Fifth Disease in Children: Symptoms & Care Tips

Fifth disease is one of the most common childhood infectious diseases, affecting thousands of children across India and millions worldwide each year. Also known as erythema infectiosum, this viral condition causes the distinctive "slapped cheek" appearance that often worries parents. Understanding the symptoms, causes, and care tips for fifth disease helps you manage this usually mild but sometimes concerning illness with confidence.

What Is Fifth Disease?

Fifth disease, medically known as erythema infectiosum, is a viral childhood illness caused by human parvovirus B19. This This parvovirus infection primarily affects school-aged children between 5 and 15 years of age, though adults can contract it too. The condition gets its name from being historically classified as the fifth of six classic childhood rash diseases.

The hallmark of fifth disease is the bright red rash on the cheeks that gives the appearance of having been "slapped". This distinctive appearance, combined with a subsequent lacy body rash, makes fifth disease relatively easy to identify once the rash stage begins.

What Causes Fifth Disease?

Fifth disease occurs due to infection with human parvovirus B19, a DNA virus that specifically targets humans. Unlike the parvovirus that affects dogs and cats, parvovirus B19 cannot be transmitted between humans and animals.

After entering the body through respiratory droplets, the virus travels to the bone marrow, where it infects red blood cell precursors. This brief interruption in red blood cell production is harmless in most healthy children but can cause complications in those with existing blood disorders or weakened immune systems.

How Fifth Disease Spreads

• Respiratory droplets: The virus spreads when infected individuals cough, sneeze, or talk, releasing contaminated droplets into the air
• Direct contact: Sharing drinks, utensils, or toys with someone carrying the virus
• Surface contamination: Touching objects contaminated with fresh respiratory secretions
• Close proximity: Spending time in confined spaces with infected individuals, particularly during the early symptomatic phase
• Blood transmission: Rarely through blood transfusions or needle stick injuries

Contagious Period of Fifth Disease

Children are most contagious during the early phase—before the rash appears. During this period, which typically lasts 4-7 days, your child may seem to have a mild cold with low fever, headache, and general tiredness.

Interestingly, once the distinctive "slapped cheek" rash develops, children are generally no longer contagious. This means by the time you recognise fifth disease symptoms, your child can typically return to school or day care, provided they feel well enough to participate in normal activities.

Symptoms of Fifth Disease

Fifth disease symptoms typically develop in two distinct phases, making recognition easier once you know what to look for:

• Early symptoms (before rash appears):
  • Low-grade fever (usually under 38.5°C)
  • Mild headache and body aches
  • Runny or stuffy nose
  • Sore throat
  • General fatigue and irritability
  • Possible mild nausea
• Rash phase symptoms:
  • Bright red "slapped cheek" facial rash
  • Lacy, pink rash spreading over the trunk, arms, and legs
  • Mild itching, particularly with the body rash
  • Rash that fades and reappears with heat, sunlight, or physical activity
  • Possible joint pain in older children and teenagers

Stages of Fifth Disease Rash

The rash of fifth disease follows a predictable pattern. This helps distinguish fifth disease from other childhood infectious diseases with similar early symptoms.

1. Incubation period (4-21 days): Your child is infected but shows no symptoms
2. Prodromal phase (4-7 days): Mild cold-like symptoms appear; child is most contagious
3. Facial rash stage (1-4 days): Distinctive bright red cheek rash develops
4. Body rash stage (1-3 weeks): Lacy rash appears on trunk and limbs, may fade and reappear

Fifth Disease in Adults

While primarily affecting children, adults can contract this parvovirus infection, especially if they haven't been previously exposed. Adult fifth disease symptoms often differ from those in children, with less prominent facial rash but more significant joint pain and swelling.

In adults, joint symptoms may persist for several weeks or even months, particularly affecting hands, wrists, knees, and ankles. Pregnant women should seek medical advice promptly, as maternal parvovirus infection can, in rare cases, affect the developing baby.

Fifth Disease in Children

Children typically handle fifth disease better than adults, with most experiencing only mild discomfort. The condition is most common among primary school-aged children due to close contact in classroom settings and developing immune systems.

Healthy children typically recover completely without specific treatment, developing lasting immunity that prevents future infection. The main concerns for parents are typically the dramatic appearance of the rash and ensuring their child remains comfortable during recovery.

Risk Factors

Several factors increase susceptibility to this childhood infectious disease:

• Age: Children aged 5-15 years face highest risk
• School attendance: Close contact environments facilitate transmission
• Compromised immunity: Children with weakened immune systems
• Blood disorders: Those with sickle cell disease or other anaemias face increased complications
• Pregnancy exposure: Pregnant women working with children
• Healthcare settings: Exposure in medical environments
• Seasonal patterns: Higher transmission rates during late winter and spring

Complications of Fifth Disease

Most children experience uncomplicated recovery, but certain groups face increased risks:

• Severe anaemia: In children with blood disorders like sickle cell disease
• Arthritis-like symptoms: Joint pain and swelling, more common in teenagers
• Pregnancy complications: Studies in the National Library of Medicine indicate a risk of intrauterine foetal demise, miscarriage, or hydrops fetalis
• Immune system complications: Prolonged infection in immunocompromised children
• Aplastic crisis: A temporary cessation of red blood cell production, usually seen in children with chronic anaemia

