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School Nurse Guide to Fifth Disease – Slapped-Cheek Syndrome – Parvovirus B19


I am TOTALLY getting spring fever! I know it’s only the middle of January, but I don’t care…I’m already doing some gardening preparations. However, if you’ve noticed a few children with “spring fever” this early in the year, it’s likely viral…and they are sick…literally. We’ve already talked about the flu and HFMD. But we haven’t talked about Fifth Disease (Slapped-Cheek Syndrome). And, the winter and spring months are when this illness is most prevalent. Welcome spring fever…

What is Fifth Disease?

Fifth Disease is caused by a virus, the Parvovirus B19. No, this virus is not a virus that can be caught from an animal. That is a different virus called Canine Parvovirus (parvo). We humans are susceptible to the Parvovirus B19. You may also see this virus referred to as Erythema Infectiosum.” Beyond that, we school nurses are more interested in how to identify Fifth Disease and how to prevent it. Let’s get to that information…

What are the signs and symptoms of Fifth Disease?

Commonly, you’ll see a child come into your office who is not feeling well. They may have a headache, fever, and a sore throat — nothing especially out of the ordinary. And, no, neither would I suspect Fifth Disease as being the culprit for the child feeling “under the weather.” After all, we medical folks usually (and unknowingly) practice under the (unofficial) guidelines of Occam’s Razor. We may treat by offering rest, OTCs (with parental permission), and even exclusion from school in order to promote resolution as well as prevention of spreading “it” to the other students (after all, flu-like symptoms are a sure way to get a few days at home).

A hallmark symptom of Fifth Disease is the tell-tale red rash area on the cheeks that shows up a week or two (or three) later. This common symptom of those infected by Parvovirus B19 is a red rash on the cheeks which has given Fifth Disease the nickname “Slapped-Cheek Syndrome.” This rash may come-and-go and become most noticeable when the child is exposed to a warm environment or after coming into the warmer school building after a cold and active recess period. But, don’t all the children have rosy red cheeks after a cold recess? Sure they do.

The “kicker” is the time at which you are seeing these red cheeks. Unfortunately (and fortunately), the contagious period lasts all the way up to the point when the rash appears.

The incubation period last for about 4-14 days. Personally, I believe that knowing incubation periods is important. It helps identify possible “locations” of exposure if the symptoms of any illness is seen early in the school year, after breaks, or just anytime.

How is Fifth Disease spread?

My son, a super-smart and super-good-lookin’ kid (takes after his mamma) of 11 years old has often received ridicule from his classmates due to his germ-aware nature. No, we don’t wear shoes in our house. Yes, we wash our hands when we enter our home after touching the “outside world.” No, we don’t share food or drinks from another person outside of our family nucleus. He often gets called a “germaphobe” by his classmates, who think he is not normal when he will not eat or drink after anyone else. The kid will not eat chips out of a bag that others have had their hands in. I just tell him to smile and wave…and wait…they will learn their lesson.

Fifth Disease is spread by the good, old-fashioned way of someone getting someone else’s slobber / mucus on their mucus membranes (respiratory (droplet) route – saliva, sputum, or nasal mucus).

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