Erythema infectiosum (fifth disease)

Symptoms

Your child:

• Starts having symptoms similar to a cold (fever, dry cough, runny nose) or the flu (fatigue, muscle aches, headache, fever)
• Has noticeably red cheeks that appear flushed from the cold, sunburnt, or as if they were slapped
• Has a pink, lace-like rash on their arms and legs
• Is frequently itchy in areas where the rash appears (exposure to heat or sunlight may make the itching worse)

However, some children experience only mild symptoms, or none at all.

• Has sore joints
• Has a temperature higher than 38.9°C (102°F)
• Has pre-existing anemia or a weakened immune system

It’s also a good idea to consult your doctor if you are pregnant and have been exposed to an infected child.

What is erythema infectiosum?

Erythema infectiosum is also called fifth disease. It is a type of upper-respiratory tract (nose, mouth, pharynx, larynx) infection caused by a virus called parvovirus B19.

The disease is usually harmless and resolves on its own, with no after-effects. Fifth disease sometimes goes unnoticed or is mistaken for a cold or the flu. The child usually doesn’t feel too sick. In adolescents and young adults, the infection can cause joint pain.

However, erythema infectiosum can cause complications in children who are already anemic or have a weakened immune system due to illness or certain medications. The infection slows down the formation of red blood cells. For most children, however, this is harmless.

After an initial infection, most people are immune to fifth disease for life.

Erythema infectiosum and pregnancy

Infections contracted in the first 20 weeks of pregnancy could impact the fetus. It may develop severe anemia, which could lead to heart failure or other issues.

If you are pregnant and have been in contact with a child infected with erythema infectiosum (fifth disease), see our fact sheet on chickenpox, measles, the flu, and fifth disease during pregnancy for suggestions.

Treatment

No medical treatment is needed unless symptoms are severe or complications arise.

Care and practical advice

• Encourage rest and quiet activities.
• Give your child plenty of fluids: water, juice, or soup.
• If your child feels unwell due to fever or aches, give them acetaminophen (Tylenol^®, Tempra^®, etc.) or ibuprofen (Advil^®, Motrin^®, etc.) as indicated, according to the recommended dose for your child’s weight and age. Do not give ibuprofen to babies under 6 months of age, and never give children or teenagers acetylsalicylic acid (ASA), such as Aspirin^®.
• It is safe to give your child an antihistamine as needed (eg., Claritin^®) to relieve itching.

Prevention

Erythema infectiosum cannot be prevented, and there is no vaccine for this virus. However, basic hygiene measures can prevent it from spreading, since it is passed on much like most cold viruses.

• Wash your hands with soap and water after coming into contact with an infected person or an object that was handled by an infected person. Wash small children’s hands frequently. Show your child how to wash their hands as early as possible, especially after they cough, sneeze, or blow their nose.
• Teach your child to cough or sneeze into a tissue or, if they don’t have one, into the crook of their elbow instead of into their hand.
• Clean faucets, door handles, and toys thoroughly, preferably with an alcohol-based cleaning product. For more information, read our fact sheet on cleaning and disinfecting toys (available in French only).

Scientific review: Dr. Anne-Claude Bernard-Bonnin, pediatrician Research and writing:The Naître et grandir team Updated: September 2023

Photo: GettyImages/ArtistGNDphotography