Fifth Disease (Erythema Infectiosum)

What is fifth disease?

Fifth disease is  a viral infection. It is also known as “slapped cheek syndrome.” This because it causes a red rash on the cheeks.  A virus called Parvovirus B19 causes fifth disease. Parvovirus B19 can spread from person to person. It spreads through droplets in the air or on surfaces we touch.

Signs and symptoms of fifth disease

  • mild fever, chills, headaches, and other flu-like symptoms (these usually appear 4 to 14 days after the virus enters the body, and can last up to 3 weeks)
  • bright red cheeks
  • pale area around mouth
  • a red, blotchy, lace-like rash that appears on the torso about 4 days after the illness starts

  • the rash then spreads to the arms and the rest of the body
  • the rash can be more well-defined after a warm bath (it can be itchy and last from 7 to 21 days)

  • sometimes joint pain or swelling

Fifth disease spreads before the rash appears

Fifth disease is mildly contagious. This means it can spread from person to person. The illness is most likely to spread before the rash appears. After the rash appears, the virus is no longer contagious. Your child can attend school while he has the rash.

The virus spreads much like the common cold virus. An infected person can spread the virus by breathing, sneezing, or touching surfaces.


Fifth disease can make children with blood disorders such as sickle cell disease or thalassemia more sick.

The virus can spread from a pregnant woman to her unborn child. If this happens, it can lead to severe and life threatening conditions in the unborn baby. It can also cause a miscarriage.

How to help your child with fifth disease

Offer your child fluids often. This helps to avoid dehydration. Treat fever or pain with acetaminophen (Tylenol, Tempra) or ibuprofen​ (Motrin, Advil).

Because fifth disease is caused by a virus, antibiotics will not work. There is no effective lotion or medication for the rash.

Children who are otherwise healthy are usually healthy again after a few weeks.

When to seek medical assistance

See the doctor if:

  • your child becomes ill with fifth disease
  • your child has an blood disorder
  • you are pregnant or if any pregnant women have been in contact with your child with fifth disease

Key points

  • Fifth disease is a viral infection that is usually mild.
  • People with blood disorders and pregnant women are at risk of complications.
  • Once the rash appears, the child is no longer contagious.

Sheila Jacobson, MBBCh, FRCPC