Fifth Disease: Not Just Another Rash

Skin rashes on children occur frequently in childcare facilities. Many rashes are mild reactions to irritants and will fade by the end of the day. Others may be caused by communicable diseases and require isolation and exclusion of the child. Still other rashes may be symptoms of allergic reactions or serious diseases that will require immediate medical attention. (See Healthy Childcare Volume 5, Issue 4's article on rashes for more information).

When a child has a rash, your policy may require that the child be seen by a physician and that the childcare program receive the physician's statement that there is no contagious disease present before being allowed to return to childcare. Remember, an appearance of the rash is not always an indication of contagious disease. One example of this is "fifth disease."

What is fifth disease?

Fifth disease (erythema infectiosum) is a common childhood viral disease caused by infection with human parvovirus B19. The disease was called "fifth disease" because it was counted among the five classical common rashes of childhood.

Symptoms usually occur from 4-14 days after exposure to the disease. The child often appears to have a mild cold, with a stuffy nose and a low grade fever. This is followed by a solid, bright red rash that occurs first on the cheeks, which is why it is often called the "slapped-cheek" rash. Within a few days the rash spreads over the trunk, arms and legs, giving a red lacy appearance. The only areas not affected by the rash are the palms of the hands and soles of the feet. The rash usually disappears in 1-3 weeks, although exposure to sunlight, stress or heat may cause it to flare up before it completely fades. Occasionally the rash may itch. Other symptoms may include swollen glands, red eyes, sore throat, diarrhea, and unusual rashes that look like blisters or bruises. While there is a specific blood test to diagnose the disease, medical diagnosis is generally based on the characteristic rash.

Controlling the outbreak

Fifth disease is very contagious and there is no vaccine to prevent it. The disease is especially common in children between the ages of 5-15 and outbreaks happen most often in the late winter and early spring. This disease is spread from person-to-person by close physical contact and by contact with droplets that occur when the infected person coughs or sneezes. In a childcare setting, children may contract the virus from fresh secretions on shared toys and eating utensils. Teach children to cover their mouths and noses and to use tissues when coughing or sneezing. Wash toys and mouthed objects frequently.

A child infected with fifth disease is contagious for 7-10 days before the characteristic rash occurs, so other children already will have been exposed by the time the problem is identified. The child is unlikely to be contagious after the rash appears. After diagnosis by a health care provider, the child probably will be cleared to return to the program. There is no need to exclude the child from childcare if he or she feels well enough to attend. However, children should always be excluded from childcare if they are too sick to participate. If a child requires a level of care that jeopardizes the safety of the other children, that child should be excluded from care.

To prevent further spreading of this and other diseases, follow state and national recommendations for cleaning in the childcare environment. Frequent and effective hand washing will always reduce the spread of this and other diseases.

Treatment

Since this disease is caused by a virus, antibiotics will not help relieve symptoms or hasten recovery. Treatment involves relieving discomfort. Most children do not look sick and have no fever, although some children may be uncomfortable and irritable. Be patient with the child; lots of rest will help him or her feel better. If the child complains of itching from the rash, tepid baths or oatmeal baths may help. Parents also may ask their child's physician about topical lotions that may be applied. The physician also may recommend acetaminophen or ibuprofen to reduce low-grade fevers. Never give aspirin to a child with fever! Aspirin has been associated with Reye's Syndrome, a potentially life-threatening condition.

Childcare workers

A person who has been infected with parvovirus B19 cannot get fifth disease again. About half of all adults have had the disease as children and therefore, will not catch it. For this reason, even though childcare providers are frequently exposed, they are usually immune. However, adults with chronic illnesses or impaired immune systems, such as sickle cell or autoimmune hemolytic anemia, are at considerable risk and should consult their physicians.

There is some evidence that the virus can cause fetal damage when a woman contracts it during the first trimester of pregnancy. Therefore, if a pregnant woman is exposed, she should discuss her concerns with her obstetrician.

As a childcare provider, you may be able to recognize the characteristic rash of fifth disease. However, childcare providers must realize that it is not their responsibility to diagnose rashes or their causes. Rather, they should follow their program's policies on illness and exclusion of sick children, particularly children that have rashes and/or fevers. If warranted by your program's policy on illness exclusion, the child should immediately be isolated from the other children. The parent should be notified to pick up her child and seek medical advice before the child may return to the facility. While awaiting pick up, the child should be isolated from other children. Remember though, never leave any child unsupervised!

Kathy Moss, RN, ICP, CPHQ
Coauthor of Nurse's Manual of Infectious Diseases published by Little, Brown and Co.

INTERNET RESOURCES

www.kidshealth.org/parent/infections/skin/fifth.html

www.drreddy.com/shots/fifth.html

www.dermnetnz.org/dna.fifth/fifth.html

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