Fifth Disease (Human Parvovirus B19) |

What is fifth disease?

Fifth disease is a common viral infection, usually with mild symptoms, that is followed by rash occurring 7 to 10 days after the start of the viral infection.

What are the signs or symptoms?

Fever.
Headache.
Tiredness.
Muscle aches or joint pain.
Uncommon symptoms are itchiness, cough, diarrhea or vomiting, and runny nose.
Red "slapped-cheek" rash appears 7 to 10 days after these signs or symptoms. This characteristic rash is followed shortly by a lacelike and often itchy rash starting at the trunk and moving to the arms, buttocks, and thighs.
Rash may disappear and reappear after exposure to heat for weeks; once rash appears, the child is no longer contagious and usually does not feel ill.
Individuals can be infected and infectious without ever having any signs or symptoms.
Disease can be severe in people with sickle cell disease or certain blood disorders, as well as those with compromised immune systems.

What are the incubation and contagious periods?

Incubation period: 4 to 14 days but can be as long as 21 days.
Contagious period: Until the rash appears.
Outbreaks occur in late winter and early spring.

How is it spread?

Respiratory (droplet) route: Contact with large droplets that form when a child talks, coughs, sneezes, or sings. These droplets can land on or be rubbed into the eyes, nose, or mouth. The droplets do not stay in the air; they usually travel no more than 3 feet and fall onto the ground. This is the most common mode of spread.
Exposure to blood or blood products (very rare).
A baby can be infected before birth through the infection of a pregnant individual (rare).

How do you control it?

Use good hand-hygiene technique at all the times listed in Chapter 2 of Managing Infectious Diseases in Child Care and Schools: A Quick Reference Guide, 7th Edition.
Perform sanitation of contaminated items.
Prevent contact with respiratory secretions. Teach children and educators to cough or sneeze into a disposable tissue or their inner elbow/upper sleeve and to avoid covering the nose or mouth with bare hands. After coughing or sneezing, practice hand hygiene to prevent the spread of respiratory droplets. Ensure that anyone who contacts mucus or debris on their skin or surfaces washes their hands and any other contaminated skin immediately. Change or cover clothing soiled with mucus. Dispose of facial tissues that contain nasal secretions after each use.

Child's leg with lacelike rash

AMERICAN ACADEMY OF PEDIATRICS, COURTESY OF EDGAR O. LEDBETTER, MD

Horizontal view of a rash on the back of a child's leg showing red and pale splotchy pigmentation resembling a lacelike pattern.

Parvovirus B19 infection (erythema infectiosum, fifth disease) with typical facial erythema, commonly referred to as the "slapped-cheek" sign

AMERICAN ACADEMY OF PEDIATRICS

Profile view of the right side of a child's face showing a red, flushed cheek.

What are the roles of the educator and the family?

Report the infection to the staff member designated by the early childhood education (ECE) program or school for decision-making and action related to care of ill children and staff members. That person, in turn, alerts possibly exposed family and staff members to watch for symptoms.

Note: This is especially important for children with blood disorders, such as sickle cell disease, or compromised immune systems, as they can become seriously ill if infected with human parvovirus B19.
Programs should inform individuals of childbearing age who work with children or have children younger than 3 years in ECE settings about the potential risks to their fetus if they become pregnant, advise them to consult their health professional, and have them sign a document acknowledging their understanding of the risks (see Letter to Staff About Occupational Health Risks and Child Care Staff Health Assessment Form in Chapter 8 of Managing Infectious Diseases in Child Care and Schools: A Quick Reference Guide, 7th Edition).

Exclude from educational setting?

No, unless

The child is unable to participate and staff members determine they cannot care for the child without compromising their ability to care for the health and safety of the other children in the group.
The child meets other exclusion criteria (see Conditions Requiring Temporary Exclusion in Chapter 4 of Managing Infectious Diseases in Child Care and Schools: A Quick Reference Guide, 7th Edition).

Readmit to educational setting?

Yes, when all the following criteria are met:

When exclusion criteria are resolved, the child is able to participate, and staff members determine they can care for the child without compromising their ability to care for the health and safety of the other children in the group

Comments

Contact with young children in ECE programs may increase exposure risk to parvovirus B19. The risk to the fetus is low, and although avoiding child care or classroom settings can reduce exposure, it does not eliminate it. Pregnant individuals (educators and family members) do not need to be routinely excluded from workplaces where fifth disease is present. Those expecting contact with children in ECE settings should consult their health professionals about the low risk to the fetus and ways to reduce that risk. Programs should emphasize hand hygiene at enrollment to reduce infection risks for everyone.

To ensure that health professionals responsible for assessing staff members of childbearing age are aware of the need to counsel their patients about parvovirus B19 risk, ECE program directors/administrators should include parvovirus B19 risk assessment and counseling in the staff health assessment form. It may also be helpful for directors/administrators to attach this Quick Reference Sheet and the Cytomegalovirus (CMV) Infection Quick Reference Sheet to the note in the following box to help health professionals in reviewing the increased risk of exposure to the fetus if the individual becomes infected during pregnancy. Health professionals may not be aware of the higher risk of exposure to these viruses for individuals of childbearing age who work with young children in ECE programs.

Dear Health Professional:

Your patient works in a setting where they have contact with young children in groups. Cytomegalovirus (CMV) and human parvovirus B19 infections occur commonly and are often asymptomatic among young children. Exposure to these viruses in individuals of childbearing age who lack immunity to CMV and/or human parvovirus B19 during pregnancy poses some risk to a pregnancy. Please discuss with your patient their reproductive intentions and whether they might want to consider the following risk-reduction measures when they might become pregnant:

Conscientious handwashing after any contact with saliva, urine, or blood
Care of children who are older than 3 years
Working in a role other than direct care of young children

About Serologic Testing

Because different strains of CMV circulate among young children, especially those in early childhood education programs, a serologic test for CMV informs about risk but does not completely guarantee immunity from exposure to novel strains. However, a serologic test for human parvovirus B19 is a reliable indicator of immunity.

Disclaimer

Adapted from Managing Infectious Diseases in Child Care and Schools: A Quick Reference Guide, 7th Edition.

The American Academy of Pediatrics (AAP) is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists, and pediatric surgical specialists dedicated to the health, safety, and well-being of all infants, children, adolescents, and young adults.

Any websites, brand names, products, or manufacturers are mentioned for informational and identification purposes only and do not imply an endorsement by the American Academy of Pediatrics (AAP). The AAP is not responsible for the content of external resources. Information was current at the time of publication. The information contained in this publication should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.

Fifth Disease (Human Parvovirus B19)—Child Care and Schools