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What Is Fifth Disease?
(Slap Cheek)

By Dr. Peter W. Kujtan, B.Sc., M.D., Ph.D.

This article originally appeared on page 20 in the April 10-11, 2004 issue
Reprinted under the title: That Dreadful Fifth Disease on page 17 in the April 15-16 issue of
The Mississauga News under the feature: Health & Wellness, Medical Matters.

Fifth Disease is an old name for a common childhood illness. It is more technically called Erythema Infectiosum. In the old days, different types of rashes signified different illnesses and each was assigned a number. It was difficult to distinguish or test for viruses and bacteria, and many people did not even believe that they existed. Measles was called first disease. Second disease was that dreaded Scarlet Fever that the child in my boyhood western movies always succumbs to. It has been easily treatable for years. Third disease was Rubella. The Fourth was Duke's Disease which might have been a staphylococcal or an enteroviral infection. But Fifth Disease seems to have stuck with us.

Fifth Disease can be thought of as a bad cold with a red rash on the cheeks. It is caused by parvovirus B19. First symptoms are: runny nose, malaise, and fever. This may be followed by a mild rash most intense on the face. This illness can be completely asymptomatic as well. The virus is spread, just like other cold viruses, through airborne droplets and body fluids. Symptoms begin between 5 and 15 days after exposure. It is a very common entity which you get only once, and tend to carry life-long immunity afterwards. It is no more severe or deadly than the common cold, unless your health is compromised to begin with.

Panic seems to arise when a "visible illness" is around. I think it generally alarms people. Personally, I would be happy roaming among patients with hordes of Chicken Pox, Measles and Fifth Disease than I would among persons afflicted with resistant Tuberculosis or staphylococcal infections. In reality, once the rash appears, it is really a signal that your immune system is well on the way to complete destruction of this invader.

There are some misconceptions surrounding pregnancy. First of all, there is no evidence whatsoever that parvovirus causes birth defects. Secondly, a fetus cannot be infected if the mother is immune. In a very small percentage of early pregnancies, infection with parvovirus has been linked with heart failure from fluid overload in the fetus, a condition called hydrops. The risk is less than 10% and even lower when the pregnancy is further along. There is little sense in removing pregnant women from sick children because the most contagious period occurs before the diagnostic rash appears. The same wisdom is true of keeping children out of school once the rash appears because they seem to feel better.

Immunity to parvovirus B19 is not routinely tested, nor is there any vaccine for it. A special blood test can be done to determine immunity, but in Ontario, it seems to take several weeks for results. Most people cannot recall having the infection, because it often goes un-noticed or is chalked up as another cold.

Related resources:

Understanding Fifth Disease -- the Basics from WebMD.
Fifth Disease from Wikipedia.
FACT SHEET Fifth Disease (Erythema Infectiosum) from Hastings & Prince Edward Counties Health Unit.
Parvovirus B19 and Fifth Disease from CDC - Centers for Disease Control and Prevention, National Center for Infectious Diseases.
Fifth disease from Wikipedia, the free encyclopedia.
First disease - Measles (1st disease).
Second disease - Scarlet fever (2nd disease).
Third disease - Rubella (3rd disease).
Fourth disease - Duke's disease (4th disease).
Fifth disease - Slap cheek (5th disease).
Sixth disease - Roseola (6th disease).

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