Slapped cheek syndrome

Slapped cheek syndrome (also known as “fifth disease”) is a type of viral infection that is most common in children, although it can affect anyone of any age.

Information written and reviewed by Certified Doctors.

Contents

Key Information

What should I do?

If you think you or your child has this condition, you may not need to see a doctor.

How is it diagnosed?

This condition is usually diagnosed based on the symptoms and a physical examination.

What is the treatment?

This condition is a mild infection and usually clears up on its own after a couple of weeks.

To ease the symptoms your doctor may suggest a non-prescription painkillers.

When to worry?

If you are pregnant, or if you or your child experience any of the following, you should see a doctor immediately:

  • you suffer from a blood disorder such as anaemia or a weakened immune system
  • the rash does not blanch (does not disappear when you press on it)
  • headache
  • pain in eyes, worse on looking at light
  • fever
  • stiff neck.

Introduction

Slapped cheek syndrome (also known as “fifth disease”) is a type of viral infection that is most common in children, although it can affect anyone of any age.

Slapped cheek syndrome usually affects children aged between 6 and 10. Most cases develop during the late winter months or early spring.

In children, the most common symptom is the appearance of a distinctive bright red rash on the cheeks. This is how the condition got its name.

Most cases of slapped cheek syndrome can be diagnosed by examining the rash. Usually, no further testing is necessary in children.

Read more information about the symptoms of slapped cheek syndrome.

What treatment will my child need?

Most children will not need treatment as slapped cheek syndrome is usually a very mild condition that passes in a few days. Occasionally it can last up to four or five weeks.

Symptoms such as headaches, high temperature or itchy skin can usually be treated with over-the-counter medications such as paracetamol and antihistamines.

Adults who develop joint pain can use non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, as painkillers.

You will probably only need to contact your doctor if one or both of the following occurs:

  • your (or your child’s) temperature rises to 39C or above
  • your (or your child’s) symptoms suddenly worsen

Read more about treating slapped cheek syndrome.

What are the causes of slapped cheek syndrome?

Slapped cheek syndrome is caused by a virus called parvovirus B19. Parvovirus B19 is an airborne virus that is spread in much the same way as the cold or flu viruses. It can be spread through coughs and sneezes that release tiny droplets of contaminated saliva which are then breathed in by another person.

It's very difficult to prevent the spread of the virus as people are most contagious before their symptoms begin, so they are unaware that they are infected.

Once you've been infected you should develop a lifelong immunity and not experience any further symptoms.

Read more about the causes of slapped cheek syndrome.

Complications

There are three high-risk groups in which the parvovirus B19 can cause a much more serious infection and trigger a range of complications. These are listed below.

  • People with certain blood disorders, such as sickle cell anaemia or thalassaemia. This is where the blood doesn't contain enough healthy red blood cells (anaemia) and infection can lead to a further and more severe loss of red blood cells.
  • Pregnant women without immunity. Parvovirus B19 infection can increase the risk of a miscarriage because the virus can cause severe anaemia in the unborn child.
  • People with a weakened immune system (immunocompromised), either due to a side effect of treatment, such as chemotherapy, or from a condition such as HIV. These groups can experience prolonged, and sometime severe, symptoms of infection.

If you're in one of these high-risk groups and you have been in close contact with someone who goes on to develop slapped cheek syndrome, contact your doctor for advice.

A blood test may be recommended to see if you are immune to the infection. If you are not immune, treatment can begin immediately to prevent complications.

You may need to be admitted to hospital and in some cases, a blood transfusion is necessary.

Read more about the complications of slapped cheek syndrome.

Prevention

At present there is no vaccination available to prevent slapped cheek syndrome. People who have already been infected with parvovirus B19 in the past are immune to another infection.

To prevent the spread of slapped cheek syndrome try to make sure that everyone in your household washes their hands frequently in order to reduce the chances of the infection spreading.

Symptoms

Try checking your symptoms with our AI-powered symptom checker.

The symptoms of slapped cheek syndrome usually begin in the first couple of weeks after your child is exposed to the parvovirus B19 virus. The symptoms tend to follow three distinct stages.

First stage

The first stage is usually characterised by mild flu-like symptoms, such as:

  • a high temperature (fever) of 38C (100.4F), although your child’s temperature will not usually rise above 38.5C (101F)
  • sore throat
  • headache
  • upset stomach
  • feeling tired
  • itchy skin

In many cases these symptoms do not occur, or are so mild as to be barely noticeable.

During the first stage of symptoms, your child will be most contagious.

Second stage

Between three to seven days after the symptoms start, your child will develop a bright red rash on both cheeks (the so-called "slapped cheeks"). The rash may be particularly noticeable in bright sunlight.

Third stage

The third stage of symptoms usually begins one to four days after the appearance of the "slapped cheek" rash.

During this stage, the rash will usually spread to your child’s chest, stomach, arms and thighs. The rash usually has a raised, lace-like appearance and may cause discomfort and itching.

The rash is usually more noticeable after exercise, or if your child is hot, anxious or stressed.

