Fifth Disease: Symptoms, Risks, Diagnosis, and Prevention
Families can recognize cheek rash and joint discomfort to make confident care choices.
Fifth Disease: All You Need to Know About Parvovirus B19 Infection
Fifth disease, medically known as erythema infectiosum, is a common viral infection primarily affecting children but can also occur in adults. Caused by human parvovirus B19, it is typically mild but may present complications in certain groups such as pregnant women or individuals with weakened immune systems. This article provides a comprehensive overview—covering symptoms, transmission, diagnosis, treatment, potential complications, and prevention strategies.
What Is Fifth Disease?
Fifth disease is an acute viral illness distinguished by a characteristic facial rash, typically called the “slapped cheek” rash. The condition was historically named as the ‘fifth’ among common childhood rash-producing diseases, following measles, scarlet fever, rubella, and Duke’s disease. It is most prevalent in preschool and school-aged children, often during the late winter and spring seasons, but adults can also be affected.
Recognizing the Symptoms of Fifth Disease
- Fever
- Headache
- Cough
- Sore Throat
- Fatigue and malaise
- Runny Nose
- Nausea or upset stomach
‘Slapped Cheek’ Rash in Children
The most identifiable symptom in children is a bright red rash on the cheeks, often resembling the effect of being slapped. This rash usually appears several days after initial flu-like symptoms and may spread to the arms, legs, chest, back, and buttocks. Over time, the rash may look lacy or appear as lighter, slightly raised areas. Itches can also occur, especially on the soles of the feet. The rash often resolves in 7–10 days but can recur for several weeks, sometimes triggered by environmental factors such as sunlight, stress, or exercise.
Symptoms in Adults
Adults infected with parvovirus B19 are less likely to develop the classic rash. Instead, they may experience joint pain and swelling, a condition known as polyarthropathy syndrome. These joint problems primarily affect the hands, feet, wrists, knees, and ankles and are more common in women. The pain can last from a week to several months but usually resolves without permanent damage. Adults may also have mild flu-like symptoms with fever and malaise.
Asymptomatic Cases
Approximately 20% of people infected with parvovirus B19 show no symptoms[]2. Most symptomatic cases remain mild and self-limiting.
Transmission: How Does Fifth Disease Spread?
- Respiratory droplets: The virus spreads when an infected person coughs or sneezes, releasing droplets.
- Contact with contaminated surfaces: Less commonly, touching surfaces contaminated with respiratory secretions may lead to infection.
- Blood transfer: Rarely, infection can be transmitted through blood products.
The incubation period (time between exposure and symptom onset) is generally 5 to 10 days[]3. Individuals are most contagious during the early “cold-like” phase and often before the rash appears.
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Who Is Most at Risk?
- Children: School-aged children are particularly susceptible during peak seasons.
- Pregnant Women: Parvovirus B19 infection during pregnancy may increase the risk of miscarriage and rarely leads to complications like fetal anemia or hydrops fetalis.
- Individuals with weakened immune systems: Those with conditions such as HIV/AIDS, cancer, or on immunosuppressant drugs are more prone to complications.
- People with underlying blood disorders: Sickle cell disease or other chronic anemias can predispose to severe outcomes, including aplastic anemia.
Potential Complications of Fifth Disease
- Severe anemia: Particularly dangerous for people with blood disorders; parvovirus B19 can halt red blood cell production.
- Joint inflammation (Arthropathy): Chronic or severe joint issues, more common in adults, especially women.
- Pregnancy complications: Infection during pregnancy can result in anemia in the unborn child or rarely fetal hydrops.
- Immunosuppressed individuals: May suffer from prolonged infection and require supportive care.
| Risk Group | Complication |
|---|---|
| Children | Mild rash, fever, rarely anemia |
| Adults (especially women) | Arthropathy, joint pain/swelling |
| Pregnant women | Miscarriage (rare), fetal anemia, hydrops fetalis |
| Immunosuppressed | Prolonged anemia, persistent infection |
When Should You Call a Doctor?
- If symptoms are severe or persist longer than expected.
- If you are pregnant and suspect exposure or symptoms.
- If you have a chronic blood disorder and notice fatigue, pallor, or rapid symptom onset.
- For individuals with compromised immunity.
- If joint pain and swelling do not resolve or worsen.
