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                                  Fifth disease

What is fifth disease?

• Fifth disease or erythema infectiousum is a common childhood viral illness caused by the human parvovirus B19. 
  
• It occurs most commonly between 2 and 10 years of age.
  
• Once someone is infected with parvovirus B19, they develop immunity to it and wont usually become infected again.

Why is this infection called fifth disease?

• This infection is counted among the 6 classical infections in children that cause a rash.
  
• The other 5 are measles, scarlet fever (see photo called scarlet fever), rubella (German measles), possibly Staph, and sixth disease is Roseola (see photo called Roseola)

How does a child get fifth disease?

• Fifth disease spreads from a person with the infection to another person through direct contact with respiratory secretions (e.g., saliva, sputum, or nasal mucus) through sneezing, coughing, or sharing drinking glasses and utensils.
  
  
• About 1/2 of the household members that are exposed to someone who has fifth disease will also become infected.
  
  
• Children exposed to classmates in school with fifth disease have anywhere from a 10 to 60 percent chance of becoming infected after being exposed.
  
  
• About 20% of adults and children who are infected with parvovirus B19 do not develop any symptoms.
  
  
• Children with fifth disease are only contagious before the rash appears, so they do not need to be excluded from school or day care once they develop the rash.
  
• This contagious period is different than that for many other rash illnesses, such as measles, for which the child is contagious while he or she has the rash.

How long will it take my child to become ill after being exposed to someone else with fifth disease?

• Remember, just because your child is exposed to an ill person does not necessarily mean they too will become ill.
  
• But if your child is to become ill, it usually takes between 4 to 14 days after the exposure but can be as long as 21 days.

What are the symptoms of fifth disease?

If present, symptoms are usually mild and can include:

1. Runny nose, sore throat, swollen glands, and maybe a low grade fever 
   
   
2. About 7-10 days later, your child may develop a bright red or rosy, nontender rash on both of their cheeks, with a pale area around his mouth, giving the appearance that their cheeks have been slapped ("slapped cheek" rash) (see photo called Fifth disease).  This rash, if it develops at all, lasts for 1 – 7 days.
   
   
3. Next, a red or pink lacelike rash (see photo called Fifth disease 2) may develop on their arms, legs, and trunk as the rash on their cheeks begins to fade. This lacy rash is usually flat, but may be slightly raised and may be itchy.
   
   
4. The lacelike rash will come and go in general for 1 - 5 weeks and may become worse when your child becomes overheated (e.g., exercise) or exposed to the sun.

• While this illness is very mild in most children, if your child has a blood disorder, immune system problems or if you are pregnant, it can cause more serious problems and you should consult your doctor for advice.

How can my child be tested for fifth disease?

• While blood tests are available to confirm an infection or to show that a person had the infection in the past, they are usually only necessary for children with chronic medical problems, such as blood and immune system disorders, or pregnant women who are exposed to fifth disease early in their pregnancy.

What is the treatment for fifth disease?

• In general, no treatment is really necessary.
  
• Acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) for fever.
  
• Your pediatrician can give you advice for relieving your child’s discomfort from itching, if present.
  
• Children with immune problems may need special medical care, including treatment with immune globulin (antibodies), to help their bodies get rid of the infection.

What should I do if I am pregnant and exposed to someone with fifth disease?

• You should see your obstetrician. The doctor will probably get a test to see if you are already have had fifth disease and therefore immune.
  
  
• Some developing babies infected with fifth disease develop severe anemia and become very ill. There are no other birth defects associated with fifth disease.
  
  
• If your child is exposed to someone diagnosed with fifth disease, he/she should avoid contact with pregnant women.

Are there any complications from fifth disease?

• The majority of healthy children with fifth disease recover with no complications.
  
• Children with certain blood disorders (e.g., sickle cell anemia) may become very ill when they get fifth disease. Parvovirus B19 can temporarily slow down or stop the bodys production of the oxygen-carrying red blood cells, causing anemia.

When can my child return to daycare or school?

• Once their rash develops, they are no longer contagious and may return to daycare or school.

When should I call my pediatrician concerning an illness in my child that resembles fifth disease?

• If you are pregnant and you suspect that your child has developed symptoms resembling fifth disease. If your doctor confirms the diagnosis of fifth disease, it is recommended that you see your obstetrician.
  
• You should also call your pediatrician anytime your child’s illness is worsening or if your child looks very ill.

How can fifth disease be prevented?

• There is no medicine or vaccine that prevents fifth disease.
  
  
• Frequent hand washing is recommended to decrease the chance of becoming infected. Click on how to prevent infection for more details.
  
  
• Since children with fifth disease are contagious before they develop the rash, excluding children with the rash from child care centers or schools is not likely to prevent the spread of the virus.