Fifth disease (erythema infectiosum) is an infectious disease that causes a skin rash. It is caused by a parvovirus B19 infection, and mainly affects children. They do not usually get seriously ill. 

Fifth disease is a viral rash: an infectious disease that causes a bright red rash on the skin. It got its name because it was once the fifth listing on a list of infectious diseases that can cause a skin rash.  

How can I recognise fifth disease?  

Children who have fifth disease get a bright red skin rash that starts on the cheeks and face. Because of this, it is nicknamed ‘slapped cheek disease’. From there, the rash can spread all over the body. Sometimes children have fever and itching, but do not feel ill other than that.  

The rash goes away on its own after about a week. For a period of three weeks after that, the skin rash can come back again temporarily in response to heat, cold or physical effort. If that does happen, the rash goes away again quickly.  

Adults who get fifth disease often have pain and stiffness in their hands and feet. These joint problems usually last 1 to 3 weeks, but can persist for months in some women. Adults are less likely to have a skin rash.  

Some of the people who get the virus do not have symptoms at all. 

Who can become very ill from fifth disease? 

People who have specific types of anaemia, such as sickle cell anaemia, thalassaemia or hereditary sferocytosis, have a higher risk of severe illness from fifth disease. People with severely impaired immunity are also more likely to develop severe illness resulting from a parvovirus B19 infection.  

If a pregnant person has fifth disease for the first time during the first half of pregnancy (up to 20 weeks), there is a higher risk of miscarriage. Most pregnant people with fifth disease have a normal pregnancy without any consequences for the baby. Indications are that 60 to 70% of women who are in the fertile age bracket have antibodies against parvovirus B19. They have already had fifth disease and cannot get it again or pass it on to others.  

How might I get fifth disease? 

Parvovirus B19 is found in the throat of a person who has the virus. It can be transmitted by coughing, sneezing and talking. People mainly transmit fifth disease to others during long or intensive contact – such as in a family or at a playgroup, childcare centre or school.  

The time between exposure to the virus and the first symptoms of illness is usually 1 to 3 weeks. The contagious period starts about 1 week after infection and continues until the rash appears. Not everyone who has been near a person with fifth disease will become ill. 

During pregnancy, the virus can pass from mother to child. This does not always happen. And it is only possible if the mother has not previously been exposed to the virus. 

Once a person has had a parvovirus B19 infection, they cannot get fifth disease a second time.  

How can I prevent fifth disease? 

There is no vaccine against fifth disease. Good coughing hygiene and hand hygiene reduce the risk of getting the virus. 

Is there any treatment for fifth disease? 

Fifth disease goes away on its own. If you think that you have fifth disease, call your GP if you have questions. The GP can request a blood test to see if a person has a parvovirus B19 infection.  

Some people can become very ill from fifth disease. If they receive treatment in time, they can recover well.  

If you are pregnant, and someone in your family has fifth disease, consult with your midwife. There is a minor risk to the unborn child if the pregnant person has fifth disease for the first time during the first half of pregnancy. Sometimes the pregnant person can have treatment to reduce this risk. 

How common is fifth disease in the Netherlands? 

Fifth disease is common all over the world. There are epidemics about every 3 to 5 years, especially in winter and spring. During an epidemic, 70% of patients are between the ages of 5 and 15 years.  

At the start of 2024, there was an increase in the number of people with fifth disease in the Netherlands. Doctors do not have to report cases of fifth disease. However, there are a number of data sources that make it possible for RIVM to monitor the spread of fifth disease. Municipal Public Health Services (GGDs), laboratories, the Netherlands Institute for Health Services Research (Nivel) and the Sanquin national blood bank share information with RIVM. All these sources reported seeing an increase in cases of fifth disease and parvovirus B19 infections in the first few months of 2024. The upward trend seems to be slowing, but there are still many more people with fifth disease compared to the same period last year.  

Other European countries have also seen an increase in people with fifth disease recently. RIVM and the European Centre for Disease prevention and Control (ECDC) are monitoring this upward trend closely. 

It is unclear why there are more people who have fifth disease. It is possible that parvovirus B19 was circulating less widely during the COVID-19 pandemic as a result of the coronavirus measures. More people may be susceptible to fifth disease because of that. Now that the coronavirus measures are no longer applicable, the virus that causes fifth disease can also spread again. 

Can a person with fifth disease go to childcare, school or work? 

A child who feels fine can go to childcare or school. Fifth disease is already contagious before a person starts showing symptoms. Staying home does not help keep others from becoming ill. 

If your child has fifth disease, tell the childcare provider or teacher. They can consult with the Municipal Public Health Services (GGDs) to notify other parents. If they know, parents can be alert to the symptoms of fifth disease in their child. 

An adult with fifth disease who feels fine can go to work as usual.