Fifth Disease Guide: Understanding the “Slapped Cheek” Rash
Updated: 2 days ago
Medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: October 2026
Source currency note: This guide reflects medical information reviewed in March 2023. Always confirm current guidance with your healthcare professional.
Quick Answer
Fifth disease, or erythema infectiosum, is a common viral infection caused by parvovirus B19, known for a bright red slapped-cheek rash and mostly affecting children aged 5 to 15. Mild flu-like symptoms come first, and people stop being contagious once the rash appears. Most cases clear alone; pregnant people and those with blood or immune disorders need extra care. [4]
What the research says
Infection in pregnancy raises the risk of fetal loss. A meta-analysis of 36 studies found that maternal parvovirus B19 infection was associated with higher odds of fetal loss (OR 2.68, 95% CI 2.02 to 3.55), spontaneous abortion (OR 2.42), and stillbirth (OR 3.53), with a pooled incidence of fetal loss of 7.6% and fetal hydrops of 9.3% among infected pregnant women. These pooled figures are higher than the roughly 2% risk often quoted, which is why prompt medical advice after exposure matters (Xiong et al., Journal of Clinical Virology, 2019 [1]).
Hydrops is the key warning sign in the fetus. A meta-analysis of 35 studies involving 611 fetuses with congenital parvovirus B19 infection found hydrops on ultrasound to be the main determinant of miscarriage and perinatal death, while outcomes in fetuses without hydrops were generally favorable (Bascietto et al., Ultrasound in Obstetrics & Gynecology, 2018 [2]).
People with sickle cell disease are often exposed. A meta-analysis of 18 studies with 2,890 patients found evidence of past parvovirus B19 infection in 48.8% of people with sickle cell disease (95% CI 39.5% to 58.0%) and evidence of acute infection in 8.3%, which is why clinicians watch this group closely (Obeid Mohamed et al., BioMed Research International, 2019 [3]).
What is Fifth disease?
Fifth disease is a temporary viral condition marked by a distinctive skin rash. It got its name from being the fifth on a historical list of six common childhood viral rashes, which also includes measles, scarlet fever, and rubella. It is caused by parvovirus B19, a human-specific virus that is different from the parvoviruses that affect pets [4].
Characteristic | Details |
Medical name | Erythema infectiosum |
Primary cause | Parvovirus B19 |
Common age group | Children 5 to 15 years old |
Contagious period | Before the rash appears (flu-like stage) |
Key sign | Bright red “slapped cheek” rash |
Fifth disease is mainly a childhood illness, but adults can get it too. Most adults are immune because they were exposed as children. In healthy people, the immune system usually clears the virus quickly and provides lifelong protection against reinfection [4].
Symptoms and stages of infection
Fifth disease usually follows a two-stage pattern. The first stage is systemic and highly contagious, and the second involves the characteristic skin changes [4].
Stage 1: the prodromal phase (contagious)
Before the rash appears, an infected person may have mild, flu-like symptoms. This is when the virus spreads most easily.
Low-grade fever: Temperatures typically between 99°F and 101°F.
Respiratory symptoms: Runny nose, sore throat, and mild cough.
General discomfort: Fatigue, headache, and muscle aches.
Stage 2: the rash phase (not contagious)
Several days after the flu-like symptoms begin, the rash appears. Once it is visible, the person is no longer considered contagious.
Cheek rash: A bright red, raised rash on one or both cheeks.
Body rash: A secondary “lacy” or net-like rash may appear on the arms, legs, trunk, and buttocks.
Joint involvement: About 10% of children and 80% of adults have joint pain or swelling, especially in the hands, wrists, and knees.
Rash type | Common locations | Duration |
Slapped cheek | Face, cheeks | 5 to 10 days |
Lacy rash | Arms, legs, trunk | 7 to 10 days (may recur) |
Causes and transmission
Fifth disease is caused by parvovirus B19. The virus is resilient and spreads quickly where children gather, such as schools and daycares, particularly in spring and summer [4].
How the virus spreads
Respiratory droplets: The main route is coughing, sneezing, or talking near others.
Surface contact: Touching surfaces contaminated with respiratory secretions and then touching the mouth or nose.
Mother to fetus: In rare cases, the virus can pass through the placenta from a pregnant woman to her baby.
Complications and high-risk groups
For most people, Fifth disease is a minor illness with no lasting effects. Some groups are at much higher risk of serious complications [4].
People with blood disorders
Parvovirus B19 interferes with red blood cell production. In people with blood disorders such as sickle cell anemia or thalassemia, the infection can cause a dangerous drop in red blood cells (aplastic crisis) that sometimes needs a blood transfusion [4].
Weakened immune systems
People having cancer treatment, living with HIV, or who have had an organ transplant may struggle to clear the virus, which can lead to chronic infection or severe anemia [4].
