Fifth Disease

What is fifth disease?

Fifth disease is a very common childhood illness. Adults can get it too. It is sometimes called “slapped cheek disease” because of the rash that some people get on the face. You spread the disease by coughing and sneezing.

As a rule, people can spread fifth disease only while they have flu-like symptoms and before they get a rash. Some people who have fifth disease, such as those who have certain blood disorders or weak immune systems, may be able to spread the disease for a longer time.

What causes fifth disease?

Fifth disease is caused by a virus called human parvovirus B19.

What are the symptoms?

Early symptoms are similar to the flu—runny nose, sore throat, headache—and may be so mild that you don't notice them. The rash comes several days later, first on the face and later over the rest of the body. The rash usually fades within 2 to 5 days.

Some people, usually adults, also get pain in their joints. This can last for several weeks or even months. Some people may also have a headache.

Not all people with fifth disease get a rash or feel sick.

How is fifth disease diagnosed?

Your doctor can diagnose fifth disease by doing a physical exam and asking questions about your medical history. Fifth disease is easier to diagnose if you have the rash.

How is it treated?

Most people can treat this illness at home with rest, fluids, and pain relievers. Fifth disease usually goes away after a few weeks.

For a few weeks, the rash may come back when you are out in the sun, get too warm, or are under stress. This does not mean the disease has gotten worse.

By the time the rash appears, you can no longer spread the disease to anyone else. As soon as your child gets a rash, he or she may return to school or day care.

If you are pregnant or have a weak immune system or certain blood disorders, see your doctor. Fifth disease can cause problems for the fetus of a pregnant woman, but this is not common.

Frequently Asked Questions

Early symptoms of fifth disease are similar to the flu. A characteristic rash follows several days later, and some people develop joint pain. Fifth disease can be confused with other conditions with similar symptoms.

Flu-like symptoms

Symptoms of fifth disease arise within 2 to 3 weeks after exposure to the virus. Typically, initial symptoms resemble the flu and may be so mild that they are not noticed. Some people with fifth disease do not have any symptoms. Early symptoms include:

• Runny nose and sore throat.
• Headache and abdominal pain.
• In rare cases, a mild fever around 100°F (37.8°C).
• Mild body weakness and joint pain.

Rash

About 7 days after the onset of flu-like symptoms, a distinctive rash may appear, although not as often in adults as in children. Some people never get a rash.

If a rash develops, usually it follows a predictable pattern with two or three distinct stages:

1. A bright red rash occurs on the sides of the face (often referred to as a "slapped cheek" appearance) and sometimes on the forehead and chin. This rash usually fades within 2 to 5 days.
2. Another rash appears on the neck, trunk, forearms, upper legs, and buttocks. This rash starts as round red spots and begins to take on a lacy appearance. It can be itchy, especially in older children. The second stage lasts a week or less.
3. After the body rash fades, it may reappear following exposure to sunlight, warm temperatures, or stress. This rash lasts an additional 1 to 3 weeks. Even though a rash reappears, it does not mean your condition is worse.

Joint pain

Joint pain in the hands, wrists, ankles, and feet commonly occurs in adults, especially in women. The pain usually lasts 1 to 3 weeks, although in rare cases, it can last longer. It usually does not cause permanent damage to the joints.

Complications

In healthy people, fifth disease usually is a mild illness that resolves within a few weeks without further problems. However, people with impaired immune systems or blood disorders, such as sickle cell disease or thalassemia, are at increased risk for developing complications. Fifth disease can also cause problems for the fetus of a pregnant woman who is infected.

A health professional usually diagnoses fifth disease by observing its distinctive rash, by asking about any history of exposure to the disease, and by conducting a physical exam. Viral tests may be done to confirm a recent infection (within the past 3 months) by the presence of certain antibodies. In addition, a complete blood count (CBC) may be done to help rule out a bacterial infection or to check for anemia.

Diagnosing fifth disease during pregnancy

A pregnant woman may have a blood test for parvovirus B19 antibodies if she is exposed to or has symptoms of fifth disease. The blood test may indicate that she has:

• Had the disease in the past and is now immune.
• Not had the disease in the past and does not have immunity. She should avoid exposure to parvovirus B19.
• Recently contracted the disease and should be closely monitored throughout her pregnancy. This may include frequent fetal ultrasounds.

General treatment

For normally healthy people, home treatment (including rest, fluids, and pain relievers) is usually the only care needed for fifth disease. The reappearance of a rash does not mean the condition is severe or has gotten worse. The rash often reappears from exposure to sunlight, warm temperatures, or stress.

Antibiotics are not used to treat fifth disease because the illness is caused by a virus rather than bacteria.

Treatment for high-risk groups

Pregnant women and people who have impaired immune systems or certain blood disorders (such as sickle cell disease or thalassemia) are at high risk for developing complications from fifth disease. These people need close monitoring by a health professional after exposure or if they develop symptoms of infection. Medical treatment for complications sometimes requires hospitalization.

If you are pregnant and have been exposed to the virus that causes fifth disease, your doctor may recommend blood tests to see if you are infected or if you are immune. If you are infected, your doctor may recommend frequent fetal ultrasounds throughout your pregnancy to monitor your fetus's condition.

Preventing the spread of fifth disease

By the time the rash appears, you can no longer spread the disease to anyone else. After a child gets a rash, he or she may return to school or day care.

People known to have fifth disease, including those who have complications, should take measures to prevent spreading the virus. It helps to wash your hands often. If people with fifth disease are hospitalized, they may be isolated from other patients.

A vaccine against parvovirus B19 is being tested and may be available in the near future.

For normally healthy people, home treatment for fifth disease consists of taking measures to keep them comfortable until their symptoms go away. Suggestions include:

• Giving plenty of liquids to prevent dehydration.
• Giving acetaminophen (such as Tylenol) or ibuprofen (such as Advil or Motrin) to reduce fever and to relieve headache and joint pain.
• Preventing scratching. Trim your child's fingernails and have him or her wear gloves at night to help prevent scratching during sleep.
• Having adults with joint pain and swelling rest and limit their activities.

The rash may itch more in adolescents and adults than in children. Some ways to help reduce itchiness include:

• Taking oatmeal baths. For an oatmeal bath, place 1 cup uncooked oatmeal in a cotton cloth, tie it off, and cook it in boiling water until the oatmeal is soft. Use the bundled oatmeal as a sponge while bathing in lukewarm water. You can also use Aveeno Colloidal Oatmeal bath instead of home-prepared oatmeal.
• Applying calamine lotion to the rash.
• Taking a nonprescription antihistamine, such as Benadryl, which may help if the itching is very bothersome. These medications may make children sleepy.
• Wearing loose-fitting cotton clothing.

Online Resources

• Hand-Washing
• Lupus (Systemic Lupus Erythematosus)
• Rash, Age 11 and Younger
• Rash, Age 12 and Older
• Rubella (German Measles)

Other Works Consulted

• Habif TP, et al. (2005). Erythema infectiosum (fifth disease). In Skin Disease: Diagnosis and Treatment, 2nd ed., pp. 268–269. Philadelphia: Elsevier Mosby.