When to See a Doctor

• High fever above 39°C or persistent fever
• Severe headache or neck stiffness
• Difficulty breathing or chest pain
• Extreme fatigue or weakness
• Signs of severe anaemia (pale skin, rapid heartbeat)
• Joint swelling or severe pain
• Rash accompanied by other concerning symptoms

How Fifth Disease Is Diagnosed

1. Clinical examination: Assessing the characteristic rash pattern and symptoms
2. Medical history: Reviewing recent symptoms and potential exposures
3. Blood tests: Checking for parvovirus B19 antibodies if diagnosis is unclear
4. Differential diagnosis: Ruling out other conditions with similar rashes

In most cases, doctors can diagnose fifth disease based on its distinctive rash and typical symptom pattern.

Treatment for Fifth Disease

No specific antiviral treatment exists for fifth disease, as it usually resolves naturally. Management focuses on symptom relief and comfort measures. Most children recover with simple home care including adequate rest, increased fluid intake, and age-appropriate pain relief for headaches or joint discomfort.

For children with underlying health conditions, closer medical monitoring may be necessary. Those with blood disorders might require specialist care to manage potential complications. The vast majority of healthy children need only supportive care while their immune system clears the parvovirus infection.

Is Fifth Disease Dangerous?

For most healthy children, fifth disease poses minimal danger and resolves without lasting effects. The dramatic appearance of the rash often causes more concern than the actual illness warrants. However, certain groups including pregnant women, individuals with compromised immune systems, and those with blood disorders should take additional precautions.

How to Prevent Fifth Disease

• Hand hygiene: Regular thorough handwashing with soap and water
• Respiratory etiquette: Teaching children to cover coughs and sneezes
• Avoiding sharing: Don't share drinks, utensils, or personal items
• Surface cleaning: Regular disinfection of frequently touched surfaces
• Isolation when symptomatic: Keeping children home during the contagious early phase
• Vaccination awareness: There is currently no vaccine available for parvovirus B19

Is Reinfection Possible?

The immune system typically clears parvovirus infection within 7–10 days, after which most people develop lifelong immunity. This means your child is unlikely to contract fifth disease again after recovering from their first infection.

When to Consult a Paediatrician

Contact your paediatrician if you're unsure about your child's symptoms or if they have underlying health conditions that might complicate parvovirus infection. Children with blood disorders, immune system problems, or chronic illnesses require professional medical assessment.

Conclusion

The key to managing fifth disease lies in recognising fifth disease symptoms early, providing comfort care during recovery, and knowing when to seek professional medical advice. Most children bounce back quickly from this parvovirus infection, and develops lifelong immunity thereafter.

When health concerns arise, having access to reliable diagnostic services provides invaluable peace of mind. With a comprehensive portfolio of over 4,000 tests and profiles—including specialised panels for infectious diseases—Metropolis Healthcare is equipped to support your family’s health journey. Our home sample collection service—spanning over 10,000 touchpoints across India—ensures accessible, accurate testing from the comfort of your home, ensures you can access quality diagnostics from the comfort of your home.

FAQs

What is fifth disease, and how serious is it?

Fifth disease, or erythema infectiosum, is a mild viral childhood infectious disease caused by parvovirus B19. For healthy children, it's typically not serious, causing a distinctive rash and mild symptoms that resolve within 1-3 weeks without specific treatment.

What are the first signs of fifth disease?

Early fifth disease symptoms resemble a mild cold, including low fever, headache, runny nose, and general tiredness. These symptoms appear 4-21 days after infection and last about a week before the characteristic rash develops.

Is fifth disease contagious?

Yes, fifth disease is contagious, but primarily during the early cold-like phase before the rash appears. Once the distinctive facial rash develops, children are typically no longer contagious and can return to normal activities.

How long does the fifth disease rash last?

The facial rash usually lasts 1-4 days, while the body rash can persist for 1-3 weeks. The rash may fade and reappear with heat, sunlight, exercise, or emotional stress for several weeks after initial appearance.

Can adults get fifth disease?

Yes, adults can contract this parvovirus infection, though it's less common than in children. Adult symptoms often include more prominent joint pain and less obvious facial rash compared to children's presentations.

How is fifth disease treated?

No specific fifth disease treatment exists. Management focuses on comfort measures including rest, fluids, and appropriate pain relief for symptoms.

Can you get fifth disease twice?

Reinfection is extremely rare. After recovering from erythema infectiosum, most people develop lifelong immunity against parvovirus B19.

Is fifth disease dangerous during pregnancy?

While most pregnant women who contract parvovirus infection have healthy babies, there is a risk of foetal complications including anaemia or even miscarriage. Consult your healthcare provider if you have been exposed to the disease.

References

• https://www.cdc.gov/parvovirus-b19/about/index.html
• https://www.ncbi.nlm.nih.gov/books/NBK513309/
• https://www.nhs.uk/conditions/slapped-cheek-syndrome/
• https://www.mayoclinic.org/diseases-conditions/parvovirus-infection/symptoms-causes/syc-20376085