When is slapped cheek syndrome contagious?

The contagious period is during the early cold-like phase, roughly the week before the rash appears. Once the red cheeks show up, the child can no longer pass it on and does not need to stay home from school. This is why outbreaks are hard to contain: the infection spreads before anyone knows what it is.

Why is parvovirus a concern in pregnancy?

Most pregnant women are already immune from childhood infection, and even when infection occurs during pregnancy, most babies are unaffected. In a small number of cases, especially before 20 weeks, the virus can cause severe anaemia in the unborn baby. If you are pregnant and exposed, a blood test can check your immunity, and if you are infected, your baby can be monitored with ultrasound scans.

Why has my child's rash come back after it went away?

The lacy body rash of fifth disease commonly fades and then reappears for several weeks, triggered by warmth, exercise, sunlight, hot baths, or emotional stress. This is not a new infection and the child is not contagious. It is harmless and eventually stops recurring.

PediatricICD-10: B08.3Common in school-age children; most adults have had it and are immune

Fifth Disease

Also known as: Slapped cheek syndrome, Erythema infectiosum, Parvovirus B19 infection

Fifth disease, also known as slapped cheek syndrome, is a common childhood infection caused by parvovirus B19. Its name comes from an old list of childhood rash illnesses on which it was the fifth. It typically begins with mild cold-like symptoms and a low fever, followed a few days later by a bright red rash on the cheeks that looks as if the child has been slapped, and then a lacy, pink rash on the body and limbs. By the time the rash appears the child is usually no longer contagious. Most children recover fully within a couple of weeks without treatment. The infection matters more for pregnant women, people with certain blood disorders, and those with weakened immunity, in whom it can cause complications.

At a Glance

Common symptoms: Low-grade fever, headache, runny nose, and sore throat in the first few days, A bright red rash on both cheeks, sparing the area around the mouth, A lacy, net-like pink rash spreading to the arms, legs, and trunk a few days later
Main treatments: No specific treatment is needed for healthy children; the infection clears on its own, Paracetamol or ibuprofen for fever, headache, or joint pain (not aspirin in children), Antihistamines or soothing lotions if the rash is itchy
Category: Pediatric · Common in school-age children; most adults have had it and are immune
See a doctor if: You are pregnant and have been in contact with someone with slapped cheek syndrome, or develop a rash

Symptoms

Low-grade fever, headache, runny nose, and sore throat in the first few days

A bright red rash on both cheeks, sparing the area around the mouth

A lacy, net-like pink rash spreading to the arms, legs, and trunk a few days later

Rash that fades and reappears with heat, sunlight, exercise, or baths for several weeks

Itching, particularly on the soles of the feet

Joint pain and swelling, especially in the hands, wrists, and knees (more common in adults)

Causes

Infection with parvovirus B19
Spread through droplets from coughs and sneezes before the rash appears
Contact with saliva or nasal mucus
Transmission from mother to baby during pregnancy
Rarely, through blood transfusion

Risk Factors

School age (5 to 15), when most infections occur
Contact with young children at home, school, or nursery
Late winter and spring outbreaks
Pregnancy, sickle cell disease, thalassaemia, or other chronic anaemias (higher risk of complications rather than of infection)
Weakened immune system

Diagnosis

Clinical diagnosis from the characteristic slapped cheek and lacy rash
Blood test for parvovirus B19 antibodies when the diagnosis matters, such as in pregnancy or in people with anaemia
Blood count in people with blood disorders to check for a drop in red cells
Ultrasound monitoring of the baby if a pregnant woman is confirmed infected

Treatment

No specific treatment is needed for healthy children; the infection clears on its own
Paracetamol or ibuprofen for fever, headache, or joint pain (not aspirin in children)
Antihistamines or soothing lotions if the rash is itchy
Plenty of fluids and rest
Blood transfusion for people with blood disorders who develop severe anaemia
Immunoglobulin treatment in rare cases for people with weakened immunity and persistent infection
Supportive: keeping the child cool, since heat makes the rash flare, and avoiding direct sunlight on the rash

Prevention

Regular hand washing, especially after wiping noses and before eating
Cover coughs and sneezes, and dispose of tissues promptly
Avoid sharing cups, cutlery, and water bottles
Pregnant women who work with young children should discuss exposure with their midwife or doctor
There is no vaccine; children do not need to be kept off school once the rash appears, as they are no longer contagious

When to See a Doctor

You are pregnant and have been in contact with someone with slapped cheek syndrome, or develop a rash
You or your child have sickle cell disease, thalassaemia, or a weakened immune system and develop symptoms
Unusual paleness, tiredness, fast breathing, or weakness, which may indicate anaemia
Joint pain that is severe or lasts more than a few weeks
Fever above 39°C, or a rash with a stiff neck, confusion, or drowsiness

Frequently Asked Questions

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Sickle Cell Disease

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