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Fifth Disease in the Child Care Setting

Fifth disease, also called erythema infectiosum or "slapped cheek disease," is an infection caused by parvovirus B19. Outbreaks most often occur in winter and spring, but a person may become ill with fifth disease at any time of the year. Symptoms begin with a mild fever and complaints of tiredness. After a few days, the cheeks take on a flushed appearance that looks like the face has been slapped. There may also be a lacy rash on the trunk, arms, and legs. Not all infected persons develop a rash.

Most persons who get fifth disease are not very ill and recover without any serious consequences. However, children with sickle cell anemia, chronic anemia, or an impaired immune system may become seriously ill when infected with parvovirus B19 and require medical care.

If a pregnant woman becomes infected with parvovirus B19, the fetus may suffer damage, including the possibility of stillbirth. The woman herself may have no symptoms or a mild illness with rash or joint pains.

Fifth disease is believed to be spread through direct contact or by breathing in respiratory secretions from an infected person. The period of infectiousness is before the onset of the rash. Once the rash appears, a person is no longer contagious. Therefore, a child who has been diagnosed with fifth disease need not be excluded from child care.

If an outbreak of fifth disease occurs in the child care setting:

  • Notify all parents. Pregnant women and parents of children who have an impaired immune system, sickle cell anemia, or other blood disorders may want to consult their physicians.
  • Make sure that all children and adults use good handwashing techniques. (See section on “Handwashing” in chapter on “Protective Practices.”)