Fifth Disease

What Is Fifth Disease? Symptoms, Causes, Diagnosis, Treatment, and Prevention

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Updated on March 29, 2023
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Fifth disease, also called erythema infectiosum, is an illness caused by a virus known as parvovirus B19. Though fifth disease is more common in children, adults can have it, too, sometimes without any noticeable symptoms.

The name “fifth disease” comes from the fact that, in the past, it was fifth on a list of the most common rash illnesses experienced by children.

 The virus is highly contagious — easily spread through respiratory droplets, such as those that are released when an infected person coughs or sneezes.

In most cases fifth disease isn’t a serious illness, and you will heal without prescription medications. However, if you or your child has an underlying medical condition, it may increase your risk of complications. For example, if you or your child has a weakened immune system or sickle cell anemia, or if you are pregnant, contact your doctor right away.

Signs and Symptoms of Fifth Disease

It’s possible for someone to have fifth disease and not experience any symptoms; approximately 20 percent of people who get the virus don’t have any symptoms. They can, however, still pass the infection to others.

Symptoms usually appear about 4 to 14 days after exposure to parvovirus B19.

 Initially, the symptoms of fifth disease will resemble those of many other viral infections such as a cold or the flu. Some symptoms are typically found early on:

After a few days, a distinctive bright red rash may develop on the cheeks, often referred to as a “slapped cheek” rash — this is the classic telltale sign of fifth disease infection. (This rash is more common in children than in adults.)

This may be followed a few days later by a rash that appears on the chest, back, arms, legs, and buttocks. The rash may be itchy, especially on the soles of the feet. It disappears within about 10 days but may come and go for a few weeks. As it starts to disappear, it may appear to have a lacelike pattern.

Fifth disease can also cause pain and swelling in the joints, particularly in the hands, feet, and knees. This symptom is rare in children — only about 10 percent of kids will experience joint pain and inflammation — but it is very common in adults, especially women. The joint problems typically last for a few weeks but can persist for months or longer.

In most cases, fifth disease goes away on its own. But if you or your child has a weakened immune system or sickle cell anemia, or if you are pregnant, there’s an increased risk of complications so it’s important to get medical attention.

Call your pediatrician if you notice the following:

  • The symptoms are getting worse instead of improving.
  • Your child has swelling or pain in the joints.
  • Your child looks pale.

Causes and Risk Factors of Fifth Disease

Parvovirus B19 causes fifth disease, and the illness occurs most often in the spring.

 Fifth disease is spread easily by coming into contact with saliva or mucus carrying the virus; if an infected person coughs or sneezes near you, you could be at risk for catching it. Parvovirus B19 can also spread through blood. If a pregnant woman is exposed to the virus, she can pass it on to her baby, which in rare cases can lead to serious problems.
Someone who is infected with the virus is most contagious when they have cold- and flu-like symptoms. By the time a child develops a rash, they are no longer contagious and can usually go back to school.

Parvovirus B19 only infects humans, so you can’t get it from or give it to your pets.

How Is Fifth Disease Diagnosed?

Doctors typically diagnose fifth disease based on symptoms — the cold- and flu-like symptoms that are accompanied by the “slapped cheek” rash common in children — but they may also decide to order blood tests to confirm the diagnosis in some rare cases (such as for pregnant women or individuals with anemia).

Prognosis of Fifth Disease

In most cases, fifth disease is a mild illness for children and adults who are otherwise healthy, and it goes away with some rest at home. Most people recover completely once the infection is over.

Once they recover completely from fifth disease, most people develop an immunity that can protect them from future parvovirus B19 infections.

Duration of Fifth Disease

In healthy children and adults, symptoms typically last for a couple of weeks and go away on their own with little or no treatment.

The rash that may develop usually goes away within a week to 10 days, though it may come and go for a few weeks. Joint pain typically lasts one to three weeks, though it can go on for longer.

 About 10 percent of adults with joint symptoms will experience prolonged problems.

Treatment and Medication Options for Fifth Disease

Treatment may involve medication to help relieve symptoms.

