Fifth Disease: Causes, Symptoms, Treatment and Prevention

Explore the causes, symptoms, complications, and prevention of Fifth Disease, a common childhood viral illness.

By Medha deb

Created on Oct 3, 2025

Explore the causes, symptoms, complications, and prevention of Fifth Disease, a common childhood viral illness.

Fifth Disease: Causes, Symptoms, Diagnosis, Treatment, and Prevention

Fifth disease, also known as erythema infectiosum, is a common viral condition most often seen in children. Characterized by its distinctive red rash on the cheeks—often called a ‘slapped cheek’ appearance—this illness is usually mild but can pose risks for certain populations. This article offers a comprehensive overview, from its causes and symptoms to preventive measures and frequently asked questions.

What Is Fifth Disease?

Fifth disease is a viral illness primarily affecting children. It is caused by the parvovirus B19 and is one of the several classic infectious childhood rashes. The disease gets its name because, historically, it was the fifth among six common childhood diseases manifesting with a skin rash (exanthema).

Also known as: Erythema infectiosum, Slapped cheek disease
Typical age group: Most common in children aged 4 to 10, but adults can also be affected

Causes of Fifth Disease

The cause of fifth disease is parvovirus B19 infection. This virus only infects humans and is transmitted through respiratory droplets, saliva, or contact with contaminated surfaces. The condition is most prevalent in late winter to early spring but can occur at any time of year.

Transmission: Spread by coughing, sneezing, or direct contact with respiratory secretions
Most contagious: In the early phase before the rash develops
Immunity: After one infection, people usually develop lifelong immunity

How Is Fifth Disease Spread?

Fifth disease is transmitted from person to person through droplets when an infected person coughs or sneezes. The virus can also be picked up from surfaces touched by infected respiratory secretions.

Contagious period: Individuals are typically contagious before the rash appears. After the rash emerges, they are usually no longer infectious.
Incubation period: 4 to 14 days after exposure, but in some cases, it may take as long as 20 days for symptoms to develop.

Who Is at Risk?

While fifth disease mostly affects children, anyone can be infected. The following groups are at higher risk for complications:

Children, especially preschool and elementary-school-aged
Women who are pregnant and not immune to parvovirus B19
Individuals with weakened immune systems (immunocompromised), such as those with leukemia, cancer, HIV, or on immunosuppressive therapy
People with certain blood disorders, particularly sickle cell anemia or thalassemia

Signs and Symptoms

Fifth disease develops in stages, starting with general symptoms of a mild viral infection, followed by the appearance of a distinctive rash.

Early Symptoms (Prodromal Phase)

Mild fever
Headache
Runny nose
Fatigue
Sore throat

These early signs are similar to those of a mild cold and generally last a few days.

Rash and Additional Symptoms

Facial rash: Bright-red cheeks, referred to as “slapped cheek” rash. This is the classic sign and often develops a few days after other symptoms have resolved.
Body rash: A lacy, red rash may appear on the trunk, arms, and legs. This rash often fades from the center outwards and may come and go over several weeks, especially if exposed to sunlight, heat, or stress.
Itchiness: The rash can sometimes be itchy, particularly in older children and adults.
Joint pain and swelling: Some people, particularly adult women, may experience joint discomfort in their hands, wrists, knees, or ankles. This symptom can last from days to weeks.

It’s important to note that about 20% of people with fifth disease may have no symptoms at all.

How Is Fifth Disease Diagnosed?

Diagnosis is usually clinical—based on physical examination and history of symptoms. The appearance of the characteristic rash is typically enough for a healthcare provider to confirm fifth disease. Laboratory tests or blood work are rarely needed but may be recommended in special cases, such as in:

Pregnant women exposed to fifth disease
Immunocompromised individuals
Patients with persistent anemia

Blood tests can detect parvovirus B19 antibodies or DNA, confirming active or recent infection.

Treatment Options

There is no specific antiviral treatment for fifth disease. The infection typically resolves on its own in otherwise healthy individuals. Treatment is supportive and focuses on relieving symptoms.

