While having lunch with nursing colleagues last week, we swapped stories – an important part of nursing culture and informal education – and life updates. I casually informed the group that all three of my children – including my infant son – recently passed around Fifth disease, but they are, thankfully, better. They had what? Fifth disease. What? Fifth disease…you know like the number five. What is that?! Out of 15 of us at the table, only myself and one other nurse knew about Fifth disease (and I admit, personal experience greatly enhanced my knowledge), so I provided a quick education for everyone. I thought I’d provide the same here considering my ever-sharpening pedi skills.

Slapped cheeks are the first indication of Fifth disease.

Fifth disease is the actual fifth disease in a list of childhood skin rashes (measles, scarlet fever, rubella, Duke’s disease, fifth disease, and roseola). It is also known as erythema infectiosum as well as “slapped cheek disease” because of its defining characteristics. It is caused by parvovirus B19, which is not transmitted between dogs or cats and humans. Fifth disease is very common in children ages five to 15 (easy to remember because those are multiples of fives!), and rarely older teens and adult are infected. A blood-borne disease, it is most commonly transmitted via respiratory secretions, thus children who do not cover their mouths/noses or wash their hands frequently or those in close proximity to them (e.g. other kids, daycare workers, teachers, parents) are more susceptible to catching the infection. The incubation period is anywhere from four to 20 days. About half of the adult population has had Fifth disease and is immune.

A lacy rash is characteristic of Fifth disease. Click to enlarge.

Fifth disease presents with a “slapped cheek,” and then a “lacy rash” spreads over the body (in varying degrees). Exacerbated by heat and sunlight, children may have minor symptoms before the cheeks turn rosy, including a runny nose or a cough. None of my children had any of those symptoms. Once a child has the “slapped cheek” appearance, he is no longer contagious. In fact, my son’s pediatrician said he could return back to school immediately even though he looked like he should be in an isolation room. Sometimes the rash itches; it may cause a low-grade fever; teens and adults may present with arthritic pain; and, in some instances, serious renal complications may occur. Fifth disease can last for several weeks, and it lasted about two weeks in each of my three children with minimal symptom-management for sporadic low-grade fevers and occasional itching.

Fifth disease is not usually a serious illness, but it definitely is a concern for pregnant women, especially those in the first trimester, and immunocompromised individuals. It may cause a crisis for those with sickle-cell disease, as well.

Reference: Center for Disease Control and Prevention. (2011). Parvovirus B19 (Fifth Disease). Retrieved May 22, 2011, from http://www.cdc.gov/ncidod/dvrd/revb/respiratory/parvo_b19.htm.