Fifth disease is a benign viral infection commonly seen in school-age children.  It is characterized by an easily-recognized rash on the face that has a "slapped-cheek" appearance and a full-body rash that develops a lace-like appearance.  Several days before the rash appears, mild fever and joint pains are common.  Parvovirus B19, the cause of fifth disease, leads to a temporary halt in production of red blood cells.  This is typically harmless in healthy children but may cause severe anemia in children with sickle cell disease or with other causes of anemia.  Fifth disease resolves after several days without treatment.

What causes fifth disease?

Parvovirus B19 -  a virus that is spread by respiratory secretions from child to child.  Parvovirus B19 affects humans only, unlike other strains of parvovirus that affect animals only (your pet dog may have gotten a "parvo" shot for one of these strains).

What are the symptoms of fifth disease?

Fifth disease may be asymptomatic, or it may start with several days of mild fever and/or joint pains.  A rash may develop on the face that has a "slapped-cheek" appearance, that is... a non-raised red rash over the cheeks with sharp edges.  Shortly after the face rash, a rash appears on the torso and arms and legs (not on the palms or soles of the feet) that has a lace-like or spiderweb appearance. 

• Fever
• Joint pains
• Face rash ("slapped cheeks")
• Body, arms and leg rash (lace-like)

When is parvovirus infection dangerous?

Children with anemia due to chemotherapy, sickle cell disease, or other chronic illness may develop severe anemia with parvovirus infection.  Parvovirus B19 infects the red blood cell precursors in the bone marrow causing them to self-destruct.  This temporarily shuts down production of red blood cells.  For healthy children, this causes little effect on the body's red blood cell supply because red blood cells in the blood stream survive about 120 days and don't need to be replaced quickly. 

Is fifth disease contagious?

Yes.  However, once the rash appears (and the diagnosis is made), the virus is no longer contagious.

How is fifth disease diagnosed?

The diagnosis is usually obvious if the rash is present.  Blood testing is available but usually not necessary.

How is parvovirus infection treated?

There is no treatment for parvovirus.  For children with other diseases that develop anemia, sometimes blood transfusions are necessary.

I am pregnant.  Can parvovirus harm my baby?

In rare cases, parvovirus infection in a pregnant female can cause severe anemia in the fetus.  This probably occurs in less than 5% of parvovirus infections in pregnant females.  In most cases the infant will not be permanently affected.

Can fifth disease be prevented?

Careful handwashing and avoidance of children with fever may be helpful.  There is no vaccine for parvovirus B19.

Photo - Note the left side of this boy’s face displaying signs of erythema infectiosum, or Fifth disease. Human parvovirus B19 is the cause of erythema infectiosum, or Fifth disease, a common rash illness that is usually acquired in childhood. B19 may be transmitted through contact with infected persons, fomites, or large airborne droplets. CDC 1975. Used with permission.