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Fifth Disease


Fifth disease is a viral condition that usually affects young children. It is called fifth disease because it was the fifth viral disease that caused rashes in children. The medical term for this condition is known as erythema infectiosum. This disease presents with a red rash on the cheeks, arms, and legs, which is why it is also called ‘slapped cheek disease.’ It is a contagious viral infection that can easily spread from one infected person to another. Like most common viral infections, the fifth disease resolves by itself after a certain duration and does not require any particular treatment. 


Fifth disease is caused by parvovirus B19. It is a highly contagious virus that can spread through cough or sneeze droplets of an infected person. For this reason, it can easily spread among young, school-going children. The spread is more prevalent during late winter, spring, and early summer. Parvovirus B19 can also spread through vertical transmission, i.e., from a pregnant mother to her baby. This can affect the health condition of the baby and may lead to life-threatening anemia. Although it is common among children, it can also affect adults with a weakened immune system. This disease often affects only once in life as your immune system develops antibodies against it to protect you later in life. 

Risk Factors And Epidemiology

Fifth disease is a very common condition that can affect children at an early age. This is because their immune systems are comparatively weak. Once exposed, you develop life-long immunity against it. School-going children, especially those between 5 and 10 years of age, are at high risk of contamination from this infection. It is uncommon in adults but can occur in case of pregnancy, sickle cell anemia, or weakened immune system.

This virus can affect people of any race or ethnicity. If this disease occurs in a single person, there’s a risk that almost 50% of the exposed family members may also become infected. Children develop 50% immunity against it, and adults have 70 to 85% immunity. 

Signs And Symptoms

The initial signs and symptoms of the fifth disease resemble those of the mild flu. They can appear 4 to 14 days after being infected by parvovirus B19. These symptoms include fever, headache, fatigue, sore throat, nausea, runny or stuffy nose, and weakness. After a few days of these symptoms, a red rash appears. It begins on the cheeks first and slowly appears on other body parts, including arms, legs, and trunk. It is a flattened rash and may be itchy. It persists for 5 to 10 days and begins to fade away afterward. Around 10% of children and 80% of affected adults also experience joint pain in the wrist, hands, and knees, along with swelling. 


Fifth disease is usually diagnosed on the basis of its clinical symptoms. If a child presents with the characteristic cheek rash along with flu-like symptoms, fifth disease can be the most likely cause. Diagnosis can be confirmed by doing a blood test to look for antibodies against parvovirus B19. Antibodies can be present if you have been infected but did not develop any symptoms. This test is specifically done in infected pregnant women and immunocompromised people. 

Differential Diagnosis

Fifth disease needs to be differentiated from other diseases and viral infections that may present with similar symptoms such as rash, fever, headache, sore throat, etc. Examples of such diseases include measles, rubella, roseola, streptococcal scarlet fever, vasculitis, and certain drug reactions. Diagnosis can be made on the basis of history, clinical symptoms, and diagnostic tests if needed. 


Fifth disease resolves on its own ad does not require any specific treatment measures. Your immune system produces antibodies against the virus, enough to fight off the infection completely. It may take one to three weeks to recover from this infection. Because this disease is contagious, preventive measures need to be taken in the case of children. School-going children should be given sick leave for a few days until the rash disappears. Bed rest and intake of fluids are recommended to help with the recovery process. If you are an immunocompromised adult diagnosed with this infection, you may be kept under supervision until symptoms are better. This precaution is also required for infected pregnant women to avoid complications.


No antiviral medications are required to treat the fifth disease. Medications can only help with symptomatic care. If you have fever or pain in joints, you can take over-the-counter pain killers such as acetaminophen or NSAIDs. Children should be given medications after consultation with a doctor. 


The prognosis for this disease is well for healthy children. They will recover completely once their immune system has fought off the infection. Once the antibodies are made in their body, the infection will not recur in most cases. Complications such as anemia or arthritis may arise in the case of pregnant women or immunocompromised adults. 


There is no vaccine available yet to prevent the fifth disease. The preventive measures for this disease are similar to other upper respiratory tract infections. Children should be taught to cover their mouths while coughing or sneezing with their elbows instead of their hands. Proper handwashing should be practiced. Close contact with an infected person should be avoided. Hygiene measures and good sanitary habits can limit the spread of this disease among children.

Our clinical experts continually monitor the health and medical content posted on CURA4U, and we update our blogs and articles when new information becomes available. Last reviewed by Dr.Saad Zia on May 19, 2023.



About Fifth Disease | CDC,getting%20infected%20with%20parvovirus%20B19.

Fifth Disease (for Parents) - Nemours KidsHealth