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Fifth disease

What is Fifth disease

Fifth disease, also called erythema infectiosum, is caused by the virus parvovirus B19. Fifth disease is also called “the slapped-cheek rash” by parents because the virus causes a characteristic rash in which the cheeks appear slapped. Most cases occur in children age 5 to 15 years.

Of historical interest, the illness is called fifth disease because it was the fifth in a list of illnesses that cause rashes in children. The others were rubella, measles, scarlet fever, Filatov-Dukes disease, and roseola.


Late winter through early spring.

Incubation period:

After exposure, initial flu-like symptoms will appear in 7 to 10 days. The rash of fifth disease will appear 2 to 3 weeks after exposure.

Symptoms of Fifth disease:

  • Initially flu-like illness-headache, muscle aches-lasting 2 to 3 days.
  • A rash appears on the cheeks, 1 week after the flu-like illness, that is fiery red and slightly raised. It is commonly called the “slapped cheek” rash.
  • Within 1 to 2 days after the facial rash has appeared, a rash will appear on the arms and legs. The rash may also be on the chest and back. This rash has a lace-like pattern. The rash will fade in several days to several weeks.
  • The rash typically comes and goes for several weeks-it can recur with exposure to sunlight, exercise, heat, and stress.
  • The rash may be itchy in older children and adults.
  • Infection may be complicated by a transient arthritis in adolescents and adults.
  • Infection in a pregnant woman may be complicated by fetal infection during the first 20 weeks of pregnancy and have the rare complication of miscarriage. Most infections during pregnancy, though, result in normal deliveries.
  • Persons with sickle cell disease may have a transient aplastic crisis (lowering of the blood counts), lasting 7 to 10 days.

How to avoid catching it:

Fifth disease is spread by respiratory droplets passed by coughing and sneezing. Good hand washing is useful in limiting spread and immediate disposal of used facial tissues is essential.

Children can no longer pass the infection once the rash appears and therefore can go back to school at that time.

According to the Report of the Committee on Infectious Disease, 2000, it is not necessary to routinely exclude pregnant women from a workplace where there may be exposure to fifth disease. This is due to several factors; (1) most women are already immune to the virus from having it as a child; and, (2) even if infected, there is a low incidence of ill effects on the fetus.