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

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