Slapped cheek disease, also known as fifth disease and erythema infectiosum, is a common and usually mild childhood viral infection. Treatment normally involves rest and relieving discomfort. However, there are potentially serious complications for pregnant women or people with immune system or blood disorders.
The condition is called "slapped cheek disease" due to a key symptom: a hot, red facial rash. It occurs mainly in children under 10 years old and is usually accompanied with mild, cold-like symptoms.
Slapped cheek disease is caused by a virus, parvovirus B19, which is spread from person to person by coughing and sneezing, and by direct contact with infected throat or nasal discharges. Once infection has occurred, the time until symptoms appear is between four and 20 days.
The infection can spread rapidly through schools and childcare facilities and is most common during winter and spring. Epidemics (outbreaks) of the condition tend to occur every three to seven years.
After infection with slapped cheek disease, lasting immunity to the condition is developed, protecting against future infection. It is estimated that by adulthood the majority of people have developed immunity to the condition, while the remainder are still at risk.
Signs and symptoms
Early symptoms can be vague and may be mistaken for the start of a cold. They may include:
The symptoms 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 can last for up to six weeks.
A person with slapped cheek disease is infectious to others up to five or six days before the first symptoms appear, and stops being infectious once the rash appears.
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.
Usually, diagnosis is made based on the 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 about the diagnosis, a blood test may be done to confirm the presence of the virus.
For most cases of slapped cheek disease treatment usually includes:
- Paracetamol to relieve fever
- Cold flannels to relieve discomfort of hot cheeks
- Encouraging adequate fluid intake.
Because the condition is caused by a virus, antibiotics have no benefit in treating it.
People with weakened immune systems and blood disorders exposed to someone with slapped cheek disease should seek specialist advice as they can suffer serious illness, such as severe anaemia, as a result of infection. They may also have difficulty forming red and white blood cells. Blood transfusions are sometimes required in these instances.
If slapped cheek disease is contracted during the first half of pregnancy, there is a small risk that the unborn child will develop a serious form of anaemia (a low level of iron in the blood), or that the baby may miscarry. Pregnant women who are exposed to individuals with slapped cheek disease should consult their maternity carer (i.e., midwife, obstetrician, or GP).
As slapped cheek disease is contagious before it is diagnosed, it is difficult to prevent infection and removing children with the condition from childcare or school may not prevent the spread of the disease.
However, ensuring that hands are washed often with soap and warm water, and are thoroughly dried, is an effective way to help reduce the spread of the virus. The sharing of eating utensils should be avoided. This advice is especially relevant for pregnant women who have contact with infants and children.
Currently there is no vaccine to prevent contracting slapped cheek disease.
Further information and support
For further information and support 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)
Canterbury District Health Board (2017). Slapped cheek disease (Pamphlet). Christchurch: Canterbury District Health Board, Communicable Diseases and Community and Public Health. http://www.cph.co.nz/wp-content/uploads/med0078.pdf
DermNet New Zealand (2015). Erythema Infectiosum (Web Page). Hamilton: DermNet New Zealand Trust. http://www.dermnetnz.org/topics/erythema-infectiosum [Accessed: 30/11/22]
Ministry of Health (2020). Slapped cheek (Web Page). Wellington: New Zealand Government Ministry of Health. https://www.health.govt.nz/your-health/conditions-and-treatments/diseases-and-illnesses/slapped-cheek [Accessed: 30/11/22]
NHS inform (2022). Slapped cheek syndrome (Web Page). Glasgow: National Health Information Service, National Health Service (NHS) Scotland. https://www.nhsinform.scot/illnesses-and-conditions/infections-and-poisoning/slapped-cheek-syndrome [30/11/22]
O’Toole, M.T. (Ed.) (2017). Erythema infectiosum. Mosby’s Dictionary of Medicine, Nursing & Health Professions (10th ed.). St Louis, MI: Elsevier.
Last Reviewed: November 2022