Fifth disease is caused by human parvovirus B19. It often affects preschoolers or school-age children during the spring. The disease spreads through the fluids in the nose and mouth when someone coughs or sneezes.

The disease causes a telltale bright red rash on the cheeks. The rash also spreads to the body and can cause other symptoms.

You can get fifth disease and not have any symptoms. About 20% of people who get the virus do not have symptoms.

Early symptoms of fifth disease include:

• Fever
• Headache
• Runny nose

This is followed by a rash on the face and body:

• The telltale sign of this illness is bright red cheeks. This is often called a "slapped cheek" rash.
• The rash appears on the arms and legs and middle of the body, and it may itch.
• The rash comes and goes and most often disappears in about 2 weeks. It fades from the center outwards, so it looks lacy.

Some people also have joint pain and swelling. This more commonly occurs in adult women.

Your health care provider will examine the rash. Most often, this is enough to diagnose the disease.

Your provider can also do blood tests to look for signs of the virus, although it is not needed in most cases.

Your provider may choose to do a blood test in certain situations, such as for pregnant women or people with anemia.

There is no treatment for fifth disease. The virus will clear up on its own in a couple of weeks. If your child has joint pain or an itchy rash, talk with your child's provider about ways to ease symptoms. Acetaminophen (such as Tylenol) for children can help relieve joint pain.

Most children and adults have only mild symptoms and recover completely.

Fifth disease does not often cause complications in most people.

If you are pregnant and think you may have been exposed to someone with the virus, tell your provider. Usually there is no problem. Most pregnant women are immune to the virus. Your provider can test you to see if you are immune.

Women who are not immune most often only have mild symptoms. However, the virus can cause anemia in an unborn baby and even cause a miscarriage. This is uncommon and occurs only in a small percentage of women. It is more likely in the first half of pregnancy.

There is also a higher risk for complications in people with:

• A weak immune system, such as from cancer, leukemia, or HIV infection
• Certain blood problems such as sickle cell anemia

Fifth disease can cause severe anemia, which will need treatment.

You should contact your provider if:

• Your child has symptoms of fifth disease.
• You are pregnant and think you may have been exposed to the virus or you have a rash.

Parvovirus B19; Erythema infectiosum; Slapped cheek rash

Hedman K, Toppinen M, Söderlund-Venermo M. Human parvoviruses, including parvovirus B19, human bocaviruses, and adeno-associated viruses (AAVs). In: Blaser MJ, Cohen JI, Holland SM, et al, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Disease. 10th ed. Philadelphia, PA: Elsevier; 2026:chap 154.

Koch WC. Parvoviruses. In: Kliegman RM, St. Geme JW, Blum NJ, et al, eds. Nelson Textbook of Pediatrics. 22nd ed. Philadelphia, PA: Elsevier; 2025:chap 298.

Michaels MG, Williams JV. Infectious diseases. In: Zitelli BJ, McIntire SC, Nowalk AJ, Garrison J, eds. Zitelli and Davis' Atlas of Pediatric Physical Diagnosis. 8th ed. Philadelphia, PA: Elsevier; 2023:chap 13.

Updated by: Charles I. Schwartz, MD, FAAP, Clinical Assistant Professor of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, General Pediatrician at PennCare for Kids, Phoenixville, PA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.