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Slapped cheek disease

Childhood infection caused by human parvovirus

Slapped cheek disease is also known as fifth disease or erythema infectiosum. It is caused by parvovirus B19 infection and is traditionally a childhood condition, characterised by a rash on the cheeks that looks like a scald or the mark left by a sharp blow.

In otherwise healthy children, slapped cheek disease is mild and short-lived. Those with reduced immunity or blood disorders, however, can suffer more serious complications. In very rare cases, women who come into contact with the virus for the first time during the first 20 weeks of pregnancy can pass on the disease to their babies with potentially serious consequences.

Symptoms of slapped cheek disease

The tell-tale hot red rash on the cheeks associated with slapped cheek disease usually appears between days three and seven.  It lasts one to three days and is often followed by a fine red rash on the body, arms and legs that has a characteristic pink lace-like pattern. The body rash may be itchy and may fade, then flare up again when the child is hot or upset, for anything from two to six weeks. 

Early symptoms include:

  • fever
  • malaise (child seems ‘off-colour’ or grizzly)
  • headache
  • cold-like symptoms
  • sore throat
  • tiredness 
  • muscle pains
  • stomach upset or diarrhoea.

The small number of adults who catch slapped cheek disease may find that they don’t develop a rash, but have sore joints, particularly in the hands and feet. This generally lasts only about two weeks, but sometimes lasts several months.

Catching slapped cheek disease

Slapped cheek disease is passed on via droplets from the respiratory tract of an infected person, mainly through coughing or sneezing.

It takes anything from four to 12 days to develop the first symptoms following infection.

A person who has been infected can pass the virus on to others from five to six days before the first symptoms appear. Once the rash appears on the face a person is no longer infectious.

Slapped cheek disease epidemics occur about every three to seven years, usually in spring or autumn. It spreads rapidly through schools as it is infectious before symptoms appear.

Approximately 60% of adults have natural immunity to parvovirus B19, having been exposed to it as children.

Very rarely, unborn babies can be affected by parvovirus B19 via their mothers’ blood.  This occurs in just 5% of women who are infected with parvovirus B19 for the first time during the first 20 weeks of pregnancy. Because 60% of all women of childbearing age are already naturally immune to this virus, the risk is considered extremely low.

Potential complications of slapped cheek disease

Slapped cheek disease can have serious implications for people with reduced immunity (eg, those undergoing chemotherapy, or people with HIV/AIDS) and those with underlying blood disorders. Bone marrow failure and a sudden inability to produce blood cells (aplastic crisis) are both serious effects that require medical attention.

In a very small number of cases, infection with the disease results in serious anaemia and miscarriage for babies whose mothers catch slapped cheek disease during the first 20 weeks of pregnancy.

Treatment for slapped cheek disease

Slapped cheek disease is caused by a virus, so there is no cure. Treatment in otherwise healthy people focuses on easing the symptoms with:

  • rest
  • plenty of fluids
  • cool flannels for cheeks
  • paracetamol for fever or aches.

Anyone with reduced immunity or blood disorders who catches slapped cheek disease should seek medical attention to monitor and treat potentially serious complications.

Pregnant women who have been exposed to someone with slapped cheek disease should consult with their lead maternity carer (LMC) or their doctor.

Prevention of slapped cheek disease

Slapped cheek disease is often caught from people with no symptoms. Quarantine is, therefore, not an effective way of preventing its spread. As long as the person feels well enough, it is not necessary for them to be away from school or work.

To minimise the chance of catching or passing on slapped cheek disease:

  • observe good cough etiquette (cough into the crook of your elbow and face away from people and food)
  • wash and dry hands regularly and thoroughly 
  • don’t share food or eating utensils.

Original article prepared by everybody. Reviewed by Dr Bronwyn Lloyd GP, November 2009.

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