Daycare Outbreaks: Fifth Disease

Inspired by a friend’s recent experience with this type of outbreak.. let’s cover Fifths Disease! You can see other posts in the daycare outbreaks series here.

Disclaimer: this is not medical advice. This blog is for information only. Please seek medical advice from your trusted healthcare provider.

Pause. What are diseases 1 through 4?

I remember hearing about Fifths Disease before I knew what it actually was and wondering this exactly. If this is “Fifths”, is that a person or are there 4 other diseases called First, Second, Third and Fourth too?!

So the answer is that there are indeed childhood skin-related diseases that were once referred to as First disease, Second disease, etc – and these do still exist but you probably know them by different names.

First disease is rubeola.

Second disease is Scarlet fever.

Third disease is Rubella (also sometimes referred to as German measles), which I promise we will cover soon.

Sixth disease is Roseola, which I covered in this series already!

I have intentionally skipped Fourth disease here because it’s debatable. Yeah I know, weird right? But for sometime the actual existent of this one has been called into question. Now some consider it to be a Staph aureus caused syndrome. This is not the topic of today’s post, but definitely a discussion for the future.. for now we’re going to focus on Fifths disease, which is of course #5 in this list and the only one to keep its original name!

So what is Fifth disease?

Fifth disease is a mild illness that is caused by parvovirus B19. You may have heard of a different parvovirus if you have dogs who receive vaccines (canine parvovirus). This is of course, not the same disease.

Fifth disease is sometimes referred to as erythema infectiosum – infectious erythema or red skin. You’ll see why red skin is relevant in a moment.

Fifth disease can affect adults and children, but is more common in childhood and therefore, a potential cause of daycare outbreaks. Although this is a mild one for kids generally, it can rarely post certain risks in pregnancy. We will review that in a later section.

What are the symptoms of Fifth disease?

The typical “mild” mix of runny nose, fever and in the case of these skin-related illnesses, a rash. Maybe a sore throat. Itching.

The rash can be anywhere on the body, but the “sign” of Fifth disease that many people do know is the slapped cheek” rash. I will link a photo of what slapped cheeks look like with Fifth disease. Cheeks appear red, feel warm and the rash is generally symmetrical on both cheeks. This rash can last up to 4 days, on average. It is part of the second stage of the illness, with the first being the cold-like symptoms.

In the third stage, rashes may also appear elsewhere on the body, such as the soles of the feet, usually a few days after the appearance of the cheek rash. Body rashes can last up to a week or slightly more, but may also come and go for weeks after. There are generally no long lasting complications.

Another symptom that can occur is joint swelling and pain, which is not necessarily uncommon with viral illnesses. This symptom is more common in adults and is often the only symptom we would experience. Similar to the rash, it can have some longevity but doesn’t seem to cause any long-term issues.

Because of the respiratory symptoms that accompany Fifth disease, it is of course often spread by respiratory droplet (sneezing, etc). You are most likely to spread the disease in the early stages. Once the rash appears or joint pain starts, you are less likely to be contagious (some sources say less likely, some say you are not).

A Note on Pregnancy and Fifth disease

For most people, this illness remains mild. Most people already have immunity to this parvovirus in adulthood – you may be tested in pregnancy (I was). If you are not immune though still most cases remain mild even in pregnancy.

Less than 5% of Fifth disease infections in pregnancy may result in miscarriage related to anemia – more commonly in the first trimester.

If you are pregnant and have young children, speak to your maternal healthcare provider about your concerns. Similarly, if you suspect you may have been exposed, you should also contact your provider as soon as possible.

You could opt to do the blood test to see if you are immune (it may provide some peace of mind), but please speak to your provider to decide what is best.

Home Management

As this is a very mild illness with not many symptoms, you would follow a symptom management protocol for home care. That means managing the symptoms that you do have (if any or many, or if irritating) – for example, a fever can be medicated if it is symptomatic and joint pain can be treated for adults with pain relief. Please discuss any medication choices with your provider/team/pharmacist.

Rest and fluids are also always a good option (barring any contraindications to fluid intake).

For the itch – have your child wear loose clothing (to avoid irritation), or administer an antihistamine for older children (speak to a pharmacist/provider). For a non-medicinal option, you can also try an oatmeal bath which can be done with oatmeal or with an oatmeal bath soap.

When can my child return to daycare/school?

As mentioned above, the contagious stage of the illness tends to be the “first stage” which is when the cold symptoms appear. By the time the rash appears, most children are no longer contagious and can return to childcare or school. Canadian Paediatric Society actually says most children can continue to go if they feel ok.

However, each school/childcare will have their own policies – so it is good to follow up with your provider/school and see what they recommend as well. Another good resource would be your local public health unit.

When and where to seek assistance:

  • Follow up with your child’s care provider or seek emergency assistance (depending on severity – I suggest either calling your office triage line if that is an option or a service like Telehealth to triage the severity!):
    • If there is no improvement in your child’s fever within a few days
    • If your child complains of symptoms not normally associated with Fifth disease such as a sore neck or pain in the ears
    • If there are signs of anemia (fatigue, pale skin, irritability, increased heart rate, etc) or if your child may have been exposed and has a weakened immune system
    • Severe joint pain (also for adults)

If you are pregnant and exposed, you should also follow up with your provider.

As you can see it is generally mild and there is not much to manage at home and thankfully, not many emergencies resulting from it.


As with most viral illnesses, the best thing we can do is wash our hands to prevent the spread of infection! You should also stay home when you are sick or keep your children home (if possible – I realize that not all jobs/situations make this possible which is a system level issue), and teach your child (age appropriately) to cover their cough and sneezes.

Additional Resources

CDC – About Fifth Disease

Canadian Paediatric Society – Fifth disease


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