Fifth disease is a mild rash illness caused by parvovirus B19. It is more common in children than adults. A person usually gets sick with fifth disease within 14 days after getting infected with parvovirus B19. This disease, also called erythema infectiosum, got its name because it was fifth in a list of historical classifications of common skin rash illnesses in children.

Parvovirus B19—which causes fifth disease—spreads through respiratory secretions, such as saliva, sputum, or nasal mucus, when an infected person coughs or sneezes. You are most contagious when it seems like you have “just a fever and/or cold” and before you get the rash or joint pain and swelling. After you get the rash you are not likely to be contagious, so it is usually safe for you or your child to go back to work or school.

People with fifth disease who have weakened immune systems may be contagious for a longer amount of time.

Parvovirus B19 can also spread through blood or blood products. A pregnant woman who is infected with parvovirus B19 can pass the virus to her baby.

Once you recover from fifth disease, you develop immunity that generally protects you from parvovirus B19 infection in the future.

The symptoms of fifth disease are usually mild and may include

• fever
• runny nose
• headache
• rash

You can get a rash on your face and body
You may get a red rash on your face called “slapped cheek” rash. This rash is the most recognized feature of fifth disease. It is more common in children than adults.

Some people may get a second rash a few days later on their chest, back, buttocks, or arms and legs. The rash may be itchy, especially on the soles of the feet. It can vary in intensity and usually goes away in seven to 10 days, but it can come and go for several weeks. As it starts to go away, it may look lacy.

You may also have painful or swollen joints
People with fifth disease can also develop pain and swelling in their joints. This is called polyarthropathy syndrome. It is more common in adults, especially women. Some adults with fifth disease may only have painful joints, usually in the hands, feet, or knees, and no other symptoms. The joint pain usually lasts 1 to 3 weeks, but it can last for months or longer. It usually goes away without any long-term problems.

The viral diseases roseola and fifth disease are somewhat similar in terms of their presentation, but they are caused by different viruses. Roseola, sometimes called roseola infantum or exanthem subitum (“sudden rash”), is a mild viral infection usually caused by human herpesvirus-6 (HHV-6) and occasionally by HHV-7. It is spread via direct contact with the saliva or respiratory secretions of an infected individual, often through droplet aerosols. Roseola is very common in children, with symptoms including a runny nose, a sore throat, and a cough, along with (or followed by) a high fever (39.4 ºC). About three to five days after the fever subsides, a rash may begin to appear on the chest and abdomen. The rash, which does not cause discomfort, initially forms characteristic macules that are flat or papules that are firm and slightly raised; some macules or papules may be surrounded by a white ring. The rash may eventually spread to the neck and arms, and sometimes continues to spread to the face and legs. The diagnosis is generally made based upon observation of the symptoms. However, it is possible to perform serological tests to confirm the diagnosis. While treatment may be recommended to control the fever, the disease usually resolves without treatment within a week after the fever develops. For individuals at particular risk, such as those who are immunocompromised, the antiviral medication ganciclovir may be used.

Fifth disease (also known as erythema infectiosum) is another common, highly contagious illness that causes a distinct rash that is critical to diagnosis. Fifth disease is caused by parvovirus B19, and is transmitted by contact with respiratory secretions from an infected individual. Infection is more common in children than adults. While approximately 20% of individuals will be asymptomatic during infection, others will exhibit cold-like symptoms (headache, fever, and upset stomach) during the early stages when the illness is most infectious. Several days later, a distinct red facial rash appears, often called “slapped cheek” rash (figure). Within a few days, a second rash may appear on the arms, legs, chest, back, or buttocks. The rash may come and go for several weeks, but usually disappears within seven to twenty-one days, gradually becoming lacy in appearance as it recedes.