By this time, your child should no longer be contagious and they will be able to return to nursery or school without the risk of passing the infection onto others.

The rash should then pass after a few days. In rare cases it can last up to four or five weeks.

Parvovirus B19 infection in adults

The most common symptom of a parvovirus B19 infection in adults is joint pain and stiffness in your:

  • hands
  • knees
  • wrists
  • ankles

Other symptoms, such as developing a fever and sore throat, are rare in adults.

In most people, the symptoms of a parvovirus B19 infection will pass within one to three weeks, although one-in-five adults will experience recurring episodes of joint pain and stiffness for several months, sometimes years.

When to seek medical advice

Slapped cheek syndrome in children and parvovirus B19 infection in adults is usually mild and the infection should clear up without treatment.

When to seek urgent medical advice

People who are in the risk groups listed below are advised to contact their doctor as soon as possible if they think they have developed a parvovirus B19 infection. If this is not possible, contact your local out-of-hours service.

  • pregnant women
  • people with a condition that is known to cause chronic anaemia, such as sickle cell anaemia, thalassaemia and hereditary spherocytosis (an uncommon genetic condition that causes red blood cells to have a much shorter life span than normal)
  • people with a weakened immune system as a result of a condition such as HIV or acute leukaemia
  • people having treatments known to weaken the immune system, such as chemotherapy or steroid medication

You may also have a weakened immune system if you're taking medication to suppress your immune system because you've recently received a bone marrow transplant or organ donation.

Chronic usually means a condition that continues for a long time or keeps coming back.

Contagious is when a disease or infection can be easily passed from one person to another through infection.

A high temperature, also known as a fever, is when someone's body temperature is 38C (100.4F) or above.

The immune system is the body's defence system, which helps protect it from disease, bacteria and viruses.

Joints are the connection point between two bones that allow movement.

Inflammation is the body's response to infection, irritation or injury, which causes redness, swelling, pain and sometimes a feeling of heat in the affected area.

Body tissue is made up of groups of cells that perform a specific job, such as protecting the body against infection, producing movement or storing fat.

Causes

Slapped cheek syndrome is caused by parvovirus B19. A parvovirus B19 infection is spread in the same way as a cold or flu.

It can be spread inside infected droplets of saliva that can be:

  • inhaled in by other people when you cough or sneeze
  • left on surfaces which other people can touch and then transfer into the body by touching their mouth or nose

A child is most contagious three to seven days before the appearance of the distinctive red rash.

Humans are not born with immunity to parvovirus B19, which is why most cases occur in children. Once infected, a person usually develops a lifelong immunity to further infection.

Children old enough to attend nursery or school are most at risk of infection because of their close proximity to lots of other children. It's also common for older children to pass the infection along to younger brothers and sisters.

Adults who haven’t previously had the infection are most at risk if they work with children, including teachers and nursery workers.

How the virus affects the body

Once parvovirus B19 enters the body, it targets cells called erythroid progenitor cells which are found in bone marrow and blood. It is the fact that the parvovirus B19 infection targets blood and bone marrow that makes it a particularly serious infection for people with blood and bone marrow disorders.

Most of the symptoms of a parvovirus B19 infection, such as the red rash, are not caused by the virus itself but by the immune system releasing antibodies to kill the virus.

Glossary

Blood supplies oxygen to the body and removes carbon dioxide. It is pumped around the body by the heart.

Diagnosis

Most cases of slapped cheek syndrome can be diagnosed by making a visual examination of the distinctive rash. No further testing is usually required in children.

In cases involving adults who have joint pain but no skin rash, a diagnosis of slapped cheek syndrome may be missed at first as the symptoms are often mistaken for arthritis or joint damage.

Because of this you may be referred for a series of blood tests and X-rays.

If there is doubt over a diagnosis, you may have a blood test to check the antibodies that your body produces as a response to infection. This results of this test will confirm a diagnosis.

High-risk groups

If you're in a high-risk group, for example, if you are pregnant or you have a weakened immune system, a blood test may be recommended if you have been in close contact with someone who is known to have the infection.

The blood test can be used to see if you are immune to the infection. If you are not immune, treatment can begin immediately to prevent complications.

Glossary

Red blood cells transport oxygen around the body and remove carbon dioxide.

Antibodies and immunoglobins are proteins in the blood. They are produced by the immune system to fight against bacteria, viruses and disease.

During a blood test, a sample of blood is taken from a vein using a needle, so it can be examined in a laboratory.

Chronic usually means a condition that continues for a long time or keeps coming back.

Treatment

There is no vaccination for slapped cheek syndrome and, for most people, the infection is usually a mild illness, which quickly passes without the need for treatment.

There are various self-care techniques that you can use to help relieve symptoms. These are explained below.

  • Painkillers, such as paracetamol or ibuprofen, can be used to relieve symptoms, such as a high temperature, headache and joint pain. Children aged 16 or under should not take aspirin.
  • Antihistamines can be used to relieve the symptoms of itchy skin. Some antihistamines are not suitable for children who are less than two years old, so check with your pharmacist beforehand.
  • Another way to soothe itchy skin is to use a moisturising lotion.
  • Make sure that you (or your child) get plenty of rest and drink plenty of fluids as this will help to relieve the symptoms of sore throat and a high temperature.
  • Adults who develop joint pain can be treated with painkillers that are non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen.

