What is Fifth Disease?

Recently I saw a 7 year old boy in clinic who was brought in by his mother. His school sent him home due to a “very concerning” rash on his face and they wanted him to be seen by his pediatrician.

I walk into the exam room to find a happy boy smiling back at me. His smile wasn’t the only thing that caught my attention. He did indeed have a fairly remarkable red rash on both of his cheeks. This particular rash has been dubbed the “slapped cheek” appearance, however, I liken it more to a severe sunburn limited to the cheeks.

The boy was clearly healthy. No fever and no other complaints. On further questioning of his mother, she did recall him having minor cold symptoms the week prior with a runny nose, congestion, and possibly a low grade fever (she didn’t take his temp). He had remained fairly active and continued with his normal activities through it all.

The rash started the day before she brought him in and she noticed a rash appearing on his chest and arms. However, he said he felt just fine.

This scenario above is classic, and textbook for Fifth Disease, aka Erythema Infectiosum.

After a thorough physical exam, I explained to his mom what he had and that yes, he could return to school that day.

So, what is Fifth Disease?

Fifth Disease is a fairly common viral illness caused by parvovirus B19. It’s most common in children ages 5-15 years old and peaks in late winter and early spring.

As in the boy above, it starts out looking just like the common cold with runny nose, congestion, low grade fever, and possibly headache. After the resolution of these symptoms, the telltale rash appears. Children get this intensely red rash on their cheeks followed by a lacy, net-like rash on their chest and upper arms.

Children typically appear quite well through it all.

Older teens and adults who come down with Fifth Disease may also complain of joint swelling and/or joint pain.

Is it contagious?

Children are contagious during the respiratory part of the illness, typically before they even know what they have. Once the rash appears, they are no longer contagious. Therefore, they do not need to be kept home.

The virus is spread in the same way that other common viruses and colds are spread…through droplet transmission from sneezing and coughing.

What is the treatment?

Since this is a virus, antibiotics do not help. The illness will run its course and the rash will resolve usually within 3 weeks. If your child has some itching associated with his rash, an appropriate antihistamine may help.

How can I prevent it?

There is no vaccine for Fifth Disease. Usually, by the time children reach adulthood, 40-60% will have had the illness and therefore will be immune to it.

Good hand washing, as always, is a great way for children to prevent the spread of this virus.

Of particular concern:

Pregnant women who come down with Fifth Disease for the first time are at a slightly increased risk for miscarriage (less than 5%). So, if you are pregnant and think you have been exposed to Fifth Disease, contact your OB for further evaluation. Keep in mind that half of all pregnant women are already immune.

Children with weakened immune systems, such as those with leukemia, cancer, or sickle cell disease are at risk from becoming very ill with Fifth Disease. They can get severe anemia and should always be monitored much more closely if Fifth Disease is suspected.

The bottom line: Fifth Disease is a common, mild, and self limiting illness in healthy children. The rash is typically what brings them in to the doctor’s office. So, if your child’s pediatrician says to you one day, “yup, it’s Fifth Disease”, you’ll know exactly what she’s talking about and it’ll save you a lot of worry.

Have you heard of Fifth Disease? Has your child had it?