Slapped cheek disease (parvovirus B19)

Slapped cheek disease is a common infectious disease that mostly affects children. It is also known as parvovirus B19, fifth disease or erythema infectiosum.

Key points about slapped cheek disease 

  1. Symptoms of slapped cheek disease include cold-like symptoms followed by a rash on your cheeks that looks like a scald or the mark left by a slap.
  2. In healthy children, slapped cheek disease is mild and short-lived, but for pregnant women or children with reduced immunity or blood disorders, it can be more serious.  
  3. You can usually look after someone with slapped cheek disease at home without needing to visit your GP.
  4. Treatment focuses on easing your symptoms with self-care measures.
  5. You can reduce the spread of slapped cheek disease if you cover all coughs and sneezes, wash your hands regularly and avoid sharing food, drinks and utensils.

Image: DermNet, NZ

What causes slapped cheek disease?

Slapped cheek disease is caused by a human virus called parvovirus B19. The virus is passed on by an infected person, mainly through coughing or sneezing. Symptoms start from 4–20 days after you are infected with the virus.

You can pass the virus on to others from 5–6 days before symptoms start. Once the rash appears, you are no longer infectious.

Slapped cheek disease is most common during winter and spring. It spreads rapidly through schools because it is infectious before you have any symptoms.

Only a small number of adults get slapped cheek disease. Many adults are already immune because they had the virus in the past, maybe without realising. Your body produces antibodies to the virus which protects you from getting it more than once.

Very rarely, unborn babies can be infected through their mother’s blood during the first 20 weeks of pregnancy. This creates a small risk of miscarriage or your baby getting a type of anaemia (low iron levels in the blood).

What are the symptoms of slapped cheek disease?

The first few symptoms of slapped cheek disease are:

  • feeling generally unwell (your child seems ‘off-colour’ or grizzly)
  • fever
  • headache
  • cold-like symptoms such as a runny nose or sore throat
  • tiredness
  • muscle aches
  • stomach upset
  • diarrhoea.

The typical hot red rash on your child's cheeks then appears between days 3–7. The face rash lasts for 1–3 days and may be followed by a rash on their body, arms and legs that has a pink lace-like pattern. This rash may be itchy. The rash may fade, then come back again when your child is hot or upset. This can happen for 2–6 weeks.

Adults who catch slapped cheek disease may not develop a rash, but have sore joints, particularly in your hands and feet. This generally lasts about 2 weeks, but sometimes lasts several months.

Some people who get infected do not have any symptoms or just feel generally unwell without any rashes.

COVID-19 pandemic

If you have any respiratory symptoms such as a cough, sore throat, shortness of breath, head cold or loss of smell, with or without fever, stay at home and call your GP or Healthline's dedicated COVID-19 number 0800 358 5453 to check whether you need to be tested for COVID-19.

How is slapped cheek disease diagnosed?

Slapped cheek disease can usually be self-managed at home without a visit to your GP. However, there are some situations where you do need to see your doctor.

See your GP if you or your child experience any of the following:

  • You are pregnant and you think you have slapped cheek disease.
  • You or your child have a blood disorder such as sickle cell disease or thalassaemia and you think you have slapped cheek disease.
  • You have a weak immune system, eg, you have diabetes or have had chemotherapy and you think you have slapped cheek disease.
  • You are worried about your child.

Call Healthline 0800 611 116 or Plunketline 0800 933 922 if you are unsure what to do.

Your doctor will ask you questions about your symptoms and examine you or your child. Depending on what your doctor thinks is causing your symptoms, they may ask you to have some blood tests.

What are the potential complications of slapped cheek disease?

Slapped cheek disease can have serious complications for people with reduced immunity, eg, people undergoing chemotherapy or who have HIV/AIDS or blood disorders. Complications include bone marrow failure and a sudden inability to produce blood cells (aplastic crisis). These conditions are serious and need urgent 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.

How is slapped cheek disease treated?

Slapped cheek disease is usually a mild and short illness which gets better by itself. Treatment in otherwise healthy people focuses on easing your symptoms with self-care measures at home, including:

  • getting lots of rest
  • drinking plenty of fluids
  • providing 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. If you are pregnant and have been in contact with someone with slapped cheek disease, consult your lead maternity carer (LMC) or your doctor.

How can I prevent slapped cheek disease?

Slapped cheek disease is often caught from people with no symptoms, so it is not easy to prevent it. By the time the rash appears you are no longer infectious. As long you feel well enough, you don't need to be away from school or work.

Instead, do these things to reduce the chance of catching or passing on slapped cheek disease:

Learn more

The following links provide further information about slapped cheek disease. Be aware that websites from other countries may have information that differs from New Zealand recommendations.   

Slapped cheek Healthinfo Canterbury, NZ
Slapped cheek Plunket NZ
Slapped cheek disease Ministry of Health, NZ
Slapped cheek disease Better Health Channel, Australia
Slapped cheek syndrome NHS, UK

References

  1. Slapped cheek disease Ministry of Health, NZ
  2. Erythema infectiosum DermNet NZ
  3. Slapped cheek disease (Fifth disease) – a patient’s guide Family Doctor, NZ
  4. Parvovirus infection Patient Info, UK

Reviewed by

Dr Alice Miller trained as a GP in the UK and has been working in New Zealand since 2013. She has undertaken extra study in diabetes, sexual and reproductive healthcare, and skin cancer medicine. Alice has a special interest in preventative health and self-care, which she is building on by studying for the Diploma of Public Health with the University of Otago in Wellington.
Credits: Health Navigator Editorial Team. Reviewed By: Dr Alice Miller, FRNZCGP, Wellington Last reviewed: 03 Jul 2021