Glossary

Pain is an unpleasant physical or emotional feeling that your body produces as a warning sign that it has been damaged.

A high temperature, also known as a fever, is when someone's body temperature goes above the normal 37°C (98.6°F).

Anti-inflammatory medicines reduce swelling and inflammation.

Joints are the connection point between two bones that allow movement.

Inflammation is the body's response to infection, irritation or injury, which causes redness, swelling, pain and sometimes a feeling of heat in the affected area.

References

Al-Khan A, et al. Parvovirus B-19 infection during pregnancy. Infectious Diseases in Obstetrics and Gynecology. 2003 Jan 1;11(3): 175-9

Florea AV, et al. Parvovirus B19 Infection in the Immunocompromised Host. Archives of Pathology and Laboratory Medicine: Vol. 131, No. 5, pp. 799–804.

Kishore J, Kapoor A. Erythrovirus B19 infection in humans. Indian Journal of Medical Research. 2000 Nov 1;112 149-64

Mandel E.. Erythema infectiosum: Recognizing the many faces of fifth disease. JAAPA : Journal of the American Academy of Physician Assistants. 2009 Jun 1;22(6): 42-6

Servey JT, Reamy BV, Hodge J. Clinical Presentations of Parvovirus B19 Infection. American Family Physician. 2007 Feb 1;75(3): 373-6.

Tolfvenstam T, et al. Frequency of human parvovirus B19 infection in intrauterine fetal death. The Lancet. 2001 May 12;357(9267): 1494-7.

Young NS, Brown KE. Parvovirus B19. The New England Journal of Medicine. 2004 Feb 5;350(6): 586-97.

Zellman GL. Erythema Infectiosum (Fifth Disease). eMedicine.com. 2008

Prevention

At present there is no vaccination available to prevent slapped cheek syndrome. People who have already been infected with parvovirus B19 in the past are immune to another infection.

To prevent the spread of slapped cheek syndrome try to make sure that everyone in your household washes their hands frequently in order to reduce the chances of the infection spreading.

Glossary

The immune system is the body's defence system, which helps protect it from disease, bacteria and viruses.

Vaccination or immunisation is usually given by an injection that makes the body's immune system produce antibodies that will fight off a virus.

Complications

In the majority of cases, slapped cheek syndrome does not lead to complications. However, sometimes complications can arise due to an already existing condition, such as those outlined below.

Pregnancy

If you develop a parvovirus B19 infection during pregnancy, and you do not have immunity, there is a one-in-three chance that you will pass the infection onto your unborn baby.

There is then a risk that your baby will develop severe anaemia. This can cause heart failure and an abnormal collection of fluid inside the baby’s tissues of your baby (hydrops fetalis) which can sometimes result in a miscarriage.

Due to this risk, it is likely that you will be given regular ultrasound scans so that the health of your baby can be carefully assessed. If your baby does show signs of severe anaemia, they may be treated with a blood transfusion.

The risk of miscarriage is highest in the first 20 weeks of your pregnancy, at around 1 in 10, but then drops sharply as the pregnancy progresses.

Blood abnormalities

If you have sickle cell anaemia, thalassaemia or other blood abnormalities, parvovirus B19 can cause severe anaemia.

This is known as an "aplastic crisis", and symptoms include:

  • very pale skin
  • feeling very tired
  • headache
  • high temperature (fever) of 38C (100F) or above
  • rapid heartbeat (tachycardia)
  • dizziness
  • fainting

If you experience an aplastic crisis, it is likely that you will need to be admitted to hospital and given a blood transfusion. After having a blood transfusion, most people will make a full recovery.

Weakened immune system

If a person with a weakened immune system (immunocompromised) develops a parvovirus B19 infection, the virus can quickly spread through their bone marrow and interfere with the production of red blood cells. This can cause symptoms of severe anaemia, a high temperature and a sense of feeling very unwell.

A blood transfusion can be used to treat anaemia. Antibodies that have been donated by someone who is immune to parvovirus B19 can be used to treat the underlying infection.

Chronic usually means a condition that continues for a long time or keeps coming back.

Acute means occuring suddenly or over a short period of time.

Joints are the connection point between two bones that allow movement.

During a blood test, a sample of blood is taken from a vein using a needle, so it can be examined in a laboratory.

A foetus is an unborn baby, from the eighth week of pregnancy until birth.

Ultrasound scans are a way of producing pictures of inside the body using sound waves.

Antibodies and immunoglobins are proteins in the blood. They are produced by the immune system to fight against bacteria, viruses and disease.

Fatigue is extreme tiredness and lack of energy.

The immune system is the body's defence system, which helps protect it from disease, bacteria and viruses.

A blood transfusion involves transferring blood into a person using a tube that goes directly into a vein in the arm.

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