged children. Fifth disease is contagious and spreads easily from person to person. However, once you are exposed to the virus, you are unlikely to get it again later in life. Fifth disease is not a serious medical condition and it goes away with little treatment.
Fifth disease is a childhood disease that appears as a bright red rash on the cheeks. It’s earned the nicknamed “slapped cheek disease” because of this rash. Fifth disease is caused by a virus called parvovirus B19. This virus is very contagious and infected people can spread it through coughing or sneezing.
Fifth disease got its name because it was the fifth viral rash disease known to affect children. The other viral rash diseases it’s grouped with include:
- Measles.
- Rubella (German measles).
- Chickenpox.
- Roseola.
In most cases, fifth disease isn’t a serious medical condition and it goes away with little treatment.
Who might get fifth disease?
Anyone can get fifth disease, but it’s most likely to happen in school-aged children. Once you are exposed to the virus, your body’s immune system builds up defenses to fight it off. This means that if you have fifth disease as a child, you will be immune to it as an adult. There are exceptions to this immunity, but typically, adults do not get fifth disease.
Fifth disease is caused by human parvovirus (parvovirus B19). It’s a virus that spreads easily, through droplets in saliva and nasal secretions. This means that it can be passed from one person to another through a sneeze or cough. This virus can also travel through a pregnant woman’s blood to her unborn baby, but this is very rarely associated with a bad outcome.
What are the symptoms of fifth disease?
About 20% of people who get fifth disease don’t have symptoms. Still, they can pass the virus to others. The disease often starts with flu-like symptoms. During this time, the virus is most contagious. The main symptoms of fifth disease can include:
It can take several days after the onset of flu-like symptoms for the raised, slap-like rash to show up on the face or body. Once the rash appears, you are no longer contagious. The rash may be itchy. It should fade in five to 10 days. In some cases, you may see a second rash that develops after the “slapped cheek” rash. This time, the rash may be located on the:
- Arms.
- Legs.
- Trunk (chest and back).
- Buttocks.
About 10% of children with fifth disease also experience joint pain and swelling.
Fifth disease is much more common in children, but it can happen in adults. Adults who get fifth disease often develop flu-like symptoms without the rash. Along with those symptoms, about 80% of adults also develop joint pain in the wrists, hands and knees.
Fifth disease is usually diagnosed based on your symptoms. The “slapped cheek” rash is a strong sign of this condition — and when it’s accompanied by the other main flu-like symptoms — your healthcare provider can usually diagnose fifth disease in the office without any other tests. In rare cases, your provider may order blood tests to confirm fifth disease.
Fifth disease symptoms typically go away in a few weeks with minimal treatment. Your healthcare provider may recommend over-the-counter (OTC) pain relievers that can treat fever, headaches and joint pain. These medicines include:
What are the complications of fifth disease?
Most people recover completely from fifth disease without any long-lasting problems. Sometimes, complications can occur, including:
- Anemia: Sometimes the virus stops the body’s production of red blood cells, leading to anemia. This problem is temporary and usually not noticeable. However, anemia can be serious if you have a weakened immune system. You are most at risk for complications if you have sickle cell disease, cancer, human immunodeficiency virus (HIV) or have had an organ transplant.
- Arthritis: A small number of children (10%) and a larger number of adults (around 80%) temporarily develop painful joints and swelling. These symptoms typically improve in a couple of weeks. However, 10% of adults develop chronic parvovirus-associated arthritis, or polyarthritis. Women are more at risk than men.
How does fifth disease affect pregnancy?
The virus can infect unborn babies through their mother’s blood. The virus doesn’t cause birth defects or developmental problems. If you’re pregnant and have been exposed to someone with fifth disease, contact your healthcare provider immediately.
If you have fifth disease while you’re pregnant, the virus can very rarely lead to:
- Fetal anemia (low red blood cell count).
- Hydrops fetalis (fluid buildup around organs).
- Miscarriage (when pregnancy ends before the baby develops fully).
- Stillbirth (when a baby dies before birth).
However, most pregnant mothers who are infected with this virus deliver normal, healthy babies.
There isn’t a vaccine to prevent fifth disease. Because the virus spreads easily through nasal and mouth droplets, good hygiene is the best way to prevent the disease. You can reduce your family’s risk of infection by taking these steps:
- Washing your hands frequently and thoroughly.
- Sneezing or coughing into the crook of your elbow.
- Avoiding close contact with an infected person.
Healthy children and adults tend to recover from fifth disease without complications. People who have fifth disease typically become immune to the virus. As a result, you are unlikely to get fifth disease more than once.
Reach out to your healthcare provider if you think you have fifth disease, or have been exposed to the virus. It’s also a good idea to call your provider if you have:
What questions should I ask my doctor?
If your child has fifth disease, you may want to ask your doctor:
- How long will we be contagious?
- How long should my child stay home from school?
- How long should I stay home from work?
- What steps can I take to ensure other family members don’t get infected?
- What can I do to make myself or my child more comfortable?
- What can I do to alleviate symptoms like an itchy rash or joint pain?
- Should I notify my child’s school (or my work) about the infection?
- How long will the rash last? Can it come back?
- What signs of complications should I look out for?
Even though fifth disease can look intimidating with its distinctive red rash, it’s usually a temporary condition that goes away with little treatment. However, it’s important to understand that fifth disease can spread easily. If a member of your family has any of the symptoms of the condition, call your healthcare provider. You may need to keep your family member away from others for a little while to keep the disease from spreading. Unfortunately, it can spread before you have symptoms and can be passed along to others without your knowledge. Talk to your provider about the timing of symptoms when your family member is diagnosed. Once diagnosed, take the time to get better before going back to daycare, school or other crowded places.
Last reviewed by a Cleveland Clinic medical professional on 05/08/2020.
References
- American Academy of Family Physicians (AAFP). Fifth Disease. (//familydoctor.org/condition/fifth-disease/) Accessed 5/11/2020.
- American Academy of Pediatrics (AAP). Fifth Disease (Parvovirus B19). (//www.healthychildren.org/English/health-issues/conditions/skin/Pages/Fifth-Disease-Parvovirus-B19.aspx) Accessed 5/11/2020.
- Arthritis Foundation. Fifth Disease. (//arthritis.org/diseases/fifth-disease) Accessed 5/11/2020.
- Centers for Disease Control and Prevention (CDC). Parvovirus 19 and Fifth Disease. (//www.cdc.gov/parvovirusb19/fifth-disease.html) Accessed 5/11/2020.
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