By Martha A. Simpson, D.O., M.B.A.
Associate Professor of Family Medicine
Ohio University College of Osteopathic Medicine

FIFTH DISEASE IS A COMMON, USUALLY MILD, CHILDHOOD DISORDER

Question: Recently several children at daycare have had something called “fifth disease.” A note was sent home with some symptoms to watch for. How concerned should I be? I have never heard of it before. Can you fill me in on this?

Answer: Fifth disease is a common, rash-producing illness usually found in children. It is also known by two other names: erythema infectiosum and parvovirus B19. The latter is actually the name of the germ that causes the disorder.

The name “fifth disease” was given because it is the fifth of six rash-associated diseases of childhood (classic exanthems) to be described by medical researchers. These rash-associated diseases, in order, are measles, scarlet fever, rubella, Dukes disease, fifth disease, and roseola.

The symptoms are usually those of a mild cold along with fever and a rash. The classic appearance of the rash is bright red cheeks with pallor around the mouth. This “slapped-cheek” rash is often the first symptom and is followed by a lacy type of rash on the body. The body rash may come and go for several weeks with exposure to heat, exercise or stress. Most experienced clinicians can diagnose this problem by examination of the rash. There is a blood test, but it is seldom needed for diagnosis. Generally this is a self-limiting illness with full recovery.

Fifth disease is spread by exposure to respiratory secretions such as saliva, sputum or nasal mucus. The virus has been found in these secretions before the onset of the rash when the infected person appears to have nothing more than a cold. The disease is probably spread from person to person by coughing or sneezing droplets of these virus-containing secretions, or through direct contact, such as occurs when sharing drinking cups or utensils.

Many people with human parvovirus B19 infection have no symptoms but can still spread the virus. Viral levels in the blood are lower after the rash breaks out, so infected children only need to stay out of school or daycare for a day or so after the rash appears. Treatment is aimed at relieving any bothersome symptoms, which are usually mild in healthy children.

There can be some serious, but rare, problems associated with this viral illness, especially in people with sickle-cell disease, chronic anemia, or immune-compromising problems like leukemia or AIDS. These people can develop a severe anemia if infected with human parvovirus B19.

Fifth disease can cause serious problems in pregnant women. The good news is that most adults have antibodies to the human parvovirus B19, indicating that they had this infection as a child and will probably not get it again. That said, pregnant women should avoid contact with infected children.

If a household member becomes infected, you should encourage other family members to wash their hands frequently and avoid sharing utensils, dishes and glasses. This can help to keep others healthy.

It is important to understand that the parvovirus that causes fifth disease only infects humans. If your veterinarian gives your pet dog or cat a parvovirus shot, it is to immunize against potentially serious animal parvoviruses that do not infect humans. Therefore, your child cannot catch parvovirus from a pet, and he or she cannot pass it on to a pet. There is no vaccine for humans.

Family Medicine® is a weekly column. To submit questions, write to Martha A. Simpson, D.O., M.B.A., Ohio University College of Osteopathic Medicine, P.O. Box 110, Athens, Ohio 45701, or via e-mail to readerquestions@familymedicinenews.org. Medical information in this column is provided as an educational service only. It does not replace the judgment of your personal physician, who should be relied on to diagnose and recommend treatment for any medical conditions. Past columns are available online at www.familymedicinenews.org.