Fifth Disease (Parvovirus, Erythema Infectiosum)

Fifth disease (parvovirus, erythema infectiosum) facts

  • A virus causes fifth disease.
  • Symptoms include low fever, fatigue, a "slapped cheeks" rash, joint pains, and a whole body rash.
  • Doctors make a diagnosis of fifth disease based on clinical features.
  • Rarely, fifth disease can become complicated.
  • Fifth disease can cause miscarriage in pregnant women.

What is fifth disease? What causes fifth disease?

Fifth disease is a viral illness caused by human parvovirus B19. Erythema infectiosum and slapped cheek syndrome are other names for fifth disease. Health care professionals first described fifth disease in 1896 and named the illness fifth disease because of its fifth position in the numerical classification of six childhood illnesses associated with rashes (exanthems). Other numbered viral exanthems included measles (rubeola or first disease), rubella (German measles or third disease), and roseola infantum (sixth disease). The bacterium Streptococcus pyogenes causes scarlet fever, or "second disease." Doctors no longer classify fourth disease as a clinical entity. Health care providers did not rename these illnesses until the molecular era, when it became possible to isolate viruses and bacteria. Parvovirus infection is very common. Almost 50% of adults have had a parvovirus B19 infection but often do not remember having it because this infection frequently does not cause symptoms.

What are fifth disease symptoms and signs in children and adults?

Fifth disease generally occurs in school-age children between 4-10 years of age, but it can affect any age group. Parvovirus infection most commonly occurs during the winter and spring. The illness classically begins with a low-grade fever, headache, runny nose, sore throat, and malaise (a sense of not feeling well). Of course, these cold-like symptoms mimic any other viral illness, so it is impossible to determine the cause early in the illness. After about a week, a characteristic bright red rash on the cheeks (the so-called "slapped cheeks") follows the initial symptoms. Finally, after three to four days, a fine, red, lace-like rash can develop over the rest of the body. This rash may last for five to seven days and occasionally comes and goes for several weeks. The other symptoms are usually gone by the time the rash appears. Patients with the rash are usually not contagious. Unfortunately, as with many other viral illnesses, the features and timing of the different stages of illness are often unpredictable.

Unlike other viral infections that usually cause hand, foot, and mouth disease (namely coxsackievirus A16 and enterovirus 71), fifth disease does not typically involve the palms and soles. However, some adults infected with parvovirus B19 can develop redness and swelling of hands and feet.

Are there other symptoms that can occur with fifth disease?

Around 5% of children and about half of adults with fifth disease experience joint pains. This arthritis or arthropathy is more common in females than males, is usually temporary, lasting for a few days to weeks, and may become a long-term problem for months. People with arthritis from fifth disease usually have stiffness in the morning, with redness and swelling of the same joints on both sides of the body ("symmetrical" arthritis). The joints most commonly involved are the knees, fingers, and wrists.


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What are the serious complications of fifth disease? Is infection with fifth disease dangerous during pregnancy?

Rarely, these patients develop erythrocyte aplasia, meaning the bone marrow stops forming a normal number of red blood cells (anemia). This complication is rare and usually transient, but anemia can be life-threatening. Patients who have compromised immune systems (by disease or treatment) are at high risk of this complication.

Pregnant women (who have not previously had the illness) should avoid contact with patients who have fifth disease. The fifth disease virus can infect the fetus prior to birth. Although no birth defects have been reported because of fifth disease, for 2%-10% of B19-infected pregnant women, fifth disease can cause severe anemia and even the death of the unborn fetus (by hydrops fetalis). Blood tests for parvovirus B19 are not routinely included in preconception or antenatal screenings.

What is the treatment for fifth disease?

The only available treatment is supportive. Fluids, acetaminophen (Tylenol), and rest provide relief. Antibiotics are useless against fifth disease, because it is a viral illness. People with persistent arthritis can use anti-inflammatory medications such as ibuprofen (Advil) or naproxen (Aleve), though children should not take aspirin due to the risk of developing Reye syndrome.

How does fifth disease spread? When is the contagious stage, and should I be isolatedif I have fifth disease?

Parvovirus B19 usually spreads by droplets. The virus spreads whenever an infected person coughs or sneezes. However, once the rash is present, that person is usually no longer contagious and need not be isolated.

Is it possible to prevent the spread of fifth disease?

Similar to most viral illnesses, the best way to prevent the spread of the disease is by proper hand washing, by covering your mouth and nose when you sneeze or cough, and by staying home when you become sick.

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Broliden, K et. al. "Clinical Aspects of Parvovirus B19 Infection." Journal of Internal Medicine 260.4 Oct. 2006: 285-304.

Committee on Infectious Diseases, American Academy of Pediatrics. Kimberlin, D.W., Brady, M.T., Jackson, M.A., Long, S.S. "Parvovirus B19." Red Book: 2018-2021 Report of the Committee on Infectious Diseases, 31st Ed. Elk Grove Village, IL: American Academy of Pediatrics, 2018. Available at:

Qiu, J., et al. "Human parvoviruses." Clinical Microbiology Reviews 30 (2017): 43-113.

Rosales Santillan, M., et al. "Adult-onset papular purpuric gloves and socks syndrome." Dermatology Online Journal 24 (2018): pii: 13030/qt02x2h6sd.

Servey, J.T., et al. "Clinical Presentations of Parvovirus B19 Infection." Am Fam Physician 75.3 Feb. 1, 2007: 373-376.

United States. Centers for Disease Control and Prevention. "Parvovirus B19 and Fifth Disease." Nov. 2, 2015. <>.

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