What To Know about Fifth Disease ("Slapped Cheek" Disease)

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

This condition typically begins 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 lace-like patterned rash on the torso and limbs. Because of the rash on the cheeks, people sometimes call fifth disease "slapped cheek disease." 

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

Fifth Disease Symptoms 

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

• Fever
• Sore throat
• Cough
• Headache 
• Runny nose
• Muscle aches

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 body rash typically only develops in children and may be itchy. It usually lasts 7-10 days but can come and go for several weeks. The rash may have a lace-like appearance as it fades. 

Rather than 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 persists for months or longer.

Causes

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 breathe in.

You also could 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 cold or flu-like symptoms. Once these symptoms resolve, it's unlikely you will spread the illness.

Risk Factors

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

Diagnosis

Healthcare providers can usually diagnose fifth disease with a physical examination based on its distinctive "slapped cheek" rash, especially in children. 

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

Your body will produce antibodies for 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've ever had fifth disease at some point in your lifetime. 

Treatments for Fifth Disease 

Most cases of fifth disease are mild and go away within a week or two without treatment. Home care measures, like Tylenol (acetaminophen), rest, and drinking fluids can manage symptoms like fever, muscle aches, and joint pain.

Fifth disease can cause complications or more severe illness in pregnant people, immunocompromised people, and those with certain blood disorders. In people with anemia and sickle cell disease, fifth disease can temporarily reduce or stop the production of oxygen-carrying red blood cells, leading 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 cell counts, blood transfusions can help replenish the body's blood cell supply. 
• Intravenous immunoglobulin (IVIG): IVIG contains antibodies to parvovirus B19, which helps the body fight the virus. This can reduce the severity of the infection and prevent complications.

How To Prevent Fifth Disease 

There is no vaccine for preventing fifth disease, but you can lower the risk of infection by practicing good hygiene habits, including:

• Wash your hands often: Wash your hands with soap and water throughout the day. 
• 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 them until they are no longer contagious.
• Disinfect surfaces: To reduce the spread of the virus, regularly clean and disinfect surfaces like doorknobs, light switches, and countertops.

Complications

Most cases of fifth disease are mild and resolve with rest and time. Complications are more likely to develop in people with a weakened immune system, such as those with cancer or human immunodeficiency virus (HIV) and organ transplant recipients.

Complications are also more common in pregnant people and those with certain blood disorders, like sickle cell anemia and thalassemia. Potential 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 heart 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 their developing baby. Complications are more likely to occur in early pregnancy. Fetuses can develop anemia, which increases the risk of hydrops—or fluid buildup in the developing baby's organs and tissues that increases the risk of miscarriage.
• Persistent joint pain: Joint pain affects about 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. 

A Quick Review

Fifth disease is a viral infection that primarily affects children. It causes mild cold and flu-like symptoms followed by a bright red rash on the cheeks that eventually spreads to the torso and limbs. Adults can also get fifth disease, though 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 can develop 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.