SLAPPED CHEEK SYNDROME (FIFTH DISEASE)

Whether the disease is called Erythema Infectiosum, Fifth Disease or Slapped Cheek Syndrome, this condition refers to the same manifestation of erythrovirus infection, also called parvovirus B19. Depending on the country it may also be known as butterfly pox or apple sickness. People of any age, adults and children, can be infected by the virus.

What is Erythema Infectiosum?

Erythema Infectiosum is a viral infection brought on by the parvovirus B19, which was first discovered in 1975 by Virologist Yvonne Cossart. B19 is transmitted through respiratory secretions, such as mucus, phlegm, spit or saliva and blood-borne transmission (spread through contamination of blood).

Why is it called Slapped Cheek Syndrome or Fifth Disease?

Erythema Infectiosum is called Slapped Cheek Syndrome because of the rash and redness that appears on the cheeks after 4 to 21 days from initial infection, making it appear as if the cheeks have been slapped. The reason it is called Fifth Disease is because the parvovirus infection is one of 5 rash-producing illnesses that commonly affect children. Parvovirus B19 was named from the patient code of a viremic blood band donor when Cossart first discovered the virus in the 1970s.

What are the origins of Slapped Cheek Syndrome or Fifth Disease?

The B19 virus that causes Slapped Cheek Syndrome or Fifth Disease is the first parvovirus subfamily found among Parvoviridae. Parvovirus originated from warm-blooded animal hosts, such as bats and small birds, and manifested as human virus B19 of the erythrovirus genus. Pets, such as dogs and cats, are immunised against the virus to prevent animal to human transmission.

Who is affected by Virus B19?

Anyone of any age can be infected by the B19 virus through either respiratory or infected blood transmission. Pregnant women and people with weakened immune systems or those who have immunodeficiency are at higher risk of infection. These may include people with anaemia, cancer or HIV/Aids. People taking medications, such as after implants or transplants which may reduce their immune system, also fall within this risk category.

How do people get Virus B19?

Virus B19 is contagious and is transmitted through breathing in or swallowing infected respiratory secretions, such as spit or saliva. For example, if someone coughs or you happen to touch a tissue with mucous on it and don’t wash your hands immediately afterwards before touching your mouth and nose. Sharing drinking cups can also be a cause. An infected pregnant mother can infect her unborn baby.

Other infections with B19 can arise through infected blood, such as using public toilets where there may be blood on the seat and not washing hands. Infection can occur through blood transfusion, but blood is usually screened for such viruses, or through negligence in infection control. Infected needles used for recreational drug purposes can also be a cause.

What are the symptoms of Virus B19 Infection?

The symptoms manifest in three stages and can affect children and adults differently. The first stage can appear after 4 to 21 days from infection, starting with a high temperature or fever, headaches, stomach upsets, itchy skin and tiredness. The first stage may not reveal a rash or be quite mild. The second stage appears about a week after the initial symptoms began, usually a red rash across both cheeks. After the rash appears the third stage is visible because the irritated rash spreads to the chest, stomach and limbs. Adults usually experience a feeling of arthritis, stiffness and pain in the joints of the fingers, wrists, elbows, knees and ankles, and sometimes a sore throat.

How long do Slapped Cheek Syndrome or Fifth Disease symptoms last?

Sunlight, exercise, bathing in warm water and stress can make the rash worse and last longer. The symptoms usually last from 3 weeks to a month but can re-occur in certain adults monthly or annually.

Is medical treatment necessary for Virus B19 infection?

Any person with immunodeficiency, an immune system disease or a woman who is pregnant should get medical help immediately. If symptoms in children and adults without such conditions are mild the infection can clear up without medical treatment. However, in babies and children medical attention is advised. In most people the infection is a mild illness that can go away without medical treatment.

How does Virus B19 affect health?

If a person is healthy before infection and the infection is mild the affect on their health may be low once it clears. Infection with the B19 parvovirus can further weaken the immune systems of people with immunodeficiency, such as cancer, anaemia and HIV – blood transfusion may be necessary in such cases. People with arthritis who contract the virus may experience increased arthritic symptoms. Pregnant women are at risk of miscarriage.

How is Virus B19 medically diagnosed?

Visual examination of rash symptoms by a medical doctor can provide diagnosis. In adults, in the absence of a rash, blood tests and x-rays may be needed to determine the cause of joint pain. Blood tests will reveal if your body is producing antibodies to fight the Virus B19 infection.

Are there treatments for Virus B19 infection?

The Virus B19 in humans does not have a vaccine to prevent infection. If the mild symptoms appear from infection and the person isn't at risk due to poor immunity, treatments can include use of paracetamol or ibuprofen as painkillers and to lower temperature. Those under age 16 should be given aspirin as an alternate painkiller. The rash can be relieved through antihistamines. Increasing fluid intake also helps to keep hydrated and reduce a sore throat. Check with a pharmacist or doctor if in doubt. Treatment for people with immunodeficiency may include blood transfusion.

Can Virus B19 infection be prevented?

Previously infected people have developed the antibodies and are therefore immune from further infection with the B19 virus. However, there is no vaccine to prevent initial infection. High standards of hygiene and infection control are the best way to try and prevent infection. Suggestions include:

Ensure bird and bat droppings are not near air conditioning units for buildings or in places where they can be touched or easily breathed in.
Wash hands frequently to prevent any spread of infection.
Do not share drinking cups or wash cups before use.
Avoid sub-standard medical treatment facilities and unqualified practitioners.
If you have a cold be considerate of others, sanitise and wash hands.
Do not partake in recreational drugs where needles are shared.
Avoid places where there is an outbreak of the virus.