What Causes Fifth Disease (Slapped Cheek Disease)?

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What is Fifth Disease and Why is It Called That?

Considered a viral infection, fifth disease is a very common childhood illness that generally affects children between the ages of 5 and 14 during the spring months. The disease can occur in adults if they were not exposed to it as a child. Fifth disease is a relatively mild disease that generally goes away on its own and has few lasting effects on otherwise healthy individuals. Individuals who are pregnant, have chronic anemia or certain autoimmune and/or blood disorders could develop complications if they contract fifth disease.

Fifth disease got its name during the early 1900’s – it was the fifth disease in a series of six that were known to cause rashes. Out of the six diseases – what are now known as measles, scarlet fever, German measles, Dukes’ disease, fifth disease and infant roseola – only fifth disease retained its numbered moniker.

What Causes Fifth Disease?

So, what causes fifth disease? It is an infection caused by the human parvovirus B19 virus that is spread through respiratory discharges such as mucus, sputum or saliva by sneezing or coughing or by direct contact such as sharing cups or eating utensils. Once an individual has been exposed to the virus, it takes about two to three weeks for the first symptoms to appear, which are similar to a mild case of the flu – runny nose, sore throat, chills, fever and achy joints. During this period of flu-like symptoms, the individual is highly contagious.

About a week later, a red rash will appear on both cheeks, making the child look as if they had been recently slapped. This rash is why fifth disease is also known as the “slapped cheek disease”. Another rash may also appear in a lacy pattern on the trunk, legs, neck, arms and/or buttocks. Both rashes generally dissipate within two to three weeks, but can reappear if the child is exposed to the sun, gets too warm or is stressed. If this happens, the rash can last an additional 1-3 weeks.

Outbreaks of fifth disease occur most often in the spring and tend to spread more rapidly within a household than within a school environment. However, elementary schools still need to be prepared in the event of an outbreak. According to the Centers for Disease Control and Prevention (CDC), approximately 50 percent of the vulnerable people in one household may develop fifth disease if a family member has been infected. In a school outbreak, about 10 to 60 percent of the students could develop fifth disease.

Dogs and cats are immunized against parvovirus, but it is an animal strain of the virus. The virus does not cross species – individuals cannot contact parvovirus from their pets and pets cannot contact human parvovirus B19 from an individual with fifth disease.

Treatment and Prevention of Fifth Disease

Once the rashes appear, the individual is no longer contagious and can return to school and/or childcare. The recommended course of treatment for fifth disease is similar to the flu – plenty of fluids, rest and over-the-counter pain relievers such as acetaminophen or ibuprofen. Antibiotics are not effective in treating fifth disease because it is caused by a virus, not bacteria. Oatmeal baths, calamine lotion and antihistamines can also be used to relieve any itchiness that results from the rashes.

Similar to the flu, hand-washing and properly discarding tissues that may contain respiratory secretions are the best way to prevent the transmission of the human parvovirus B19 virus that causes fifth disease.


Centers for Disease Control and Prevention (CDC) website, https://www.cdc.gov/ncidod/dvrd/revb/respiratory/parvo_b19.htm

eMedicineHealth.com website, https://www.emedicinehealth.com/fifth_disease/article_em.htm

University of South Carolina School of Medicine website, https://pathmicro.med.sc.edu/mhunt/parvo.htm

WebMD.com website, https://children.webmd.com/tc/fifth-disease-topic-overview