Fifth Disease (Erythema Infectiosum): Symptoms, Causes & Treatment

Ever noticed your child come home from school with cheeks so rosy they look like they've been spending all day outside in the winter chill, even if it's the middle of summer? While this may be normal, sometimes it can be a sign of a common childhood illness called the fifth disease.

If you are here, then you must not have heard of the Fifth Disease. In this blog, we will discuss everything you need to know about the fifth disease health condition.

What is Fifth Disease?

Fifth disease, also known by its medical name, Erythema Infectiosum, is a common and usually mild viral illness that usually affects children. It’s caused by the human parvovirus B19.

This illness is highly contagious and spreads through respiratory secretions, such as saliva and mucus, similar to a common cold. The most notable characteristic of the condition is the bright red rash on the cheeks, which is why it is often called "slapped cheek disease." Most children who get fifth disease will experience a mild illness and recover without complications. However, in certain at-risk individuals, like those with weakened immune systems or pregnant women, the virus can pose a greater threat.

Why is it Called the Fifth Disease?

Now that you know what fifth disease is, you must be wondering why it is called the fifth disease. Then let’s shed some light on this.

The disease gets its name from a historical classification system that listed common childhood rashes. It was the fifth rash on that list, after measles, scarlet fever, rubella, and a couple of others that are now less common or have been reclassified.

While this classification system is now considered outdated, the name "fifth disease" stuck, and it is still the most commonly used name for erythema infectiosum fifth disease.

The Stages and Symptoms of Fifth Disease

The course of fifth disease can be divided into distinct fifths disease stages, each with its own set of fifths disease symptoms. It’s important to note that many people, especially adults, may not experience all the symptoms or might have a very mild case that goes unnoticed.

Stage 1: The Incubation Period

This period, typically lasting 4 to 14 days after exposure to the virus, is when the virus is replicating in the body. There are usually no noticeable fifths disease symptoms during this time, but the person is highly contagious during this particular period.

Stage 2: The Prodromal Phase

In the days leading up to the rash, some people may experience mild, flu-like symptoms. These early fifths disease symptoms can include:

• Low-grade fever
• Headache
• Runny nose
• Sore throat
• General feeling of being unwell (malaise)

It is during this phase that the virus is most contagious, even before the characteristic rash appears. The virus spreads through respiratory droplets, which is why it can sweep through schools and daycares so quickly.

Stage 3: The Rash Phase

Now, this is the most recognisable phase of fifth disease. It’s when the distinctive fifth disease rash makes its appearance. The one that can help in the detection.

The rash typically develops in two parts:

• Part 1: The "Slapped Cheek" Rash: The first sign is a bright red rash that appears on both cheeks. It looks like the person has been slapped, hence the popular nickname. This facial rash may feel warm to the touch and can last for a few days to a week.
• Part 2: The Lacy, Body Rash: A few days after the facial rash appears, a second rash may develop on the rest of the body, particularly on the arms, legs, and trunk. This fifth disease rash has a unique, lacy or web-like appearance and can be itchy. It may come and go for several weeks, often triggered by heat, sunlight, or physical activity.

This is why it is extremely important to keep a note of everything on the body, because something as small as a rash can lead to a health condition.

Stage 4: The Recovery and Recurrence Phase

The rash may fade over a few weeks, but it can reappear or "re-emerge" for several weeks or even months. This is especially true after exposure to heat, sunlight, or stress. The characteristic lacy fifth disease rash can be a lingering reminder of the illness, but it is not a sign of active infection or contagiousness.

Fifth's Disease Stages

Fifth disease, also known as erythema infectiosum, is a mild viral infection caused by parvovirus B19. It commonly affects children but can also occur in adults. The illness progresses through distinct stages, each with specific signs and symptoms. Understanding these stages helps identify the disease early and manage it effectively.

Stage 1: Incubation Period (Exposure to Virus)

This is the period after exposure to parvovirus B19 but before symptoms appear. It usually lasts 4 to 14 days, though in some cases, it can extend up to 21 days. During this stage, the person does not show any visible signs of illness but is most contagious, meaning the virus can easily spread to others through coughing or sneezing.

Stage 2: Early Symptoms (Mild Flu-like Illness)

In this stage, the person may start showing mild, cold-like symptoms such as low-grade fever, headache, sore throat, fatigue, and body aches. These early symptoms are often mistaken for a common viral infection. The contagious period continues during this phase, but once the rash appears, the person is typically no longer contagious.

