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Slapped cheek disease (fifth disease)

Slapped cheek disease, also known as fifth disease, is a common childhood viral infection.  It is caused by the human parvovirus B19 and is called "slapped cheek disease" due to its characteristic red facial rash. It is sometimes called erythema infectiosum.
The disease mainly occurs in children and is usually accompanied with mild, cold-like symptoms. However, complications can occur in those with weakened immune systems and blood disorders. 
If a woman contracts slapped cheek disease during the first half of her pregnancy, there is a small risk that the unborn child can develop a serious form of anaemia, or that the baby may miscarry. This occurs in less than 10% of pregnant women infected with the condition. 
After infection with slapped cheek disease, lasting immunity to the condition is developed, protecting against future infection. It is estimated that by adulthood 50% to 70% of people have developed immunity to the condition. 

Signs and symptoms

Slapped cheek disease is usually a mild disease.  Early symptoms can be vague and may be mistaken for the start of a cold.  Symptoms may include:
  • Mild fever
  • Chills
  • Headache
  • Body ache
  • Sore throat
  • Upset tummy/diarrhoea
These may last for two or three days then subside or disappear altogether.
Children then develop firm, bright red cheeks that are burning hot ("slapped-cheek").  Commonly a fine, red, lace-like rash then develops on the body, arms and legs.  The rash may be itchy and may seem to fade then flare up when the child is hot or emotionally upset. The rash usually lasts for about two weeks, but may last for up to six weeks. 
If adults develop the condition, they are less likely to have rashes but sometimes suffer swollen and painful joints, especially in the hands and feet.  This joint pain usually only lasts for one to two weeks, but in severe cases may last for several months.
Around 30% of infected individuals will display no symptoms.   

Transmission and incubation period

Once infection with the virus has occurred, the incubation period (the time until symptoms appear) is between four and 20 days.  The person is infectious to others up to five or six days before the first symptoms appear, and stop being infectious to others once the rash appears. 
Slapped cheek disease can be spread from person to person in airborne droplets or by direct contact with infected throat or nasal discharges.  Coughing and sneezing are the most common modes of transmission. 
The condition can spread rapidly through schools and childcare facilities and is most common during winter and spring.  Epidemics of the condition tend to occur every three to seven years.   


Usually diagnosis is made based on clinical signs and symptoms.  In an otherwise healthy child red, hot cheeks and a lacy rash are usually enough to indicate the condition.  If there is any doubt a blood test may be recommended to confirm the presence of parvovirus B19.   


Most cases of slapped cheek disease require only supportive treatment. Because the condition is caused by a virus, antibiotics will be of no benefit in treating it. 
Supportive treatment usually includes:
  • Rest
  • Paracetamol, to relieve fever
  • Cold flannels to relieve discomfort of hot cheeks
  • Encouraging adequate fluid intake.
People with weakened immune systems and blood disorders should seek specialist advice as they can suffer serious illness, such as severe anaemia, due to slapped cheek disease.  They may also have difficulty forming red and white blood cells.  Blood transfusions may be required in these instances.


As slapped cheek disease is contagious before it is diagnosed, excluding children with the condition from childcare or school will not prevent the spread of the disease.
Ensuring that hands are washed often with soap and warm water and are thoroughly dried is an effective way to help prevent the spread of the virus.  This is particularly important for pregnant women who have contact with infants and children.  The sharing of eating utensils should also be avoided. 
Pregnant women who are exposed to individuals with slapped cheek disease should consult their Lead Maternity Carer (ie: midwife, obstetrician or GP).

Further information and support

For further information and support about Slapped cheek disease contact your GP, public health unit, practice nurse, or contact:

Freephone: 0800 611 116 (operates 24 hours a day, 7 days a week)
Freephone: 0800 933 922 (operates 24 hours a day, 7 days a week)


Auckland Regional Public Health Service (2006) Slapped Cheek Syndrome/Fifth Disease Pamphlet. Auckland: Auckland District Health Board
Canterbury District Health Board (2011) Slapped Cheek Disease. Pamphlet. Canterbury District Health Board, Communicable Diseases Team.
Cherath, L. (2006) Fifth disease. The Gale Encyclopedia of Medicine. Third Edition. Jacqueline L. Longe, Editor. Farmington Mills, MI. Thompson Gale.
NZ Dermnet Development Group (2011) Fifth disease.  Hamilton:  New Zealand Dermatological Society Incorporated -
Last Reviewed – November 2012


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