Slapped cheek syndrome

What is slapped cheek syndrome?

Slapped cheek syndrome, sometimes called fifth disease or erythema infectiosum, is an infection caused by the parvovirus B19 virus. Slapped cheek syndrome most commonly occurs in children aged 3-15 years but anyone can be affected. Slapped cheek syndrome can be passed on (it is infectious). The infectious period is for 4-20 days before the rash appears. By the time the rash develops, it is usually no longer infectious.

In the UK, April and May are the peak months for slapped cheek syndrome. However, it may occur at any time.

Approximately 50-60% of people in the UK have had slapped cheek syndrome in the past, usually without realising it. You only have slapped cheek syndrome once in a lifetime. This is because you make antibodies during the infection which protect you from future infections with this same germ (virus).

Note: pet dogs or cats can be immunised against parvovirus. However, these are animal parvoviruses which are different from parvovirus B19.

How is slapped cheek syndrome spread?

Slapped cheek syndrome spreads through droplets in the air from the nose and throat when an infected person coughs or sneezes. It can also spread by touching surfaces contaminated with the virus. The infection is most contagious before the rash appears, which can make it difficult to prevent transmission.

Symptoms of slapped cheek syndrome

The symptoms typically appear in stages and may include:

Stage 1 (Initial Symptoms)

• Low-grade fever.

• Headache.

• Mild cold-like symptoms (runny nose, sore throat).

• Fatigue or feeling unwell (malaise).

Stage 2 (Rash)

• A bright red rash develops on the cheeks, making the skin look like it has been slapped.

• A lacy, red rash may then spread to the arms, legs, and torso.

• The rash can sometimes itch or feel warm to the touch.

Stage 3 (Rash Fades)

• The rash may gradually fade, and in some cases, it may reappear with exposure to heat (such as hot baths, exercise, or sun exposure).

• Joint pain or swelling may also occur, especially in adults.

Rash

Typically, the rash looks like a bright red scald on one or both cheeks. It looks as if the cheek(s) have been slapped. Sometimes there is just a blotchy redness on the face. The rash is painless.

Sometimes a more widespread faint rash appears on the body, arms and legs. Occasionally, the rash on the face and body keeps fading and returning several times for up to several weeks. However, it is more common for the rash to come and go completely within a few days.

Other symptoms

Although the rash can look quite dramatic, the illness itself is usually mild. You will usually not feel too ill. You may have a headache, sore throat, runny nose or mild temperature (fever) that last for a few days and occur around 7-10 days before the rash appears. Occasionally, mild pain and stiffness develop in one or more joints for a few days. This is more common in adults than in children.

You may have no symptoms

Around one in four people who become infected with this germ (virus) do not develop any symptoms at all. Some people just have a fever and feel generally unwell, without any rashes.

Diagnosing slapped cheek syndrome

Slapped cheek syndrome is usually diagnosed by the appearance of the classical rash on your cheeks.

A blood test is sometimes performed. This will show if you have slapped cheek syndrome and can also show if you have had this disease in the past. If you have had the disease in the past (even if you had it without developing any symptoms) then you will be immune to it. Testing is generally only carried out in pregnant women, or in people who have other medical conditions that reduce their immune system, not in healthy non-pregnant adults or in children.

Complications from slapped cheek syndrome

Usually not. Rarely, the aching joint symptoms last for some time after the other symptoms have gone.

The only times the illness may become more serious are:

• In children with some types of hereditary anaemia such as sickle cell disease, beta-thalassaemia and hereditary spherocytosis. This germ (virus) can cause these types of anaemia to become suddenly much worse.

• In people with a weakened immune system. If you have leukaemia or cancer, have had an organ transplant or have HIV infection then you may develop a more serious illness with this infection.

Slapped cheek syndrome during pregnancy

Most pregnant women are immune to this germ (virus), or will not be seriously affected if they become infected by it. However, like some other viruses, the virus that causes slapped cheek syndrome can sometimes harm an unborn child. Miscarriage is more common in women who are infected with this virus before 20 weeks of pregnancy.

If you develop a rash during your pregnancy or come into contact with a person with a rash then you should seek medical advice. Your doctor will usually arrange for you to have a blood test to see if you have had slapped cheek syndrome in the past. If this is the case then you can be reassured and will not usually need other tests or treatment.

However, if the test does not show that you have had slapped cheek syndrome in the past, you may need to have other blood tests and also other tests - for example, a scan of your unborn baby.

Treatment for slapped cheek syndrome

You do not usually need any treatment. If you have a headache, high temperature (fever) or aches and pains then painkillers such as paracetamol or ibuprofen will help.

Those people who develop complications (which is very rare) may require other treatment.

You can still go to school (or work) if you have slapped cheek syndrome, as you are only able to pass it on (are infectious) before you develop the rash. People infected with parvovirus B19 are considered non-infectious one day after the rash begins.

Preventing slapped cheek syndrome

There is no vaccine or treatment that prevents slapped cheek syndrome. However, the following steps may prevent the infection spreading:

• Wash hands frequently with soap and water.

• Cover your mouth and nose with a tissue or elbow when coughing or sneezing.

• Avoid close contact with anyone who is sick, especially pregnant women or people with weakened immune systems.

• Disinfect commonly touched surfaces.