Rest: Allow the body to recover naturally
Fluids: Encourage adequate hydration
Fever or pain management: Acetaminophen (Tylenol) or ibuprofen for fever, headache, or joint pain (Never give aspirin to children; it can cause Reye syndrome—a serious condition)
Itchiness: Consider antihistamines if the rash is itchy (under medical guidance)

Treatment Measures Overview
Symptom	Suggested Management
Fever, Mild Pain	Acetaminophen or Ibuprofen (avoid aspirin in children)
Itchy Rash	Antihistamines (if recommended by provider)
Joint Pain	Rest, pain relievers (as above)
General Discomfort	Plenty of fluids, extra rest

Note: Antibiotics are not effective against viral infections like fifth disease.

Possible Complications of Fifth Disease

Fifth disease is usually mild. However, serious complications can occur in specific populations:

Pregnant Women: Infection during pregnancy—especially in the first half—can (rarely) cause severe anemia in the unborn baby or miscarriage, occurring most often when the mother is not immune.
People with weakened immune systems: Infection can cause chronic anemia or prolonged infection, requiring medical intervention.
Chronic blood disorders: In people with sickle cell disease or similar anemias, parvovirus B19 can trigger an aplastic crisis—a rapid drop in red blood cell count that can be life-threatening without prompt treatment.

How Long Does Fifth Disease Last?

The duration of fifth disease generally spans from one to three weeks:

Initial symptoms (fever, runny nose, headache) usually last 2–5 days
The facial rash appears next, often lasting for 2–5 days
The lacy body rash can come and go for up to 3 weeks, especially with triggers like exercise, temperature changes, or sun exposure
Joint symptoms, if present, can last days to weeks (rarely, months)

Prevention Tips

While there is no vaccine to prevent fifth disease, certain measures can reduce the risk of transmission:

Encourage frequent and thorough handwashing with soap and water
Avoid sharing eating utensils, cups, or towels, especially during outbreak periods
Teach children to cover their mouths and noses with a tissue or arm when sneezing or coughing
Keep children home from school or daycare if they have a fever or are feeling unwell (note: exclusion after rash appears is not generally necessary, as the disease is no longer contagious)
Pregnant women or people with chronic illnesses should consult their doctor if exposed

When to Contact a Healthcare Provider

Severe anemia symptoms (such as pale skin, rapid heartbeat, fatigue)
Persistent high fever or unusual weakness
Pregnant women exposed to fifth disease
People with compromised immunity or chronic blood disorders exposed or showing symptoms
Signs of complications in children or adults

Fifth Disease in Special Populations

Pregnant Women

Most pregnant women exposed to fifth disease do not experience complications since many are already immune. For women who are not immune, there is a small risk of fetal complications, especially in the first half of pregnancy. Prenatal care providers may recommend blood tests to check immunity and monitor for fetal health if necessary.

People with Weakened Immune Systems

Individuals with compromised immune function are at higher risk for prolonged infection and chronic anemia, requiring medical management and possible antiviral therapy.

People with Chronic Blood Disorders

Fifth disease can suppress red blood cell production, leading to severe or sudden anemia. These individuals should seek medical attention promptly if symptoms appear.

Frequently Asked Questions (FAQs)

Q: Is fifth disease dangerous?

A: In healthy children and adults, fifth disease is usually mild and self-limiting. However, it can be more serious in pregnant women, people with weakened immune systems, or those with chronic blood disorders.

Q: Can my child go to school with the rash?

A: Yes, once the rash appears, children are usually no longer contagious and may return to school, provided they are otherwise well.

Q: Can you get fifth disease more than once?

A: No, after infection, lifelong immunity to parvovirus B19 is typically developed, so repeat infections are rare.

Q: Is there a vaccine for fifth disease?

A: There is currently no vaccine to prevent fifth disease. Prevention depends on good hygiene practices.

Q: Should pregnant women be worried?

A: Most pregnant women are immune or have mild symptoms. Non-immune pregnant women should notify their healthcare provider if exposed, so testing and extra monitoring can be arranged if needed.

Summary and Tips for Parents

Fifth disease is common, mild, and generally resolves on its own
Distinctive red rash on cheeks is a hallmark sign
Maintain good hygiene practices to lower risk
Contact your healthcare provider with any concerns, especially during pregnancy or in children with blood disorders

Being informed about fifth disease helps reduce unnecessary worry and ensures prompt care when needed. Practicing prevention and understanding the symptoms leads to healthy outcomes for children and adults alike.

References

Author

medha deb

Medha Deb is an editor with a master's degree in Applied Linguistics from the University of Hyderabad. She believes that her qualification has helped her develop a deep understanding of language and its application in various contexts.

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