Fifth Disease

Overview

What is fifth disease?

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:

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.

Symptoms and Causes

What causes 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.

Diagnosis and Tests

How is fifth disease diagnosed?

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.

Management and Treatment

How is fifth disease managed or treated?

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?

If you're pregnant, the virus can infect the develop fetus. 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 fetus develops fully).
  • Stillbirth (when a baby dies before birth).

However, most people who are pregnant and are infected with this virus deliver normal, healthy babies.

Prevention

How can I prevent fifth disease?

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.

Outlook / Prognosis

What is the prognosis (outlook) for people with fifth disease?

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.

Living With

When should I call the doctor?

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?

A note from Cleveland Clinic

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. (https://familydoctor.org/condition/fifth-disease/) Accessed 5/11/2020.
  • American Academy of Pediatrics (AAP). Fifth Disease (Parvovirus B19). (https://www.healthychildren.org/English/health-issues/conditions/skin/Pages/Fifth-Disease-Parvovirus-B19.aspx) Accessed 5/11/2020.
  • Arthritis Foundation. Fifth Disease. (https://arthritis.org/diseases/fifth-disease) Accessed 5/11/2020.
  • Centers for Disease Control and Prevention (CDC). Parvovirus 19 and Fifth Disease. (https://www.cdc.gov/parvovirusb19/fifth-disease.html) Accessed 5/11/2020.

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