STORY BY“I have the fifth disease!” my 4-year-old daughter proudly announces as she pats the head of the baby next to us. The baby's mother hugs her child close, eyeing the angry red rash coloring my daughter's cheeks and arms.
“She's not contagious,” I blurt out, trying to reassure the mother at the party, who appears only partly convinced. I don't blame her. The rash looks scary and the word “disease” sounds scary. But for most children, fifth disease is relatively mild.
And by the time children begin sporting the signature bright red rash on their cheeks (hence fifth disease's nickname, “slapped cheek disease”) they can no longer infect others.
“What's interesting about fifth disease is that it is contagious only in the early part of the illness,” says Amy Vyas, MD, assistant professor of pediatrics at The University of Texas Medical School at Houston. “By the time the patient presents with the rash, she is no longer contagious.”
The baby at the party was safe, but my daughter's preschool classmates were not. Many children have mild or no symptoms in the early part of the illness, so they unwittingly infect their classmates. In my daughter's class, no one seemed immune (during school outbreaks, as many as 60 percent of students may get fifth disease, according to the US Centers for Disease Control and Prevention). Every day, a new kid joined the rosy cheeks club.
Fifth disease got its name in the early 1900s because it was one of five common childhood diseases that caused a rash—measles, scarlet fever, rubella and Dukes' disease were the other four. The other diseases eventually were named, while fifth disease retained its numerical moniker.
The disease is caused by parvovirus B19, a viral illness that infects only humans. A child cannot catch parvovirus from a pet dog or cat, and a pet cat or dog cannot catch human parvovirus B19 from an ill child. Children catch parvovirus from contact with one another's respiratory secretions. They spread the disease to their friends and classmates by coughing, sneezing or sharing utensils.
How is fifth disease diagnosed?
Fifth disease is diagnosed once the child has the typical 'slapped cheek' rash. A blood test can also be performed to check for viral antibody level, but the majority of the time diagnosis is based on clinical symptoms.
When can my child go back to school?
Once your child has the rash, she is no longer contagious. So she may return to daycare or school.
How can I prevent my child from getting fifth disease?
Parvovirus B19 is transmitted by respiratory secretions: that means it hangs out in your sputum, nasal secretions, and saliva. So, the virus is spread from one person to another by coming into contact with those secretions, by coughing, sneezing or sharing utensils. To prevent it, always practice good hygiene, frequent hand washing and not sharing cups and utensils with others.
While fifth disease affects mainly children, adults also can contract it if they did not have fifth disease as children and developed immunity to the disease. The disease may be more dangerous for persons with certain medical conditions and women who are pregnant.
“Patients with sickle cell anemia or other types of anemia can become severely anemic when infected with this virus,” Vyas says. “Also patients with weak immune systems or leukemia can have a very serious form of this disease. Additionally, pregnant females who may have been exposed during the infectious stage of the illness may sometimes have serious complications and need to consult with their obstetrician immediately.”
About half of pregnant women are immune to parvovirus and pass that immunity on to their unborn children. Most women who aren't immune develop only a mild form of the illness. In a very small percentage of women—less than 5 percent of all pregnant women who are infected with parvovirus B19—the virus will cause severe fetal anemia and increase the risk of miscarriage.
In children, the disease is more of a nuisance than anything else—one I thought my family had avoided. A couple of weeks into the outbreak at my daughter's school, she was still rash-free and feeling fine. In reality, she was in the incubation phase of the disease, which can be quite long. A person exposed to the virus usually becomes ill four to 14 days after being infected with the virus, but it may take up to 20 days after infection for a person to become ill.
The first symptoms of fifth disease are similar to the common cold or flu—fever, tiredness and sore throat. These symptoms were so mild in my daughter that we wrote them off as signs of a passing cold or seasonal allergy. Children are contagious during this phase.
Once the first symptoms go away, children may have no symptoms at all for several days until they break out in a bright, rosy red rash on their cheeks. This is often the first time parents realize something is wrong with their child. Children also may have a faint, lacy-type rash on their arms, leg and trunk area, which may be accompanied by mild joint swelling. Joint swelling is most common in adults.
While nasty-looking, the rash is usually not dangerous, just a little itchy and embarrassing to more self-conscious kids. Many children in my daughter's class, including her, stayed home for a day or two when the rash was at its peak. Other kids didn't miss a minute of school, oblivious to their rash-covered faces and bodies.
That first stage of the rash, when it is on the face, lasts an average of two to four days. The second stage of the rash appears as a patchy rash on the arms and legs then turns into the third stage—a lacy, faintly red-colored rash. The rash usually goes away in seven to 10 days.
To make the wait more tolerable for my daughter, we played the “where will the rash show up next?” game. Every morning, we looked in the mirror and checked out where it was on her body. First the cheeks, then the chest, then the arms, then the legs. Then one day—about 10 days after the rash first appeared—it was gone. Just like that. She had clear skin and a lifelong immunity to fifth disease.
Rest, fluids, pain relievers and time are the best treatments for fifth disease, Vyas says. Fifth disease has no cure and no medicines or vaccines have been developed to combat the virus. Thankfully, the symptoms of fifth disease are so mild that many children don't need treatment—just a little sympathy and patience.
“If you suspect the disease, you should speak with your child’s physician to confirm the diagnosis,” Vyas adds. “It’s better to get fifth disease while you’re young and resilient and symptoms are less severe. And once your child is affected, he is protected for life.”
Last Updated: 5-27-2009
The University of Texas Health Science Center at Houston (UTHealth), the most comprehensive academic health center in The UT System and the U.S. Gulf Coast region, is home to schools of biomedical informatics, biomedical sciences, dentistry, medicine, nursing and public health. UTHealth educates more healthcare professionals than any health-related institution in the State of Texas and features the nation’s seventh-largest medical school. It also includes a psychiatric hospital and a growing network of clinics throughout the region. The university’s primary teaching hospitals include Memorial Hermann-Texas Medical Center, Children’s Memorial Hermann Hospital and Lyndon B. Johnson General Hospital. Founded in 1972, UTHealth’s 10,000-plus faculty, staff, students and residents are committed to delivering innovative solutions that create the best hope for a healthier future.
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Dr. Amy Vyas is an assistant professor of pediatrics at UTHealth Medical School.
Simple Ways to Help
Young and Old Eyes
May is Healthy Vision Month and it is imperative to take care of eyes whether they’re young or old.
Children should have their vision checked by age 6, even if there aren’t any signs of eye problems. Healthy eyes and vision are very important to a child’s development. Finding and treating eye problems early on can save a child’s sight. Two common eye problems in children are:
Both of these eye problems can be treated if they are found early.
Here are ways to help your child develop vision skills:
Don’t let poor vision put elders at risk. Leave a three-foot, clear path through each room of their house. Outline edges of steps, coffee tables, doorways and bathtubs with colored tape to contrast with surrounding areas. Install lights along outdoor pathways and keep foyers well lit to avoid having to enter dark areas. Replace switch plates with colors that contrast with walls, or outline them with tape of contrasting colors. It is also always smart to use nightlights during the night.