In children, the disease usually resolves on its own without medical treatment beyond symptom relief as needed. Adults may experience different and possibly more serious symptoms. Many adults with fifth disease do not develop any rash, but may experience joint pain and swelling that lasts several weeks or months. Immunocompromised individuals can develop severe anemia and may need blood transfusions or immune globulin injections. While the rash is the most important component of diagnosis (especially in children), the symptoms of fifth disease are not always consistent. Serological testing can be conducted for confirmation.

Healthcare providers can often diagnose fifth disease just by seeing “slapped cheek” rash on a patient’s face. They can also do a blood test to determine if you are susceptible or possibly immune to parvovirus B19 infection or if you were recently infected. This is not a routine test but can be performed in special circumstances. The blood test may be particularly helpful for pregnant women who may have been exposed to parvovirus B19 and are suspected to have fifth disease. Any pregnant woman who may have been exposed to parvovirus B19 should contact their obstetrician or healthcare provider as soon as possible.

Fifth disease is usually mild and will go away on its own. Children and adults who are otherwise healthy usually recover completely. Treatment usually involves relieving symptoms, such as fever, itching, and joint pain and swelling.

People who have complications from fifth disease should see their healthcare provider for medical treatment.

Fifth disease is usually mild for children and adults who are otherwise healthy. But for some people, parvovirus B19 infection can cause serious health complications, such as chronic anemia that requires medical treatment.

You may be at risk for serious complications from fifth disease if you have a weakened immune system caused by leukemia, cancer, organ transplants, or HIV infection.

Fifth disease is the most common illness caused by parvovirus B19 infection.

Parvovirus B19 infection can cause painful or swollen joints (polyarthropathy syndrome), which is more common in adults. It can also cause the body to temporarily stop making new red blood cells. This can lead to severe anemia and other complications, but these are not very common. They usually affect people who have

• sickle cell disease or similar types of long-lasting anemia or problems producing red blood cells, or
• weakened immune systems caused by leukemia, cancer, organ transplants, or HIV infection.

If you have severe anemia or other chronic illnesses caused by parvovirus B19 infection, you can potentially spread the virus to others.

You may want to talk to your healthcare provider if you have a weakened immune system, sickle cell disease or a similar long-lasting anemia and you

• have been exposed to someone with fifth disease
• have an illness that might be caused by parvovirus B19

Your healthcare provider may want to test your blood to see if you have parvovirus B19 infection.

Fifth disease is a mild rash illness caused by parvovirus B19. This disease is usually not a problem for pregnant women and their babies. About half of pregnant women are immune to parvovirus B19, so they and their babies are usually protected from getting the virus and fifth disease. Pregnant women who are not immune usually have only mild illness if they are exposed to fifth disease. Also, their babies usually do not have any problems.

Rarely, a baby will develop severe anemia caused by its mother’s infection with fifth disease, and the woman may have a miscarriage. But this is not common. It happens less than 5% of the time among all pregnant women with parvovirus B19 infection, and it happens more commonly during the first half of pregnancy. Any pregnant woman who may have been exposed to parvovirus B19 should contact their obstetrician or healthcare provider as soon as possible.

Testing for Parvovirus B19 during Pregnancy

A blood test for parvovirus B19 can show if you

• are possibly immune to this virus and have no recent serologic evidence of infection
• are not immune and have never been infected
• have had a recent infection

Monitoring Parvovirus B19 Infection during Pregnancy

Any pregnant woman who may have been exposed to parvovirus B19 should contact their obstetrician or healthcare provider as soon as possible to discuss if she

• has been exposed to someone with fifth disease
• has an illness that might be caused by parvovirus B19 infection
• were recently infected with parvovirus B19

There is no single recommended way to monitor pregnant women with parvovirus B19 infection. Your healthcare provider may recommend additional prenatal visits, blood tests, and ultrasounds.

Fifth Disease Outbreaks in the Workplace & Pregnancy

Pregnant women may choose to continue going to their workplace if there is an outbreak of fifth disease happening. However, if you are not immune to parvovirus B19 and are not currently infected, you may want to stay away from people with fifth disease while you are pregnant. Talk with your family, healthcare provider, and employer to decide what is best for you.