Medication Options

In some cases, your doctor may recommend over-the-counter pain relievers and other medications to relieve pain and discomfort from symptoms such as fever, itching, and joint pain and swelling. Suggested medications may include these options:

  • Acetaminophen
  • Nonsteroidal anti-inflammatory drugs, such as ibuprofen
  • Antihistamine to relieve itching
An important note: Never give a child or teenager aspirin when they are ill with any virus, as it can increase the risk for Reye’s syndrome, a rare but serious disorder that can cause brain and liver damage.

Prevention of Fifth Disease

No vaccine can prevent fifth disease. The best way to reduce your risk of getting the virus is to practice good hygiene habits (and teach them to your child):

  • Washing your hands thoroughly and often with soap and water
  • Covering your mouth and nose with your elbow when you cough or sneeze
  • Being careful to avoid touching your eyes, nose, or mouth
  • Avoiding close contact with people who are sick
  • Staying home and not going to work or school when you or your child is sick
Pregnant women should avoid contact with children who have been diagnosed with fifth disease since the condition can in rare cases cause anemia in unborn babies and even miscarriage in a small percentage of women.

Complications of Fifth Disease

While fifth disease is usually a mild illness for most people, certain individuals can be at increased risk for complications. If you have a weakened immune system, have a blood problem such as anemia, or are pregnant, you may be at risk for serious complications from a parvovirus B19 infection.

Possible complications from fifth disease include these issues:

Anemia Because fifth disease can interfere with making new red blood cells in the body, adults and children who have a compromised immune system or a blood disorder such as sickle cell disease face an increased risk of severe anemia and other complications.

Fetal Anemia and Miscarriage In most cases, fifth disease is not a problem for pregnant women. Approximately half of all pregnant women are immune to the virus, which means they and their fetuses are usually protected from getting the infection

 Pregnant women who do contract the virus usually experience only a mild illness and don’t experience any problems. However, in less than 5 percent of pregnant women who get fifth disease, the fetus may develop severe anemia and the infection may lead to a miscarriage.

 This is why pregnant women who may have come into contact with parvovirus B19 are advised to contact their obstetrician as soon as possible.
Arthritis While joint pain and swelling are not common in children with fifth disease, nearly 80 percent of adults experience problems in their joints one to three weeks after infection with parvovirus B19.

 While these symptoms usually go away after a week or two, approximately 10 percent of adults with fifth disease–related joint problems will continue to experience chronic joint pain and difficulties that can last for years.

Research and Statistics: Who Has Fifth Disease?

Anyone can get fifth disease, but the illness is most common among school-age children — ages 5 to 15.

Because the infection is highly transmissible, it gets easily passed from one person to another at places where children gather, such as school.

Your body’s immune system builds up a defense against parvovirus B19 once you’ve been exposed to the virus, so you should be immune to it if you had fifth disease as a child. (This is why adults typically do not get the disease.)

Infections That Are Similar to Fifth Disease

Numerous other skin rash illnesses may be confused with fifth disease:

In adults, common fifth disease symptoms of joint pain and swelling can resemble those of other conditions as well:

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Erin C. Mayfield, DO

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Erin C. Mayfield, DO, is board-certified in lifestyle medicine and obstetrics-gynecology, and is a Harvard Culinary Health Education Fundamentals coach. She is the founder and CEO of Lifestyle Medicine Wellness and Recovery, an interactive group-coaching medical practice offering personalized lifestyle interventions and culinary medicine classes on a web-based platform. She has over 40 years of experience taking care of patients, primarily in a rural community in Georgia. Her passion has always been helping people improve longevity and resilience using the six pillars of health.

Dr. Mayfield loves community outreach programs and is a physician volunteer at the Health & Hope Clinic in Pensacola, Florida. She teaches nutrition science and culinary medicine in various locations in northwest Florida, including as volunteer faculty at the University of West Florida's Leisure Learning program, and does speaking engagements to introduce the community to lifestyle medicine. She is a medical editor for Natural Awakenings magazine.
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Katherine Lee

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Katherine Lee is a writer and editor who specializes in health, science, and parenting content. She has written for Verywell, where she covered school-age parenting, and worked as an editor at Parenting and Working Mother magazines. She has written and edited numerous articles and essays on science, parenting, and children's health and development for What to Expect, the American Association for the Advancement of Sciences, the American Psychological Association, and Newsweek, among others

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Additional Sources