What is fifth disease?

Fifth disease is a common childhood viral illness. It is called fifth disease because it is the fifth in a historical list of childhood illnesses that cause skin rashes.

Fifth disease is also called:

• parvovirus B19
• slapped cheek disease
• erythema infectiosum

The name 'slapped cheek disease' comes from the red rash that makes your cheeks look like they have been slapped.

It is a common infection — about 1 in 2 adults have been infected previously. Once you have had fifth disease, you will generally be immune for life.

What are the symptoms of fifth disease?

In children, the symptoms of fifth disease are often mild and you may not notice them. The first symptoms in a child may include:

• fever
• headache
• upset stomach (tummy)
• aches and pains

After a few days, they may have a bright red rash on their cheeks. This looks like the mark left by a slap.

Your child may also have a pink, lacy rash on their torso (trunk) and limbs. This may sometimes be itchy.

The rash usually clears up in 7 to 10 days. However, it may come and go for a few weeks, especially if they are exposed to the sun or after exercise.

A few children may get pain in the joints of their hands and feet.

Adults with fifth disease may not have any symptoms at all. They may also have a rash, joint pain or swelling. Joint pain and swelling are more common in adults. The joint pain usually takes 1 to 2 weeks to go away, but may last longer.

What causes fifth disease?

Fifth disease, or slapped cheek disease, is a viral infection caused by human parvovirus B19.

How is fifth disease spread?

The virus is spread through contact with infected mucus or droplets from the nose or mouth, such as through coughing and sneezing. It may also be passed from mother to unborn baby.

The incubation period for fifth disease varies from 4 to 14 days. This is the time between being infected and developing symptoms.

How long am I infectious with fifth disease?

You are infectious with fifth disease before the rash appears. Once the rash appears, the virus can no longer be passed on.

Children with slapped cheek are contagious until 24 hours after their fever has gone.

Fifth disease is very infectious. It will infect around half of all previously uninfected household contacts and up to 1 in 5 school contacts.

When should I see my doctor?

You should contact your doctor immediately if your child has been in contact with human parvovirus and they:

• have sickle cell anaemia
• have severe anaemia
• are taking long-term corticosteroids
• are immunosuppressed (have a weak immune system)

See your doctor if your child is unwell with a fever and a skin rash that does not blanch (disappear) when you press on it. This may be a sign of meningococcal infection.

If you are pregnant and have been exposed to someone with fifth disease, speak with your doctor or midwife.

How is fifth disease diagnosed?

Doctors can often diagnose fifth disease by noting the characteristic rash during a physical examination.

Blood tests may be done if you are at risk of complications. The blood tests detect antibodies to fifth disease, which can show both an active infection and previous infection.

How is fifth disease treated?

Because fifth disease is caused by a virus, antibiotics are not effective. Instead, treatment aims to manage the symptoms and can usually be done at home.

This is what you can do to help your child with fifth disease:

• Make sure they rest.
• Encourage them to drink plenty of liquids (such as water).
• Give them paracetamol or ibuprofen to help relieve any discomfort or fever if needed and suitable for your child.

Do not give children under the age of 16 years aspirin unless it is prescribed by a doctor. Aspirin can increase the risk of a potentially life-threatening condition in children.

Adults with fifth disease may need to rest or take pain relief medicine if they have joint pain. Your doctor or pharmacist will be able to advise which medicine is suitable for you.

What are the complications of fifth disease?

Fifth disease is usually mild in children and adults who are healthy.

In some people, fifth disease can cause serious health problems. It can affect the heart, nerves, joints or blood system.

In people with certain blood disorders or with a weakened immune system, fifth disease may cause aplastic anaemia.

What if I get fifth disease while pregnant?

If you are pregnant and come into contact with fifth disease, see your doctor or midwife as soon as possible.

Usually, there are no serious complications for you or your baby following exposure to fifth disease.

About half of all females have had fifth disease previously and are immune to parvovirus. This protects both you and your baby.

Even if you are not immune to fifth disease, the illness is usually mild and does not affect your baby.

Rarely, an unborn baby can develop anaemia or fluid accumulation (hydrops fetalis) from a parvovirus infection during pregnancy. This can lead to miscarriage and more commonly happens during the first half of pregnancy.

Can fifth disease be prevented?

There is currently no vaccine to prevent fifth disease.

Frequent hand washing is recommended to reduce the spread of fifth disease.

Exclusion from school and work is not likely to stop the spread of fifth disease. This is because people are contagious before they get the rash.

Resources and support

The Royal Children's Hospital has a fact sheet about fifth disease.

The Sydney Children's Hospitals Network has information on diagnosis and treatment of fifth disease.

The National Health and Medical Research Council (NHMRC) has a fact sheet on fifth disease, including tips for parents and carers.

Read more on common childhood rashes at Pregnancy, Birth and Baby.

If you have questions about fifth disease you can call the healthdirect helpline on 1800 022 222 (known as NURSE-ON-CALL in Victoria). A registered nurse is available to speak with 24 hours a day, 7 days a week.

Call Pregnancy, Birth and Baby to speak to a maternal child health nurse on 1800 882 436 or video call. Available 7am to midnight (AET), 7 days a week.

Languages other than English

The Royal Children's Hospital has a fact sheet on rashes in many community languages.

Health Resource Directory has fact sheets on rashes in children in a number of languages other than English.

Health Translations has information on rashes in a range of languages.