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Fifth Disease (Parvovirus B19)

Fifth Disease (Parvovirus B19) Fifth Disease (Parvovirus B19)

By: S. Elizabeth Williams, MD, MPH, 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 because it was the fifth disease on a 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.

The illness usually is not serious. Symptoms of fifth disease may include a mild rash, fever, runny nose, muscle aches, and a headache. Outbreaks in school-aged children are common in late winter and early spring.

How do I know if my child has fifth disease?

Fifth disease starts off like many other viral infections, so it can be hard to know for sure if your child has it. Your doctor will look at the rash and may do blood tests to check for antibodies to the virus.

The rash is the best clue. A bright red rash that first appears is what is known as the “slapped cheek" rash. Sometimes another rash that looks lacy appears a few days later. The 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, the rash can reappear weeks or months later when your child is hot (during exercise, bathing, etc.).

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 before the rash appears and is not contagious after the rash appears. Once a person has fifth disease, they usually cannot get it again.

Good hand hygiene is the best way to prevent the spread of fifth disease in school, child care, and at home. Remind children to throw away used tissues and make sure that surfaces and objects that children touch are cleaned and sanitized regularly.

When can my child go back to school or child care?

When you see a rash, 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.

Does the virus ever cause serious problems?

Yes. 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 must 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 for pregnant women and their babies. Rarely, serious problems can occur if the virus gets passed on and makes it hard for the fetus to make red blood cells. This can lead to severe anemia that causes hydrops fetalis, a buildup of fluid that can lead to heart failure or death.

Pregnant women with fifth disease may need to have the following tests:

  • Ultrasound to see if the baby is having problems.

  • Amniocentesis, a procedure to take amniotic fluid from the womb.

  • Cordocentesis, a procedure to check umbilical cord blood and find out how severe your baby's anemia is. Usually, the anemia is not severe.

If you or your child is diagnosed with fifth disease, you should let any pregnant women 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 chicken pox (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 with questions. Call right away if your child's symptoms seem to be getting worse instead of better, you notice joint swelling, your child has chronic anemia, or your child looks very pale.

More Information

About Dr. Williams

S. Elizabeth Williams, MD, MPH, FAAP, a board-certified pediatrician, is an assistant professor of general pediatrics at Monroe Carrell Jr. Children's Hospital in Nashville, Tenn. Within the American Academy of Pediatrics, Dr. Williams sits on the Education Committee on for the Society for Pediatrics Infectious Diseases. Her research interests include vaccine hesitancy, vaccine safety, and medical education. Dr. Williams is married to a pediatric hospitalist and has three active sons.

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American Academy of Pediatrics Section on Infectious Disease (Copyright © 2020)
The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.
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