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Fifth disease

What is Fifth disease?

Fifth disease, usually a mild rash illness with low or no fever, is caused by a human parvovirus (B19). For many years, fifth disease was viewed as an unimportant illness of children. Recently, studies have shown that the virus may be responsible for serious complications in certain individuals. No accurate estimate of disease occurrence is available in New York City because fifth disease is not a reportable condition.

Who gets Fifth disease?

Anyone can be affected, but the disease seems to occur more often in elementary school children.

How is the virus spread?

The virus is spread by exposure to airborne droplets from the nose and throat of infected people.

What are the symptoms of Fifth disease and when do they appear?

One to two weeks after exposure, some children will experience a low grade fever and tiredness. By the third week, a red rash generally appears on the cheeks giving a "slapped face" appearance. The rash may then extend to the body and tends to fade and reappear. Sometimes, the rash is lacy in appearance and may be itchy. Some children may have vague signs of illness or no symptoms at all.

When and for how long is a person able to spread the disease?

People with fifth disease appear to be contagious during the week before the appearance of the rash. By the time the rash appears, the person is probably no longer contagious.

How can Fifth Disease be prevented?

Measures to effectively control fifth disease have not been developed and there is no treatment for it. As with any communicable disease, general preventive measures include frequent hand washing, avoiding touching your nose, mouth or eyes and covering your mouth when coughing or sneezing.

How is Fifth disease diagnosed?

In most cases, the diagnosis is based on the appearance of typical symptoms. A specific antibody test to confirm the diagnosis has recently became available but is not necessary in healthy children.

Does past infection with the virus make a person immune?

It is thought that people who have been previously infected acquire long-term or lifelong immunity. Studies have shown that more than 50 percent of adults are immune to parvovirus B19.

What is the treatment for Fifth disease?

At this time, there is no specific treatment.

What are the complications associated with Fifth disease?

While considered a mild disease it is of concern for staff with the following conditions: pregnant, immune-compromised, undergoing chemotherapy treatment or chronic red blood cell disorders such as sickle cell.

While there is no evidence that human parvovirus B19 infection is a significant cause of fetal defects, some studies have shown that infection during pregnancy may increase risk of miscarriage or spontaneous abortion. In people with chronic red blood cell disorders, such as sickle-cell disease, infection may result in severe anemia. Infection has also been associated with arthritis in adults.

What should I do if I am exposed to a child with Fifth disease if I am considered at risk for complications (pregnant, immune-compromised, etc.) from exposure to this disease?

You should immediately consult your physician if you are exposed to a case or develop symptoms of fifth disease. Your physician may wish to perform a blood test to see if you are already immune or have been infected with parvovirus B19.

I am pregnant and I have had a blood test for parvovirus B19. What do the results of the blood test mean?

A blood test for parvovirus B19 may show 1) that you are immune to parvovirus B19 and have no sign of recent infection, 2) that you are not immune and have not yet been infected, or 3) that you have had a recent infection.

If you are immune, then you have nothing further to be concerned about. If you are not immune and not yet infected, then you may wish to avoid further exposure during your pregnancy. (Please see the attached sample letter to request a temporary transfer but please know the transfer may be denied). If you have had a recent infection, you should discuss with your physician what to do to monitor your pregnancy.

Sample transfer letter for pregnant school staff

Recommendation for Women Who are Pregnant or Plan to Get Pregnant

If you are pregnant now or you are planning to get pregnant, consider getting the blood test now so that you know your status prior to any outbreaks of fifth disease at your school.