Fifth Disease (“Slapped Cheek” Disease): Symptoms and More

Fifth disease, or erythema infectiosum, is a viral infection that mainly affects children, although adults can also get the disease. The virus that causes fifth disease is parvovirus B19, which spreads through respiratory droplets when someone with the infection coughs or sneezes.

This condition usually starts with cold or flu-like symptoms, such as low-grade fever, runny nose, and headache. A few days later, a bright red rash appears on the cheeks, followed by a rash with a lacy pattern on the trunk and extremities. Because of the rash on the cheeks, people sometimes call fifth disease “slapped cheek disease.”

Although fifth disease can be uncomfortable, most cases are mild and go away without treatment. However, the infection can sometimes cause serious health complications in certain groups, including pregnant people, people with weakened immune systems, or people with anemia.

Fifth disease symptoms develop between 4 and 14 days after exposure to the virus. Not everyone with fifth disease develops symptoms, but when they do occur, they are similar to a cold or flu and may include:

• Fever
• A sore throat
• Cough
• Headache
• Runny nose
• Muscle pain

A few days after these symptoms develop, a bright red rash appears on the cheeks before spreading to the chest, back, buttocks, arms and legs. The rash on the body usually only occurs in children and can be itchy. It usually lasts 7-10 days, but can come and go for several weeks. The rash may take on a lacy appearance as it fades.

Instead of a rash, adults with fifth disease tend to develop joint pain and swelling 1-3 weeks after the initial infection. The joints in the hands, knees, and feet on both sides of the body can become painful and swollen. Joint pain lasts for a week or two, but about 10% of adults experience joint pain that lasts for months or longer.

Parvovirus B19 causes fifth disease. The virus spreads through respiratory droplets when someone with the infection coughs or sneezes, releasing virus particles into the air that another person can inhale.

You can also become infected by touching a doorknob or countertop contaminated with the virus and then touching your face. It can also spread through blood, blood products and during pregnancy from a pregnant person to their unborn baby.

Fifth disease is most contagious early in the infection, usually when you have a cold or flu-like symptoms. Once these symptoms go away, you are unlikely to spread the disease.

Risk factors

Fifth disease can affect people of all ages, but is most common in preschoolers and school-age children. Most fifth disease infections in the United States occur in late winter, spring, and early summer. Mini-outbreaks of the disease usually occur every 3-4 years.

Healthcare providers can usually diagnose fifth disease with a physical examination based on the characteristic rash on the cheek, especially in children.

If the rash never develops, the joint pain lasts longer than the rash, or you have risk factors for complications such as pregnancy or pregnancy anemiayour healthcare provider may order a blood test to check for antibodies to parvovirus B19 and confirm the diagnosis. When you have fifth disease, your immune system produces antibodies to fight the virus, which can be detected by a blood test.

Your body will produce antibodies against the virus for up to two months after an active infection. After this, a blood test is less effective and can only determine whether you have ever had fifth disease in your life.

Most cases of fifth disease are mild and resolve within a week or two without treatment. Home care measures, such as Tylenol (acetaminophen), rest, and fluids can control symptoms such as fever, muscle aches, and joint pain.

Fifth disease can cause complications or more serious illness in pregnant people, people with weakened immune systems, and people with certain blood disorders. In people with anemia and sickle cell diseaseFifth disease can temporarily reduce or stop the production of oxygen-carrying red blood cells, which can lead to severe or life-threatening anemia. In this case, you may need medical treatments such as:

• Blood transfusions: If fifth disease causes a drop in red blood cells, blood transfusions can help replenish the body’s blood cell supply.
• Intravenous Immunoglobulin (IVIG): IVIG contains antibodies against parvovirus B19, which help the body fight the virus. This can reduce the severity of the infection and prevent complications.

There is no vaccine to prevent fifth disease, but you can lower your risk of infection by practicing good hygiene habits, including:

• Wash your hands often: Wash your hands with soap and water all day long.
• Cover your nose and mouth: When you cough or sneeze, use a tissue or your elbow to cover your mouth and nose.
• Avoid contact with sick people: If someone you know has fifth disease, limit contact with that person until he or she is no longer contagious.
• Disinfect surfaces: To prevent the spread of the virus, regularly clean and disinfect surfaces such as doorknobs, light switches and countertops.

Most cases of fifth disease are mild and go away with rest and time. The risk of complications is greater in people with a weakened immune system, such as people with cancer or the human immunodeficiency virus (HIV), and in organ transplant recipients.

Complications are also more common in pregnant people and people with certain blood disorders, such as sickle cell anemia thalassemia. Possible complications include:

• Aplastic anemia: Fifth disease can affect red blood cells and cause the body to stop producing oxygen-carrying red blood cells, leading to aplastic anemia. Symptoms include weakness, pale skin, fatigue, chills, easy bruising and bleeding, and shortness of breath. Untreated aplastic anemia can cause palpitations or lead to heart failure.
• Fetal complications: Although rare, fifth disease causes complications in about 5% of pregnancies when the pregnant person has an infection that spreads to the developing baby. Complications are more common in early pregnancy. Fetuses can develop anemia, which increases the risk of hydrops – or fluid buildup in the developing baby’s organs and tissues, which increases the risk of miscarriage.
• Persistent joint pain: Joint pain affects approximately 10% of children and 78% of adults with fifth disease. In about 10% of adults, joint pain persists for months or years after the infection.

Fifth disease is a viral infection that mainly affects children. It causes mild cold and flu-like symptoms, followed by a bright red rash on the cheeks that eventually spreads to the trunk and limbs. Adults can also get fifth disease, although they are more likely to develop joint pain than a rash.

Most cases of fifth disease are mild and resolve within 1-2 weeks without treatment. People with weakened immune systems, certain blood disorders, and pregnant people may experience more severe symptoms or complications.

Good hygiene habits and regularly cleaning shared surfaces can help lower the risk of infection and prevent the spread of fifth disease.