Fifth Disease

What is fifth disease?

Fifth disease is a viral illness that causes a condition called an exanthem. An exanthem is another name for a rash or skin eruption. Fifth disease is also known as erythema infectiosum and as "slapped cheek" disease because the rash can cause a child's cheeks to become quite 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 moderately contagious.

What causes fifth disease?

Fifth disease is caused by the human parvovirus B19. It happens most often in the winter and spring. It is most common in 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. 

What are the symptoms of fifth disease?

Symptoms usually show up 4 to 14 days after being exposed to the disease. About 80 percent of children have very mild symptoms for about a week before getting the rash. About 20 percent will have no symptoms at all before the rash appears. Children are most contagious before the rash occurs. Therefore, children are contagious before they even know they have the disease. The following are the most common symptoms of fifth disease. However, symptoms can be different for each child.

  • Early symptoms are sometimes very mild and nearly unnoticed. These symptoms may include:

    • Low grade fever

    • Headache

    • Runny nose

    • Sore throat

    • Itching

    • Nausea or vomiting

    • Diarrhea

  • A rash is usually the primary symptom of fifth disease. The rash:

    • Starts on the cheeks and is bright red. It often looks like "slapped" cheeks.

    • Spreads to the trunk, arms, and legs, and lasts two to four days. It often has a "lacey" appearance. 

    • May come back when the child is exposed to sunlight, very hot or cold temperature, or trauma to the skin. This may continue for several days.

Fifth disease is usually a mild illness. However, parvovirus B19 infection may cause an acute severe anemia in persons with sickle-cell disease or immune deficiencies. There is a small risk of fetal death if fifth disease is acquired during pregnancy.

The symptoms of fifth disease are similar to other conditions or medical problems. Always see your child's health care provider for a diagnosis.

How is fifth disease diagnosed?

Your child’s health care provider will do a complete medical history and physical examination of your child. This may be enough to diagnose fifth disease as the rash and progression of fifth disease are unique. Your child's provider may also order blood tests.

Treatment for fifth disease

The goal of treatment is to help reduce symptoms. Since it is a viral infection, there is no cure for fifth disease. Treatment may include:

  • Drinking more fluids

  • Taking acetaminophen or ibuprofen for fever (DO NOT GIVE ASPIRIN to children. Aspirin can cause a serious health condition called Reye syndrome.)

  • Using an antihistamine for itching 

The best ways to keep fifth disease and other illnesses from spreading include hand-washing with soapy water, and covering the mouth and nose when coughing or sneezing.