Stage 3: Facial Rash (“Slapped Cheek” Appearance)

A few days after the initial symptoms, a distinctive bright red rash develops on the cheeks, giving the appearance of having been slapped, hence the nickname “slapped cheek” rash. This rash is the hallmark of Fifth’s disease and often signals that the contagious phase has ended. The rash may cause mild itching or discomfort but usually fades within a few days.

Stage 4: Body Rash (Spreading Rash Phase)

After the facial rash, a lacy or net-like rash may spread to the arms, legs, and trunk. The rash tends to come and go for one to three weeks, often becoming more noticeable after sun exposure, exercise, heat, or stress. Although it may look alarming, it’s typically not painful or dangerous.

Stage 5: Recovery Phase

In the final stage, the rash fades completely, and the person feels better overall. Once the rash appears, the infection is no longer contagious. Most people recover fully without complications. However, individuals with weakened immune systems, anemia, or pregnant women should consult a doctor, as the virus can cause more serious issues in these cases.

What is Fifth’s Disease?

Fifth Disease, also known as erythema infectiosum, is a mild viral infection most commonly seen in children, though adults can also be affected. It is caused by parvovirus B19, a virus that spreads through respiratory secretions like saliva, sputum, or nasal mucus when an infected person coughs or sneezes. The condition gets its name because it was historically the fifth identified childhood rash-causing illness, after measles, scarlet fever, rubella, and Duke’s disease.

The illness is usually mild and self-limiting, meaning it resolves on its own without medical treatment. Typical symptoms include a bright red rash on the cheeks (“slapped cheek” rash), mild fever, fatigue, headache, and sometimes joint pain. Once the rash appears, the person is usually no longer contagious.

Blood test for fifth disease? 

A blood test for Fifth Disease helps detect the presence of parvovirus B19 antibodies in the bloodstream. Doctors usually recommend this test when symptoms are unclear or when it’s important to confirm infection, such as in pregnant women or patients with anaemia.

The test checks for two types of antibodies:

• IgM antibodies, which indicate a recent or current infection, and
• IgG antibodies, which suggest past infection and immunity.

If the blood test confirms the presence of parvovirus B19, no specific antiviral treatment is required in most cases. Instead, care focuses on rest, hydration, and symptom relief. The body’s immune system naturally clears the virus over time.

Causes of Fifth Disease

As mentioned above, fifth disease is caused by the human parvovirus B19. This is a common virus that spreads from person to person through respiratory secretions, similar to how the common cold or flu spreads.

The transmission usually occurs through:

• Droplets: When an infected person coughs, sneezes, or talks, they release tiny droplets containing the virus into the air. If you breathe in these droplets, you can become infected. 
• Direct Contact: Touching a surface contaminated with the virus and then touching your eyes, nose, or mouth can also lead to infection.

Children are most commonly affected because they are in close contact with each other in school, daycare, and other group settings, which makes the spread of erythema infectiosum fifth disease very easy.

Diagnosis of Fifth Disease

In most cases, a doctor can diagnose fifth disease simply by looking at the characteristic fifth disease rash and considering the other fifths disease symptoms.

However, in certain situations, a blood test may be necessary to confirm the diagnosis, particularly for pregnant women or individuals with weakened immune systems. A blood test can detect the presence of antibodies to parvovirus B19, which indicates a recent or past infection. This is especially important for confirming fifths disease during pregnancy to assess the potential risk to the fetus.

Who is at Risk?

For most healthy children and adults, what is fifth disease is a simple, self-limiting illness with no serious long-term effects. The main concern is the distinctive rash and the mild, flu-like symptoms. However, certain groups are at a higher risk for complications:

• Pregnant Women: If a pregnant woman contracts fifths disease during pregnancy, particularly in the first half, there is a small risk that the virus can be passed to the fetus. In rare cases, this can lead to severe fetal anaemia, heart failure, and even miscarriage. This is why it is so important for pregnant women to be aware of the risks and seek medical advice immediately if they are exposed to the virus.
• Individuals with Weakened Immune Systems: People with compromised immune systems due to conditions like HIV/AIDS, cancer, or organ transplants may have difficulty clearing the virus. The infection can become chronic, leading to a persistent form of anaemia.
• Individuals with Chronic Blood Disorders: People with conditions such as sickle cell disease or thalassemia are also at risk. The parvovirus B19 targets and destroys red blood cells, which can cause a temporary halt in red blood cell production. In people who already have an underlying blood disorder, this can lead to a severe and sudden drop in red blood cell count.

