Parvovirus

Dear Lisa,

My son had Fifths disease about a month ago. He now has it again. Most of the children at the daycare have it or has had it. What can be done besides washing hands to get it out of the daycare? Is it likely for a child to get it more than once in that time period?

“Child with Fifth Disease”

Dear “Child with Fifth Disease”,

Fifth Disease also known as Erythema Infectious is caused by the virus Parvovirus B 19. The infection develops in stages. First an afflicted child develops a low grade fever, general malaise, muscle aches and headache.(1) Sometimes these symptoms are so mild that they go undetected. (1) Following this stage a symptom free period occurs which lasts 1 to 7 days. Next the characteristic “slapped cheek” rash develops on the face which is accompanied by a pale color noticed around the lips. The important thing to know is that once the rash develops the child is no longer contagious.

Following the appearance of red cheeks a body rash develops. This rash is diffuse, lacey, flat and pink in color. It appears on the torso, extremities and buttocks. The palms and soles are spared. The rash may become pruritic in some with fifteen percent of the children affected complaining of itching.(1)

During the third stage of the disease the rash appears to come and go. There are certain triggers associated with the reappearance of the rash. These triggers include exercise, emotional stress, hot tubs and sunlight.(2) This waxing and waning of the rash can go on for weeks and in some cases months. (2) Therefore a reoccurrence of the rash does not mean that a child developed Fifth Disease again, it just means that they are in the third stage of the disease which can be quite prolonged.

Young adults may develop a less common presentation called the “gloves-and socks” syndrome. This condition includes an itchy, eruption on the hands and feet that consists of small pink bumps. The rash causes some mild pain and swelling and is frequently followed by a body rash that consists of tiny broken blood vessels.(3)

In regards to your question about your son getting Fifth Disease again, Fifth Disease is a virus that children only get once. It is likely that the recurrence of the rash is the continuation of the original infection contracted one month ago. He probably is in the third stage of the disease, the time that the rash comes and goes.

Your other question about getting Fifth Disease out of your son’s daycare is a common question that parents ask. Typically outbreaks occur during the winter and spring months. Fifth Disease is a very difficult virus to contain. The transmission of the disease occurs before the eruption of the rash and therefore it is not determined that a child has Fifth disease until the contagious part of the disease has passed. Since many children have such mild symptoms during the first stage of the disease and because there is an asymptomatic period immediately before the development of the rash there is no way to know that a child is contagious until it is too late. In addition the virus is formed in such a way that it is resistant to heat, cold and detergents which are the typical conditions that kill most other viruses.(4)

The transmission of Fifth Disease occurs via respiratory droplets, which means the disease is spread when a child coughs, sneezes or comes into contact with another child’s nasal discharge. The infection can also be spread from exposure to an infected person’s blood or blood products and from a pregnant mother to her fetus.(5) The incubation period or the time it takes a person to become infected once exposed is 4 to 21 days.(6)

Although it may seem alarming because Fifth Disease is difficult to contain, this is not a significant concern because in the majority of cases, Fifth Disease is a mild, and self limiting condition.(1) The best way to prevent the spread of infection is to practice good hand washing at all times, even when children do not appear to be ill. It is also a good idea to teach children to cover their mouths and noses when they cough and sneeze and to properly dispose of soiled tissues.

It is important to note that Fifth’s Disease is not the only medical condition that causes a child’s cheeks to become red. I have had children who experienced recurrences of red cheeks accompanied by a body rash and it turned out that these children did not have Fifth Disease but had food allergies.

The condition “Popsicle Panniculitis” is another condition that can cause red cheeks in young children. This rash develops three days after a young child is exposed to cold from sucking on ice pops, the use of a cold pack or exposure to cold air. It appears as red, painless, swollen nodules or plaques on the cheeks. No treatment is necessary except avoidance of the cold and the rash will subside on its own.(7) Other potential causes of red cheeks in a child includes skin abscesses and Lupus erythematosus.(7)

The diagnosis of Fifth Disease is usually made through history and Physical Examination. If necessary a blood test for antibodies to Parvovirus B19 may be performed in order to confirm the diagnosis.(1) The development of a new rash in a child should be examined by a health care professional so that the correct diagnosis can be made and proper treatment recommended.

For more information about topics discussed, read other Pediatric Advice Stories:


Fifth Disease

Skin Abscesses

Food Allergies

References:
(1)Leung A, Robinson WM. What’s Your Diagnosis? Consultant for Pediatricians. 2006. June:366-370.(
2)Leach CT., Jenson HB. Erythema infectiosum (fifth disease). In: Jenson HB, Baltimore RS. Pediatric Infectious Disease. Principles and Practice. Philadelphia: WB Saunders Company;2002:325-330.
(3)Harrington J. Parvovirus B19 Infection. Consultant for Pediatricians. 2006. April:234-235.(4)Koch WC. Fifth(human parvovirus B 19) and sixth (Herpesvirus 6) diseases. Curr Opin Infect Dis. 2001.14:343-356.
(5)Frydenberg A, Starr M. Slapped cheek disease. How it affects children and pregnant women. Aust Fam Physician. 2003. 32:589-592.
(6)Weir E. Parvovirus B 19 infections: fifth disease and more. CMAJ. 2005. 172:743.
(7)Kamat D. “Popsicle” Panniculitis. Consultant for Pediatricians. 2006. Nov:729.

Lisa-ann Kelly R.N., P.N.P.,C.
Certified Pediatric Nurse Practitioner

Pediatric Advice About Childhood Infectious Diseases