Healthcare providers who are pregnant should know about the potential risks to their baby and discuss this with their doctor. All healthcare providers and patients should follow strict infection control practices to prevent parvovirus B19 from spreading.

There is no vaccine or medicine that can prevent parvovirus B19 infection. You can reduce your chance of being infected or infecting others by

• washing your hands often, for at least 20 seconds, with soap and water
• covering your mouth and nose when you cough or sneeze
• not touching your eyes, nose, or mouth
• avoiding close contact with people who are sick
• staying home when you are sick

Once you get the rash, you are probably not contagious. So, it is usually safe for you to go back to work or for your child to return to school or a child care center.

Healthcare providers who are pregnant should know about potential risks to their baby and discuss this with their doctor.

All healthcare providers and patients should follow strict infection control practices to prevent parvovirus B19 from spreading.

What is fifth disease?

Fifth disease, also called erythema infectiosum, is a viral infection caused by parvovirus B19. This virus only infects people; it's not the same type of parvovirus that dogs and cats can get.

Fifth disease mostly affects children. It often causes a bright red rash on their cheeks (sometimes called a "slapped cheek" rash).

In the United States, parvovirus B19 infections are more common in late winter, spring, and early summer. There are usually minor outbreaks of fifth disease about every 3 to 4 years.

What causes fifth disease?

Parvovirus B19, which causes fifth disease, can spread from person to person:

• Through respiratory droplets, such as saliva (spit), sputum, or nasal mucus. The droplets can spread when:
  • Someone who has the virus coughs and sneezes
  • You touch an item that has the virus on it
• Through blood or blood products
• From a pregnant parent to the baby during pregnancy

You are most contagious early in your infection, when you usually only have a fever or cold-like symptoms. You are not likely to be contagious after you get later symptoms such as a rash and joint pain.

What are the symptoms of fifth disease?

About 2 out of 10 people who get a B19 parvovirus infection will have no symptoms.

But most people will get the symptoms of fifth disease, which are usually mild and can include:

• Fever
• Headache
• Cough
• Sore throat
• Rashes
• Joint pain

The "slapped cheek" rash is more common in children. They usually get the rash a few days after they first have other symptoms. The rash can then spread to the arms, legs, chest, back, and buttocks.

Adults who get fifth disease might also have joint pain and swelling (called polyarthropathy syndrome).

Sometimes the infection can cause serious health complications affecting the nerves, joints, or blood system. This is more likely to happen if you are pregnant, have a blood disorder such as anemia, or a weakened immune system.

Because of these risks to you and some possible risks to your baby, contact your health care provider if you are pregnant and:

• You show signs of fifth disease (or a "slapped cheek" rash)
• You may have been exposed to someone who has the infection

How is fifth disease diagnosed?

There is no routine lab test to diagnose fifth disease. Providers can often diagnose fifth disease just by seeing the "slapped cheek" rash and rashes on the body.

There is testing to show whether or not you have protection (immunity) against the B19 parvovirus or if you have had a recent infection. This test is usually not needed, but your provider may order the test if you are pregnant or at higher risk for complications of the disease.

What are the treatments for fifth disease?

There is no specific treatment for fifth disease. It is usually mild and goes away on its own.

To feel better, get plenty of rest. Taking acetaminophen can help with the fever and pain. Do not give aspirin to children, because it may cause Reye syndrome. This is a rare, serious illness that can affect the brain and liver.

Can fifth disease be prevented?

There is no vaccine to prevent fifth disease. But you can help protect yourself and others by:

• Washing your hands often with soap and water
• Covering your mouth and nose when you cough or sneeze
• Avoiding touching your eyes, nose, and mouth with unwashed hands
• Avoiding close contact with people who are sick
• Staying home when you are sick

Most people become immune to the virus after having it once.