Diagnosing Fifth Disease
Most cases are diagnosed based on clinical symptoms—a distinctive rash and history of recent flu-like illness. Lab testing for parvovirus B19 antibodies may be indicated in certain scenarios:
- Pregnant women with suspected infection
- Immunosuppressed individuals
- Complex or atypical presentations
Blood tests check for antibodies or signs of recent infection. Routine testing in mild cases is not necessary[]2.
Treatment and Relief for Fifth Disease
- Rest: Most cases resolve with rest.
- Acetaminophen: Helps with fever and joint pain (use as directed).
- Do not give aspirin to children: Risk of Reye syndrome exists, a potentially serious condition affecting the brain and liver.
- Symptom relief: Manage itchiness and discomfort with cool compresses or moisturizing lotions.
There is no specific antiviral therapy for parvovirus B19. Treatment focuses on supportive care and addressing complications in vulnerable individuals. Severe anemia may require hospitalization and blood transfusions. Joint symptoms usually resolve but can persist; consult a provider if they interfere with daily activities.
Treatment for High-Risk Groups
- Blood disorders: Monitor closely for signs of severe anemia; supportive therapy may be needed.
- Pregnancy: Regular ultrasounds and monitoring for fetal complications may be necessary if infection occurs.
- Immunosuppressed patients: May need specialized medical interventions.
Preventing Fifth Disease: Tips to Stay Safe
- Frequent handwashing with soap and water
- Cover mouth and nose when coughing or sneezing
- Avoid touching your face with unwashed hands
- Stay home when sick to avoid spreading the virus
- Avoid close contact with infected individuals
There is no vaccine for parvovirus B19 or fifth disease. Once infected, most people acquire immunity and are unlikely to get the disease again.
Fifth Disease and Pregnancy: What You Need to Know
Although most pregnant women who contract parvovirus B19 do not experience serious complications, there is an increased risk for their fetus, especially in early pregnancy. The virus can cross the placenta and—in rare cases—cause fetal anemia, hydrops fetalis (abnormal fluid buildup), or miscarriage.
- If you are pregnant and develop symptoms or know of exposure, contact your health care provider.
- Testing can confirm immunity or recent infection.
- Monitoring the pregnancy may involve ultrasound and blood tests for fetal well-being.
Frequently Asked Questions (FAQs) About Fifth Disease
Q1: Is fifth disease contagious?
Yes, fifth disease is contagious, particularly during its early ‘cold-like’ phase—often before the rash develops. It spreads mainly through respiratory droplets.
Q2: How long does fifth disease last?
Most rashes and symptoms resolve within 7–10 days, but the rash may come and go for up to three weeks.
Q3: Can adults get fifth disease?
Yes, adults can get fifth disease. They are more likely to experience joint pain rather than the classic rash seen in children.
Q4: Is there a vaccine or specific medicine for fifth disease?
No, there is no vaccine or targeted medication. Treatment is supportive and aimed at relieving symptoms.
Q5: Should I keep my child home from school?
By the time the rash appears, children are usually no longer contagious. However, if they have fever or other symptoms, they should stay home until they feel well enough to return.
Summary Table: Keys to Understanding Fifth Disease
| Aspect | Details |
|---|---|
| Main Cause | Human parvovirus B19 |
| Common Symptom (Children) | ‘Slapped cheek’ facial rash |
| Common Symptom (Adults) | Joint pain/swelling |
| Contagious Period | Early cold-like phase, before rash |
| Treatment | Supportive care; rest, acetaminophen |
| Prevention | Handwashing, respiratory etiquette |
| Vaccine | No vaccine available |
Key Resources and Further Reading
- Centers for Disease Control and Prevention: Parvovirus B19 Overview
- MedlinePlus: Fifth Disease Information
- Mayo Clinic: Parvovirus Infection Symptoms
- American Academy of Pediatrics: Pediatric Advice on Fifth Disease
References
- https://www.cdc.gov/parvovirus-b19/about/index.html
- https://medlineplus.gov/fifthdisease.html
- https://www.mayoclinic.org/diseases-conditions/parvovirus-infection/symptoms-causes/syc-20376085
- https://www.mountsinai.org/health-library/diseases-conditions/fifth-disease
- https://my.clevelandclinic.org/health/diseases/15774-fifth-disease
- https://my.clevelandclinic.org/health/diseases/16633-parvovirus-infection
- https://www.nationwidechildrens.org/conditions/fifth-disease
- https://cdphe.colorado.gov/child-care-school-settings/fifth-disease
- https://www.healthychildren.org/English/health-issues/conditions/skin/Pages/Fifth-Disease-Parvovirus-B19.aspx
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