Pregnancy risks
Most adults and pregnant women have already been infected and are protected. If a pregnant person who is not immune becomes infected, the risk of fetal loss is about 2% by this source’s estimate. The virus can cause hydrops fetalis, in which fluid builds up in the baby’s organs, and the greatest risk is during the second trimester [4].
Diagnosis and treatment
Providers usually diagnose Fifth disease with a physical exam. The “slapped cheek” rash is often enough to confirm it without further testing [4].
Diagnostic tools
Clinical exam: Reviewing the history of flu-like symptoms and looking at the rash pattern.
Blood tests: In rare cases, such as during pregnancy or in high-risk patients, a blood test checks for parvovirus B19 antibodies.
Management strategies
There is no specific antiviral treatment or vaccine for Fifth disease. Management focuses on easing symptoms while the body clears the virus [4].
Fever and pain relief: Over-the-counter medicines such as acetaminophen or ibuprofen can reduce fever and joint pain.
Hydration: Drink plenty of fluids to prevent dehydration during the fever stage.
Rest: Give the body time to recover.
Situation | Recommended action |
Mild cases | Home rest, hydration, and over-the-counter pain relief |
High-risk cases | Prompt consultation with a specialist |
Pregnancy exposure | Monitoring by an obstetrician |
Outlook and prevention
The outlook for Fifth disease is excellent. The facial rash usually fades within a week, although the body rash can come and go for several weeks, especially with sun or heat exposure. After the infection clears, most people have lifelong immunity [4].
Prevention tips
Hand hygiene: Wash hands often with soap and water.
Cover coughs: Use a tissue or the crook of your elbow when coughing or sneezing.
Avoid sharing: Do not share drinking glasses, utensils, or personal items.
If your child has a weakened immune system or a blood disorder and develops a rash or flu-like symptoms, contact their healthcare provider right away. Pregnant people who have been exposed to Fifth disease should also seek medical advice so the pregnancy can be monitored properly.
Frequently Asked Questions
Why is it called Fifth disease?
Fifth disease was historically the fifth viral rash identified in a list of six common childhood illnesses, following measles, scarlet fever, rubella, and Dukes’ disease.
Is Fifth disease contagious?
The virus is highly contagious during the initial flu-like stage. Once the characteristic “slapped cheek” rash appears, the person is no longer contagious and can return to school or work.
Can adults get Fifth disease?
Yes, but it is less common. Most adults are immune because they had the infection as children. Adults who do get it often have joint pain and may not develop a rash.
What does the “slapped cheek” rash look like?
The “slapped cheek” rash appears as a bright red, slightly raised rash on the cheeks that looks as though the person has been slapped. It may be itchy but is generally not painful.
Is there a vaccine for Fifth disease?
Currently, there is no vaccine available to prevent parvovirus B19 infection or Fifth disease.
Can Fifth disease affect pregnancy?
While most pregnant women are already immune, a new infection during pregnancy carries a small risk of fetal complications, including miscarriage or stillbirth, particularly in the second trimester.
How long does the rash last?
The cheek rash usually lasts 5 to 10 days. A secondary lacy rash on the body may last another week or come and go for several weeks.
What is parvovirus B19?
Parvovirus B19 is the specific human virus that causes Fifth disease. It is not the same as the parvovirus that affects pets.
How is Fifth disease treated?
Treatment is supportive, focusing on rest, fluids, and over-the-counter medicines to manage fever and pain. Most cases resolve on their own.
When should I see a doctor for Fifth disease?
See a provider if the person has a blood disorder or weakened immunity, if a pregnant person has been exposed, or if joint pain becomes severe.
References
Xiong YQ, Tan J, Liu YM, et al. The risk of maternal parvovirus B19 infection during pregnancy on fetal loss and fetal hydrops: a systematic review and meta-analysis. Journal of Clinical Virology. 2019;114:12-20. PMID 30897374. https://doi.org/10.1016/j.jcv.2019.03.004
Bascietto F, Liberati M, Murgano D, et al. Outcome of fetuses with congenital parvovirus B19 infection: systematic review and meta-analysis. Ultrasound in Obstetrics & Gynecology. 2018;52(5):569-576. PMID 29785793. https://doi.org/10.1002/uog.19092
Obeid Mohamed SO, Osman Mohamed EM, Ahmed Osman AA, et al. A meta-analysis on the seroprevalence of parvovirus B19 among patients with sickle cell disease. BioMed Research International. 2019;2019:2757450. PMID 31886191. https://doi.org/10.1155/2019/2757450
Cleveland Clinic. Fifth disease. Cleveland Clinic. Medically reviewed March 21, 2023. https://my.clevelandclinic.org/health/diseases/15774-fifth-disease
Medical disclaimer
This article was prepared for general information only and is not a substitute for professional medical advice.
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