Treatment of Fifth Disease

There is no specific antiviral fifth disease treatment. Since it is a viral illness, antibiotics are ineffective. The treatment is focused on managing the fifths disease symptoms and providing supportive care.

• For Children: The illness is typically mild and resolves on its own. Over-the-counter medications can be used to relieve fever, headache, and joint pain. However, ensure your child gets plenty of rest and stays hydrated.
• For Adults: Adults may experience more pronounced joint pain and swelling. Nonsteroidal anti-inflammatory drugs (NSAIDs) can be helpful in managing this discomfort.
• For At-Risk Individuals: In severe cases, such as aplastic crisis in people with chronic blood disorders, hospitalisation and blood transfusions may be necessary. For a pregnant woman with fifths disease during pregnancy, close monitoring of the foetus through ultrasounds and blood tests is crucial.

Wrapping Up

So, whether you're a first‑time parent or helping your niece with a "mysterious rash," knowing the fifth disease rash, the timeline, triggers, causes, and what to do (or not do) brings real relief.

At Niva Bupa, we believe health isn’t just about what you know; it’s about having the support systems when things go sideways. For NRIs concerned about medical care for their family back home, our tailored NRI health insurance brings coverage and comfort from trusted healthcare professionals, even when you’re miles away. We provide a range of benefits, like coverage for medications, hospital stays, cashless hospitalisations, and more, ensuring your family has access to medical attention when needed.

People Also Ask

Is fifth disease contagious?

Yes, it is. Fifth disease is contagious during the prodromal phase (when a person has flu-like symptoms but before the rash appears). Once the characteristic fifth disease rash shows up, the person is no longer contagious.

Can adults get fifth disease?

Yes, while it's most common in children, adults can get fifth disease. Adults, however, are more likely to experience joint pain and swelling, which can be more severe than in children.

What is the main difference between fifth disease and measles?

The main difference is the cause and the rash. Fifth disease is caused by parvovirus B19 and has a distinct "slapped cheek" rash. Measles is caused by a different virus and has a characteristic red, blotchy rash that starts on the face and spreads down the body.

Can you get Fifth Disease more than once?

No. Once you've had fifth disease, your body develops immunity to the parvovirus B19, which means you can't get it again.

How long does the rash last?

The initial facial rash usually fades in a few days. The lacy body rash may come and go for several weeks or even months, especially when triggered by heat or sunlight.

How to Get Rid of Fifth Disease Rash?

Fifth disease, also known as erythema infectiosum, is caused by the parvovirus B19. In most cases, the rash resolves on its own within 1–3 weeks without specific medical treatment. Here’s how you can manage it:

• Rest and hydration: Ensure plenty of fluids and rest to help the body recover.
• Relieve itching: Use calamine lotion or mild antihistamines if itching is uncomfortable.
• Avoid sun exposure: Sunlight can worsen the redness or irritation of the rash.
• Fever or pain management: Over-the-counter pain relievers like acetaminophen or ibuprofen can help with fever or mild aches.

The rash usually fades naturally and does not leave scars. Most people, especially children, recover fully without complications.

Can Newborns Get Fifth Disease?

Newborns can technically be exposed to fifth disease, but it is rare for them to develop symptoms. The virus is typically more concerning for pregnant women, as it can sometimes affect the fetus, particularly in the first 20 weeks.

If a newborn is exposed, most healthy babies do not develop serious complications, but vigilance is important. Any signs of unusual rash, fever, or pallor should be assessed by a paediatrician immediately.

What is the Blood Test for Fifth Disease?

Fifth disease can be confirmed through a blood test that detects antibodies or the virus itself:

• IgM antibodies: Indicate a recent infection.
• IgG antibodies: Show past infection or immunity.
• PCR (polymerase chain reaction) test: Detects parvovirus B19 DNA in the blood, usually in more complicated cases or in immunocompromised individuals.

These tests are generally ordered if the diagnosis is uncertain, if complications are suspected, or in special populations like pregnant women.