Fifth disease: slapped cheek syndrome

Fifth disease, which is also known as ’slapped cheek syndrome’ or erythema infectiosum is a common viral infection caused by parvovirus B19. Fifth disease is usually a disease of school aged children but occasionally adults can catch it if they have not been exposed in childhood.

How it is spread

Fifth disease is a highly contagious disease, spread by airborne droplets of respiratory secretions (saliva, sputum) when people sneeze or cough. It can also be spread by blood transfusion. It can only be caught from humans and is different from the parvovirus found in dogs and other animals.

Symptoms

The characteristic symptom is a bright red rash on the face, which has a ‘slapped-cheek’ appearance. A generalized lace-like rash then appears on the body. The rash can sometimes be itchy. It will usually resolve in 7-10 days, but can come and go for several weeks particularly after exposure to sunlight or exercise.

Sometimes, before the rash, the person may have ‘flu-like’ symptoms for 1-4 days, such as sore throat, malaise, headache, diarrhoea and occasionally a fever. It is during this stage of the illness that people are infectious to others.

The symptoms generally develop 4-20 days after the person is infected. Unlike children the majority of affected adults will also experience joint aches and pains, which can last for days to months.

How serious is fifth disease

Most people with fifth disease recover without any complications. However, people who are immunosuppressed or who have anaemia may develop severe, chronic anaemia, and may remain infectious for a prolonged period.

For most pregnant women who develop fifth disease, there are no serious complications for them or their unborn baby. Less than 10% of pregnant women in their first 20 weeks of pregnancy who are not immune and acquire parvovirus B19 infection have a miscarriage. The risk of miscarriage reduces to less than 1% in the second half of pregnancy.

In about 5% of infections during the first 20 weeks of pregnancy, the unborn baby can develop severe anaemia and other complications.

Infectious period

A person is infectious for the 7-10 days before the rash appears. Once the rash appears the person is usually no longer infectious.

Who is at risk

Fifth disease can affect any age group, but most commonly affects children between the ages of 5-15 years. Most adults have had the infection when they were young (some without any symptoms) and have long term immunity. If adults get parvovirus B19 they are more likely to get joint pain as well as the other symptoms.

Treatment

Most people do not require any specific treatment other than rest, fluids and paracetamol. If the skin rash is itchy, your doctor can advise you regarding creams or lotions that may help.

Fifth disease is caused by a virus, so antibiotics are not helpful.

Pregnant women and people who are immunosuppressed who may have been in contact with someone with fifth disease, or who think they may have the disease, should contact their doctor for further advice.

How fifth disease can be prevented

Maintaining good hygiene is the best way to stop the spread of parvovirus B19. Adults and children should cough into their upper arm or inner elbow and wash their hands regularly. 

If a tissue is used to cover the nose or mouth when sneezing or coughing, the tissue should be put into the bin immediately followed by handwashing. Handwashing even when not coughing is important to prevent diseases spreading. Surfaces contaminated by discharge from the nose and throat should be cleaned.

As people are not infectious once the rash appears, they should not be excluded from child care, preschool, school or work.

Contact

For more information contact your nearest Centre for Disease Control.

Last updated: 27 June 2017