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Fifth Disease

Fifth Disease Overview

Fifth disease is a mild illness caused by a virus called human parvovirus B19. The medical name for fifth disease is erythema infectiosum (EI). This infection occurs primarily in school-age children between 5 and 14 years of age during winter and spring. Fifth disease causes a reddish, lacy rash on the child's face, appearing as though the child had been slapped on both cheeks. Sometimes in North America, the disease has been referred to as slapped cheek syndrome or simply slapcheek. The characteristic appearance of the rash gave rise to the names "apple sickness" (or ringo-byou) in Japan and "butterfly pox" in Hungary (since the cheeks resemble the wings of a butterfly).

  • The virus is thought to spread via droplets in the air (respiratory secretions transmitted by coughs and sneezes) or by blood from other infected people. Early during the illness, nasal secretions contain the viral DNA. Blood has been found to contain viral particles as well as DNA.
  • Cases of fifth disease can occur either sporadically or as part of community outbreaks. Outbreaks occur mainly in elementary schools during the spring. Half of the cases occur from spread of the virus to others in the patient's household. Transmission of the infection in schools is less common.
  • At least half of North-American adults have been infected by parvovirus B19 and are unlikely to be reinfected. About 10% or fewer of young children are immune.
  • People with this illness are contagious before the onset of symptoms and are probably not contagious after they develop the rash. The incubation period (the time from acquiring the infection to the development of symptoms) usually lasts between four and 21 days.
  • The name fifth disease comes from a classification system developed in the 1890s but no longer used. It was the fifth in a list of the five most common rashes (or exanthems) of childhood and therefore acquired this name.
Medically Reviewed by a Doctor on 2/26/2015

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Fifth Disease Treatment

People who have impaired immune systemsor certain blood disorders (such as sickle cell diseaseor thalassemia) are at high risk for having complicationsfrom fifth disease. They need close monitoring by a doctor after exposure or if they develop symptoms of infection.


Read What Your Physician is Reading on Medscape

Pediatrics, Fifth Disease or Erythema Infectiosum »

Erythema infectiosum is usually a benign childhood condition characterized by a classic slapped-cheek and lacy exanthem.

Read More on Medscape Reference »

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