FIFTH DISEASE (cont.) 
Division of Public Health Services  Disease Handbook for Childcare Providers 
Bureau of Infectious Disease Control   REVISED –January 2018 
FIFTH DISEASE 
 
Fifth disease is an illness caused by a virus called 
human parvovirus B19.  Although people may be 
asymptomatic with the illness, most children with it 
develop a facial rash (i.e., “slapped check” 
appearance) and a lace- like rash on the tr unk and 
extremities.  The rash may reappear for several 
weeks following exposure to non- specific stimuli 
such as sunlight, change in temperature or 
emotional stress. 
 
Except for the rash, the patient is typically 
otherwise well:  but some give a history of  mild 
general symptoms one to four days before rash 
onset.  Fever, sore throat or pain and swelling in the 
joints may also occur. 
 
Who gets this disease? 
Although most commonly recognized in children, 
anyone is susceptible.  Studies indicate previous 
infection with Fifth disease correlates with a lower 
risk of a second infection.  Outbreaks in schools 
often begin in late winter or early spring and may 
continue until the school year is over. 
 
In the U.S. about 50% of the adult population are 
already immune t o the disease.  Some studies 
indicate the pregnant women who are exposed to 
Fifth disease and subsequently develop infection 
may have an increased risk for fetal death.  
However, this risk is felt to be extremely low.  
There is no evidence that the infecti on during 
pregnancy causes fetal malformations (i.e., birth 
defects).  Pregnant childcare workers should contact 
their obstetricians. 
 
How is it spread? 
The virus that causes Fifth disease has been found 
in the respiratory secretions of patients and is, 
therefore, most likely spread by direct person-to-
person contact through the respiratory route. 
How soon do symptoms appear? 
It takes from 4 -21 days after exposure to develop 
the characteristic rash illness of Fifth disease.   
People with the rash are past the period of 
infectiousness to others.  The highest risk of 
transmitting the Fifth disease virus to others is felt 
to occur before the rash develops. 
 
How is it diagnosed and treated? 
A healthcare provider based on the characteristic 
rash and any other ac companying symptoms may 
diagnose Fifth disease.  There is no specific 
treatment for Fifth disease. 
 
How can the spread of this disease be 
prevented? 
1. Because transmission of the Fifth disease 
virus usually occurs before the rash develops 
– when a child may seem well or has a non -
specific illness – excluding children with the 
Fifth disease rash is of no proven value.  
However, it is very important  for a 
healthcare provider to rule out other rash-
causing illnesses (e.g., measles, chickenpox) 
that may require exclusion from childcare. 
2. Transmission of infection can be lessened by 
routine hygienic practices for control of 
respiratory infections, which include hand 
washing and disposal of facial tissues 
containing respiratory secretions. 
3. People with particular conc erns about 
contracting Fifth disease (e.g., pregnant 
women) should consult their healthcare 
providers. 


FIFTH DISEASE (cont.) 
Division of Public Health Services  Disease Handbook for Childcare Providers 
Bureau of Infectious Disease Control   REVISED –January 2018 
Who should be excluded? 
Children with Fifth disease MAY attend daycare or 
school, as they are not contagious after onset of 
rash.  Routine exclusion of pregnant women from 
the workplace where Fifth disease is occurring is 
not recommended. 
 
Reportable? 
No, Fifth disease is not reportable by New 
Hampshire law to the Division of Public Health 
Services, Bureau of Infectious Disease Control .  
However, Public H ealth Professionals are available 
for consultation at (603) 271-4496.