Fifth disease, also known as erythema infectiosum, is a common viral infection that primarily affects school-age children. The illness is caused by parvovirus B19 and is most prevalent during late winter, spring, and early summer. About 50% of adults are immune to fifth disease because they had it in childhood, often without realizing it.
In children, the symptoms of fifth disease often start out like a cold, followed by the development of a rash within 7 to 10 days. The most recognizable sign of fifth disease is the bright red rash on the cheeks, which makes it look as if the child has been slapped, hence the nickname "slapped cheek disease."
Common symptoms of fifth disease include:
Mild fever
Stuffy or runny nose
Headache
Bright red cheeks
A flat or raised red rash, usually on the arms and legs, which may itch and can last from 2 to 39 days
In adults, the symptoms are usually more severe and flu-like, including:
Headache
Sore throat
Muscle pain
Joint pain, particularly in the hands, wrists, knees, and ankles
Belly pain
Fever
Fifth disease is caused by parvovirus B19, which only infects humans. The virus is spread through blood and respiratory droplets that enter the air when an infected person coughs or sneezes. Adults who work with young children, such as child care providers, teachers, and health care workers, are most likely to be exposed.
To limit the spread of fifth disease among children at home or in a child care setting, follow these steps:
Wash hands often, especially after wiping or blowing noses and before preparing or eating food
Don't share food, pacifiers, bottles, eating utensils, or drinking cups
Clean and disinfect toys that end up in children's mouths
Avoid kissing children on the mouth
Encourage outdoor play, as the virus spreads more easily indoors
Teach children to cough or sneeze into a tissue or the inside of their elbow, away from others
In most cases, fifth disease is diagnosed based on the appearance of typical symptoms. A blood test can confirm the presence of the virus, but this is usually not necessary for individuals with a healthy immune system. Pregnant women who have been exposed to fifth disease may undergo a blood test to determine immunity.
If you are pregnant and don't have immunity to fifth disease, take steps to avoid infection. Discuss with your doctor whether to stay home from work during an outbreak. At home, wash your hands thoroughly after touching tissues used by infected children and avoid sharing drinking glasses or utensils with anyone who has the illness or was exposed to it.
In rare cases, fifth disease can cause severe anemia in the unborn baby. Tests such as amniocentesis, percutaneous umbilical blood sampling (PUBS), and ultrasound can be used to assess the severity of fetal anemia and monitor for complications.
The goal of fifth disease treatment is to ease symptoms and provide comfort. There is no specific medicine to treat the virus, but your doctor might suggest:
Acetaminophen to help lower fever
Ibuprofen for joint or muscle pain
Antihistamines to treat itching associated with the rash
For individuals with weakened immune systems, such as those with sickle cell anemia, chronic anemia, or impaired immunity, a shot of immunoglobulin may be administered to fight off the virus. In some cases, red blood cell transfusions may be necessary.
Contact your doctor if:
Your child has sickle cell anemia, any other chronic anemia, or an impaired immune system and has been exposed to fifth disease or is showing symptoms
You're pregnant, don't know if you're immune to parvovirus B19, and have come into contact with someone who has the infection
The rash becomes purple, painful, blistered, or lasts longer than 5 weeks
Your infected child looks or acts very ill
For more information on fifth disease, visit the Centers for Disease Control and Prevention (CDC), Mayo Clinic, or KidsHealth websites.
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