By: Margaret Ikeda, MD, MS, FAAP
If your child has bright red cheeks but has not been playing outdoors in the cold, it might be fifth disease.
This common childhood illness got its name from where it fell on historical list of six common
skin rash illnesses in children. It is caused by a virus called parvovirus B19, which is also known as
Erythema infectiosum.
Outbreaks of fifth disease are common among preschool-age and elementary school-age children, especially in late winter to early spring. In August 2024, however, the Centers for Disease Control and Prevention (CDC)
reported a rising number of cases of fifth disease in the U.S. The biggest increase was among children ages 5 to 9 years old.
Symptoms of fifth disease
Many people with fifth disease have mild or no symptoms. When they do have symptoms, these may include a mild rash, fever, runny nose, muscle aches and a headache. But fifth disease can cause serious health complications for some people.
For example, children with blood disorders, weakened immune systems and cancer are at higher risk for complications. So are
pregnant people, who should talk with their doctor if they have been exposed to fifth disease.
How do I know if my child has fifth disease?
Fifth disease starts off like many other viral infections. Because of this, it can be hard to know for sure if your child has it.
Before diagnosing fifth disease, your child's pediatrician will look at the rash. This provides the best clue. They may do blood tests to check for antibodies to the virus. Once you have had fifth disease, you are immune and cannot get it again.
What does parvovirus rash look like?
A bright red rash that first appears with fifth disease is what is known as the "slapped cheek" rash. Sometimes another rash that looks lacy appears a few days later. A second rash often starts on the trunk and spreads to the arms, legs, and even the soles of the feet. It may be itchy but usually goes away after about a week.
Even after a child is better, a rash can reappear weeks or months later. This typically happens when your child is hot, like while they are exercising or bathing, for example.
How does fifth disease spread?
Fifth disease spreads from person to person through respiratory droplets.
Symptoms usually show up 4 to 14 days after being exposed to the virus, with the slapped-cheek rash showing up about 4 to 21 days after your child gets infected.
A child is most contagious in the first 5 days before the rash appears. The symptoms in the first phase are fever, muscle aches and tiredness. Once the rash appears, the person is no longer contagious.
Good
hand hygiene is the best way to prevent the spread of fifth disease in
school, child care, and at home. Remind children to cough or sneeze into a tissue or their elbow, but not their hand, and to throw away used tissues. It is also important to make sure surfaces and objects are cleaned and sanitized regularly.
When can my child go back to school or child care?
When you see a rash caused by parvovirus, your child is no longer contagious. Fifth disease is often mild and goes away with some rest and recovery at home. Your doctor may suggest
acetaminophen for fever, aches or pain.
How does parvovirus cause serious problems for some children?
The virus can affect the way the body makes red blood cells, the cells that carry oxygen through the body. This puts children who have a blood disorder or weak immune system at serious risk if they catch the virus.
The virus can also cause red blood cell counts to drop so low that a blood transfusion is needed. Children with
cancer such as leukemia, HIV infection, and certain types of anemia (low red blood cell counts) such as from
sickle cell disease, often need to go to the hospital if they catch fifth disease. If your child has any of these conditions, check with your doctor at the first sign of the rash.
What if I get fifth disease when I am pregnant?
Most times, fifth disease does not cause problems in pregnancy. Rarely, serious problems can occur if the virus gets passed on in the early stages of pregnancy and makes it hard for the fetus to make red blood cells. This can lead to severe anemia in the baby and risk of miscarriage.
Pregnant people who are exposed to fifth disease may need to have additional tests and should see their obstetrician or health care provider. A blood test for parvovirus B19 antibodies may indicate that you are protected (immunity) against fifth disease. It can tell you whether you have had a recent or past infection.
If you or your child is diagnosed with fifth disease, you should let any pregnant people know who may have been exposed.
Can fifth disease be confused with another rash?
There are many other skin rash illnesses, but not all of them look the same. Some—like
measles, rubella (German measles), and chickenpox (varicella)—are easy to prevent if your child is up to date on
immunizations.
Viruses also are to blame for common childhood skin rashes like
hand, foot and mouth disease,
roseola and even
cold sores.
When should I call my child's doctor?
If you think your child may have fifth disease, it's okay to call your pediatrician's office with questions. Your child may need to see the doctor if their symptoms seem to be getting worse instead of better. Also reach out if you notice joint swelling, your child has chronic anemia or they look very pale.
More information
About Dr. Ikeda
Margaret Ikeda, MD, MS, FAAP, is a board-certified pediatrician, working in primary care at the Yale University School of Medicine. She has been a member of the American Academy of Pediatrics Section on Infectious Diseases for many years. Her interests include travel medicine, adoption and sports medicine. She supports members of the Armed Forces.
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