Fifth Disease & Parvovirus B19 Infection

Fifth Disease & Parvovirus B19 Infection

We recently received an emergency notification that some children have come down with Fifth Disease & Parvovirus B19 Infection. I was completely lost on this one, so I have decided to share what Fifth Disease & Parvovirus B19 Infection is with as many people as possible.

What is “fifth disease?”
Fifth disease is a mild rash illness that occurs most commonly in children. The ill child typically has a “slapped cheek” rash on the face and a lacy red rash on the trunk and limbs. Occasionally, the rash may itch. An ill child may have a low-grade fever, malaise, or a “cold” a few days before the rash breaks out. The child usually not very ill, and the rash resolve in 7 to 10 days.

What causes fifth disease?
Fifth disease is caused by infection with human parvovirus B19. This virus infects only humans. Pet dogs or cats may be immunized against “parvovirus,” but these are animal parvoviruses that do not infect humans. Therefore, a child cannot “catch” parvovirus from a pet dog or cat, and a pet cat or dog cannot catch human parvovirus B19 from an ill child.

Can adults get fifth disease?
Yes, they can. An adult who is not immune can be infected with parvovirus B19 and either have no symptoms or develop the typical rash of fifth disease, joint pain or swelling, or both. Usually, joints on both sides of the body are affected. The joints most frequently affected are the hands, wrists and knees. The joint pain swelling usually resolve in a week or two, but they may last several months. About 50% of adults, however, have been previously infected with parvovirus B19, have developed immunity to the virus, and cannot get fifth disease.

Is fifth disease contagious?
Yes. A person infected with parvovirus B19 is contagious during the early part of the illness, before the rash appears. By the time a child has the characteristic “slapped cheek” rash of fifth disease, for example, he or she is probably no longer contagious and may return to school or childcare center. This contagious period is different than that for many other rash illnesses, such as measles, for which the child is contagious while he or she has the rash.

How does someone get infected with parvovirus B19?
Parvovirus B19 has been found in the respiratory secretions (e.g. saliva, sputum, or nasal mucus) of infected persons before onset of rash, when they appear to “just have a cold.” The virus is probably spread from person to person by direct contact with those secretions, such as sharing drinking cups or utensils. In a household, as many as 50% of the susceptible persons exposed to a family member who has fifth disease may become infected. During school outbreaks, 10% to 60% of the students may get fifth disease.

How soon after infection with parvovirus B19 does a person become ill?
A susceptible person usually becomes ill 4 to 14 days after being infected with the virus, but may become ill for as long as 20 days after the infection.

Does everyone who is infected with parvovirus B19 become ill?
No. During outbreaks of fifth disease, about 20% of adults and children who are infected with parvovirus B19 do not develop any symptoms. Furthermore, other persons infected with the virus will have a non-specific illness that does not have characteristics or fifth disease. Persons infected with the virus, however, do develop lasting immunity that protects them against infection in the future.

How is fifth disease diagnosed?
A physician can often diagnose fifth disease by seeing the typical rash during a physical examination. In cases in which it is important to confirm diagnosis, a blood test may be done to look for antibodies to parvovirus. Antibodies are proteins produced by the immune system in response to parvovirus B19 and other germs. If immunoglobulin M (IgM) antibody to parvovirus B19 is detected, the test result suggests that the person has had recent infection.

Is fifth disease serious?Fifth disease is usually a mild illness that resolves on its own among children and adults who are otherwise healthy. Joint pain and swelling in adults usually resolve without long-term disability.

Parvovirus B19 infection may cause a serious illness in persons with sickle-cell disease or similar types of chronic anemia. In such persons, parvovirus B19 can cause n acute, severe anemia. The ill person may be pale, weak and tired and should see his or her physician for treatment. (The typical rash of fifth disease is rarely seen in these persons.) One the infection is controlled, the anemia resolves. Furthermore, persons who have problems with their immune systems may also develop a chronic anemia with parvovirus B19 infection that requires medical treatment. People who have leukemia or cancer, who were born with immune deficiencies, who have received an organ transplant, or have human immunodeficiency virus (HIV) infection are at rise for serious illness due to parvovirus B19 infection.

Occasionally, serious complications may develop from parvovirus B19 infection during pregnancy. For details see the CDC information sheet entitled, “Parvovirus B19 Infection and Pregnancy.”

How are parvovirus B19 infections treated?
Treatment of symptoms such as fever, pain, or itching is usually all that it needed for fifth disease. Adults with joint pain and swelling may need to rest, restrict their activities, and take medicines such as aspirin or ibuprofen to relieve symptoms. The few people who have anemia caused by parvovirus B19 infection may need to be hospitalized and receive blood transfusions. Persons with immune problems may need special medical care, including treatment with immune globulin (antibodies), to help their bodies get rid of infection.

Can parvovirus B19 infection be prevented?
There is no vaccine or medicine that prevent parvovirus B19infection. Frequent hand washing is recommended as a practical and probably effective method to decrease the chance of becoming infected. Excluding persons with fifth disease from work, child care center or schools is not likely to prevent the spread of the virus, since people are contagious before they develop the rash.

For further information, contact the Respiratory and Enertic Viruses Branch, National Center for Infectious Diseases, at 404-639-3607 (telephone) or 404-639-4960 (facsimile)
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