Prather Pediatric and Allergy Center - Ask Doctor Brent

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Title: Fifth's Disease and Safety Measures

Category: Child Care


Fifth's Disease (erythema infectiosum) is a viral infectious disease characterized by a bright red rash on the cheeks described as a "slapped cheek" appearance. Also, children with Fifth's Disease usually have a hives-like lacy rash scattered over the extremities and trunk. They may have a low grade fever but are usually not very sick. Occasionally, atypical rashes that look more like measles occur with this virus. In adults, particularly women, the infection can also present with swollen, tender joints. Many patients with Fifth's Disease are totally asymptomatic and do not even have a rash and, therefore, go undiagnosed. The cause of Fifth's Disease is the human Parvo Virus. This is Parvo Virus B19 and infects humans only. It is transmitted principally by respiratory secretions and a good way of avoiding the spread is good common sense hand washing and avoidance of tissue paper and handkerchiefs being passed around.

The great majority of people who contract Fifth's Disease are not at very much risk to themselves or anyone around them. Occasionally, however, Fifth's Disease can cause the patient to be fairly sick and require close follow-up by their doctor. The main individuals who are susceptible to complications from Fifth's Disease are pregnant women in the first 20 weeks of pregnancy and patients with blood diseases such as Sickle Cell Disease. The pregnant women are at danger because their fetuses can become anemic and the virus can cause spontaneous abortion. The risk is estimated to be less than 1 percent in mothers or teachers who are in very close contact with a child with Fifth's Disease during the first 20 weeks of pregnancy. The risk is considered well below 1 percent if it is just an incidental exposure as opposed to a close all-day exposure.

Sickle Cell patients contracting the disease can develop what is called an aplastic crisis in which their bone marrow gets suppressed and their red cell count goes down drastically. This can cause a very dangerous level of anemia and even heart failure. Other blood diseases and immuno-deficient patients are also at high risk if they catch Parvo Virus B19. These patients are also at greater risk to health care workers because they excrete a more active form of the virus than the routine patients with the rash.

Normal patients with Fifth's Disease, e.g., with a typical rash, are at no risk to anyone once the rash appears. For that reason, the American Academy of Pediatrics Committee on Infectious Disease recommends that these children not be restricted from school for any length of time and that as long as they are well themselves, they should be able to return to school.

At present, there are few blood tests available to diagnose Fifth's Disease and these can be obtained through the State Health Department and the Center for Disease Control in Atlanta. In the future, a simple blood test will be available which will allow anyone to find out whether they have already had it, so they need not worry about present exposure. Most studies show about 50% of adults have had it and about 20% of children, when screened.

In summary, Fifth's disease is a mild, common viral illness seen more commonly in the winter and spring, sometimes in large epidemics and is rarely a problem unless the patient catching it has an immune problem or sickle cell disease or is a non-immune mother in her first 20 weeks of pregnancy. If you fall into any of these categories, please check with your pediatrician or OB/GYN for advice and evaluation and treatment. Otherwise, don't let those children running around with bright red cheeks scare you. We will see many more cases in years to come and we should all be OK despite that exposure.