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Fifth Disease

What Is Fifth Disease?

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 during winter and spring, most commonly in children between 5-14 years of age. Initially, fifth disease causes an erythematous (reddish) 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. The virus is capable of crossing the placenta and affecting the fetus if a pregnant women becomes infected.
  • 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 that is 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. Other childhood exanthems included measles (first), scarlet fever (second), German measles (third), etc.
  • After recovery from fifth disease, lifelong immunity is generally guaranteed.
Medically Reviewed by a Doctor on 11/10/2016

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Fifth disease - Symptoms

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Fifth Disease Symptoms & Signs

This very common infection appears in the majority of children as a cold followed by a rash on the face and body. The typical description of the rash is a "slapped-cheek" appearance, since the rash is usually bright and appears as a reddish patch. The rash usually resolves within a week to 10 days.


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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