In the always busy school health office, amid the usual suspects of sniffles and stomach bugs to the more unusual aches and ailments, one condition stands out for its distinctive presentation: fifth disease, commonly referred to as "slapped cheek" syndrome. Caused by the human parvovirus B19, fifth disease typically targets the elementary school-aged population, making schools prime breeding grounds for outbreaks, particularly during late winter and early spring. 

Symptom Snapshot

While about 20% of infected individuals remain asymptomatic, others may experience a range of mostly mild symptoms that progress in stages.

• Initial Phase: This phase often mimics a common cold, with symptoms like low-grade fever, headache, runny nose, sore throat, fatigue, and muscle aches. Itching, nausea, vomiting, and diarrhea may also occur.

• Rash Phase: The hallmark symptom of fifth disease is the "slapped cheek" rash, a bright red rash that appears on both cheeks, typically a few days to a week after the initial phase symptoms. Gradually, a lacy or net-like rash may develop on the trunk, arms, and legs. This rash is often itchy and may come and go, particularly when exposed to heat or sunlight.

Pass It On

The virus, spread primarily through respiratory droplets like saliva, sputum, or nasal mucus, can be easily transmitted through seemingly innocent actions like sharing food, drinks, utensils, or any of the other myriad ways kids tend to pass along slobber. Parvovirus B19 can also spread through blood or blood products, although this is rare.

Kids are most contagious during that sneaky pre-rash phase when they just seem to have a run-of-the-mill virus. This makes it challenging to identify and isolate infected individuals. Once the characteristic rash appears, the student is no longer contagious. For this reason, if the student does not meet any other exclusion criteria (ex., fever) and is feeling well, exclusion from school is unnecessary.

Beyond The Rash

Fifth disease is generally a mild viral infection, but it poses specific risks for certain groups, such as immunocompromised individuals and pregnant women. For students with weakened immune systems or blood disorders like sickle cell anemia, fifth disease can lead to severe complications, including chronic anemia due to the virus's ability to suppress red blood cell production. Infection during pregnancy, particularly in the first trimester, carries a small risk of miscarriage or fetal complications. Pregnant school staff should be informed about these potential risks and advised to consult their healthcare providers for guidance on preventive measures and to assess their immunity status. 

Classroom Combat

School nurses should implement a comprehensive hygiene strategy to effectively prevent the spread of fifth disease in schools. The cornerstone of this strategy is reinforcing proper hand hygiene. Encourage students and staff to wash their hands thoroughly with soap and water, particularly after using the restroom, before eating, and after coughing or sneezing. Promote good respiratory etiquette by teaching the proper use of tissues for coughing and sneezing, followed by immediate disposal and handwashing.

Environmental cleanliness is equally crucial. Implement a systematic approach to disinfecting high-touch surfaces such as doorknobs, desks, and shared equipment. This should be done regularly and thoroughly to minimize viral transmission.

Education plays a vital role in prevention. Teach students the importance of not sharing personal items, especially food, drinks, and utensils. By combining these practices - hand hygiene, respiratory etiquette, environmental cleaning, and community education - school nurses can significantly reduce the risk of fifth disease transmission in the school setting.

Need to inform parents about fifth disease in your school? Access a ready-to-use letter template HERE to communicate essential information effectively!