Parvovirus B19: What parents need to know about fifth disease

Fifth disease (erythema infectiosum) is a common childhood illness often recognized by the bright red rash it creates on a child's cheeks. Because of this, it's sometimes called “slapped cheek” disease. Fifth disease is caused by parvovirus B19, a contagious respiratory virus that can also cause mild flu-like symptoms.

"What we typically see with fifth disease is kids who come to the doctor after having cold or flu-like symptoms, which were often mild, and now have bright red cheeks," says Kelley Smith, M.D., a pediatrician at Children's Health℠. "The rash may be alarming to parents, but rest assured, most children with fifth disease have mild illness. In fact, once the rash appears, the initial symptoms from the virus that caused it are often starting to fade, and the child is no longer contagious to others."

How does fifth disease spread?

Fifth disease is caused by parvovirus B19 and spreads when an infected person coughs or sneezes. The virus is most contagious before the rash appears, which is why it often spreads quickly in schools and daycares.

After a child has fifth disease, they develop immunity and won't get it again. Parents who were previously exposed to parvovirus B19 are unlikely to catch fifth disease from their child.

What are the symptoms of fifth disease in kids?

A common sign of fifth disease is a bright red rash on the cheeks, which can look like a "slapped cheek." Before the rash appears, your child might experience mild flu-like symptoms, such as:

• Fever
• Headache
• Cough
• Sore throat
• Runny or stuffed nose
• Fatigue
• Joint pain

A few days after the initial symptoms, the red rash may spread to the arms, legs and torso. Some children might also have joint pain or swelling, particularly in the hands, wrists, knees and ankles.

How is fifth disease treated?

Fifth disease doesn't usually require specific treatment. Since it's caused by a virus, antibiotics are not effective. The focus of treatment is to keep your child comfortable. Here are some ways to soothe your child at home:

• Rest: Ensure your child gets plenty of rest to help their body fight off the infection.
• Hydration: Encourage your child to drink plenty of fluids to stay hydrated.
• Fever and pain relief: Over-the-counter medications like acetaminophen or ibuprofen can be used to reduce fever and discomfort. Be sure to follow dosing instructions based on age or consult your pediatrician for advice. Ibuprofen is not safe for infants under 6 months of age.
• Soothing the rash: The rash associated with fifth disease doesn't usually require treatment and typically goes away on its own. If the rash is itchy, applying a cool compress or anti-itch lotion may help.

In most cases, children recover fully from fifth disease within one to three weeks, although, in some children, the rash can come and go for up to six weeks. If your child has a weakened immune system or another underlying health condition, they may need additional medical care.

When can kids return to school after fifth disease?

Once the rash appears, children are usually no longer contagious and can return to school if they feel well enough. The rash may linger for several weeks, but that doesn't mean your child is still contagious. Kids should stay home from school if they have a fever of 100.4 or higher. Most schools require kids to be fever-free for 24 hours without using fever-reducing medicines before they return to class.

When to see your pediatrician for fifth disease

Most cases of fifth disease are mild and resolve on their own without medical treatment. However, you should contact your pediatrician if your child:

• Has a weakened immune system due to a medical condition or treatment
• Has certain blood disorders such as sickle cell disease
• Develops a high fever or symptoms that worsen instead of improving
• Experiences severe joint pain or swelling
• Shows signs of severe anemia, such as fatigue or pale skin

Information for high-risk patients

Fifth disease can cause serious complications for certain high-risk groups, including:

• Children with weakened immune systems and/or blood disorders
• Pregnant women: Infection during pregnancy can lead to serious complications, so it's crucial for pregnant women who've been exposed to the virus to seek medical advice.

While fifth disease is generally a mild illness for most children, it's important to be aware of the symptoms and the potential risks for high-risk individuals. If you have any concerns or if your child falls into a high-risk category, don't hesitate to contact your health care provider for guidance.

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Children's Health Primary Care offers comprehensive health care for children from birth through young adulthood. Our pediatricians combine quality care with evidence-based practice to meet your child's medical needs. Learn more and find a pediatrician.