Key takeaways

Fifth disease, caused by human parvovirus B19, is a common and usually mild childhood illness, notable for its “slapped cheek” rash and more common in children ages 5 to 15.
It spreads through respiratory droplets and is most contagious when cold-like symptoms occur, before the rash appears.
Cold-like symptoms occur first, lasting up to 10 days. These symptoms are followed by a distinctive rash. Some people experience joint pain. While there is no cure for fifth disease, treatment focuses on relieving symptoms such as fever and joint pain.
Prevention strategies mirror those for other viral infections, including frequent handwashing and avoiding close contact with sick individuals; once infected, individuals typically gain immunity and do not contract the disease again.

Endless coughs and sneezes, runny noses, and unexplained itchy bumps—kids seem to be a magnet for germs. In our parent’s guide to childhood illnesses, we talk about the symptoms and treatments for the most common conditions. Read the full series here.

What is fifth disease? | Symptoms | Diagnosis | Treatments | Prevention

As an adult, I was checked for immunity to fifth disease. Despite working in daycare, I had never heard of it. It turned out I was immune from a past infection—even though I (nor my parents) never knew I had it as a child.

Fifth disease is very common in children, and usually mild, but in rare circumstances, it can cause complications. So, it’s important to know the signs of fifth disease—and what to do if you think your child has it.

What is fifth disease?

Fifth disease, also called erythema infectiosum, is a common and usually mild illness in childhood. It’s called fifth disease because it’s number five in a historical list of childhood rash illnesses (the other four being measles, rubella, chicken pox, and roseola).

It is caused by a human parvovirus B19 infection. “Most children are exposed and develop antibodies to parvovirus B19,” says Leann Poston, MD, a medical contributor for Ikon Health.

Fifth disease is contagious to both children and adults, but it is more common in children ages 5 to 15. Adults who have not had a previous fifth disease infection and who work with children (such as child care providers and teachers) are also at a higher risk of catching it.

How does a child get fifth disease?

Fifth disease spreads through droplets of an infected person (from speaking, sneezing, coughing, saliva, etc.). It can also be transmitted through blood, including from mother to fetus. Serious complications do not occur in most pregnancies affected by fifth disease, and fetal death from fifth disease is rare.

Fifth disease can be contracted or spread at any time of year, but outbreaks tend to be more common in winter and spring. Fifth disease is usually not serious. “Many people with fifth disease are either asymptomatic or have mild symptoms,” says Soma Mandal, MD and board certified internist at Summit Medical Group. “Most people recover in a few weeks.”

Because fifth disease can affect how the body makes red blood cells, it can be serious for people with a compromised immune system, such as people with HIV or leukemia, or for people who have types of sickle cell disease like sickle cell anemia.

Fifth disease symptoms

After contracting fifth disease, the incubation period is about two weeks before symptoms appear. It is most contagious during the first stage when cold-like symptoms are present, before the skin rash appears. Once the rash appears, most people are no longer contagious and can go to school, daycare, or work.

The initial symptoms of fifth disease include cold-like symptoms that last for seven to 10 days, such as:

Fever
Runny nose
Sore throat
Swollen glands
Headache
Diarrhea
Red eyes

As those symptoms begin to fade, the fifth disease rash develops. The characteristics include:

A bright red rash on the face that looks like a “slapped cheek” (more common in children than adults).
A body rash that begins on the torso then moves to the arms, buttocks, and legs. This comes after the face rash. It often appears lacelike. It is slightly raised and can be itchy, particularly if it appears on the soles of the feet. As it fades, it may take on a lacelike appearance.

“The rash may come and go for weeks, but usually lasts one to two weeks,” Dr. Poston says. It can briefly reappear weeks or months later when the child becomes hot while bathing, exercising, or spending time in the sun.

An important note: Descriptions of rashes are usually characterized by how they look on light skin. Skin conditions may look different on darker skin. Photos of skin rashes available both online and in medical schools tend to show the rash on light skin. More research and resources are needed to help parents and healthcare professionals recognize what these rashes look like on darker skin.

Some people also experience joint pain and swelling, called polyarthropathy syndrome. This symptom is more common in women, older teens, and adults (may be the only symptom in adults.) It occurs in hands, knees, wrists, ankles, or feet. Joint pain most commonly lasts one to three weeks, and typically does not cause long-term problems.

Do you need to see a doctor for fifth disease?

“Anyone in whom the diagnosis is not clear, appears ill, or whose fever will not go down should consult a healthcare provider,” says Dr. Poston. Take babies younger than 12 weeks to the pediatrician for a fever higher than 100.4 degrees F. Children younger than age 2 should see a physician for a fever higher than 104 degrees F that persists for more than 24 hours. Anyone with a fever for longer than three days should see a healthcare provider for professional medical advice, according to Dr. Poston. If you or your child develop joint swelling, see a healthcare provider. And if a child has sickle cell disease and you suspect fifth disease, the child should see a provider.

“If symptoms are lasting for more than a month, a doctor’s visit is advisable,” Dr. Mandal says. “If you have an immune or blood disorder and have symptoms of fifth disease, a doctor’s visit is recommended.” For example, children with sickle cell anemia should see a healthcare provider with any fever, particularly if they seem pale. Additionally, children with joint swelling or who seem to be getting worse with time should be examined by a healthcare provider, according to the American Academy of Pediatrics.

Fifth disease is usually diagnosed by a general practitioner, family healthcare provider, or pediatrician. Blood tests are available, but only performed under some circumstances (such as during pregnancy). Typically, fifth disease is diagnosed by a visual inspection of the face rash.

Fifth disease treatment

There is no treatment that cures the virus that causes fifth disease. Treatment is only to provide symptom relief of the viral infection.

“Most people who have fifth disease get better without treatment,” says Dr. Mandal. “Pain relievers such as [Tylenol] acetaminophen [or ibuprofen] can be taken for joint pain and fevers.”

Antihistamines may provide relief if the rash is itchy or uncomfortable.

Blood transfusions and hospitalization may be necessary for people with serious anemias.

Fifth disease prevention

According to the Centers for Disease Control and Prevention (CDC), you can prevent fifth disease the same way you avoid catching any other virus (such as a cold or COVID-19):

Frequent handwashing with soap and water, lasting at least 20 seconds each time
Cover coughs and sneezes
Avoid touching your face, nose, eyes, and mouth
Stay home when sick
Avoid others who are sick

Once someone has had fifth disease, they do not get it again, so most adults need not worry about catching it. Some pregnant people who have not had fifth disease and who work with children choose to stay home if there is a case of fifth disease present at their job, or for the duration of their pregnancy as a precaution. Parvo virus infection can cause serious pregnancy complications, so if you have a known parvo exposure during pregnancy, consult your obstetrician. There is no vaccination to prevent fifth disease.