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Slapped cheek disease


What is slapped cheek disease?

What are the causes of slapped cheek syndrome?

Is slapped cheek disease infectious?

How common is slapped cheek disease?

What are the symptoms?

Are the symptoms different in an adult?

Are there complications with slapped cheek?

Complications in children with blood abnormalities

Complications in people with a weakened immune system

Complications in pregnant women

Is there a treatment for slapped cheek disease?

My child has slapped cheek disease, what can I do for them at home?

Can you prevent the spread of slapped cheek disease?

Are there any tests for slapped cheek disease?

What is slapped cheek disease?

Slapped cheek disease is normally a mild, short illness caused by a viral infection.
It is characterised by a distinctive bright red rash on the cheeks, which is how the condition got its name. Although this rash may appear to be quite dramatic, slapped cheek disease is usually a very mild condition that passes in a few days.
It often occurs in small outbreaks and will rapidly spread through schools and day care centres.
Slapped cheek disease is also known as fifth disease because it's the fifth rash in a group of five red rash diseases that also includes scarlet fever, measles, rubella and roseola. The long name for slapped cheek disease is erythema infectiosum.

What are the causes of slapped cheek syndrome?
A virus called parvovirus B19 causes the slapped cheek infection. Parvovirus B19 is an airborne virus that is spread the same way as the cold or flu viruses through sneezing, coughing, kissing or close contact.

Is slapped cheek disease infectious?
Yes, this condition is infectious, typically between four to 20 days before the rash appears. By the time the rash develops, it is usually no longer infectious.
However, about 60% of adults become immune to slapped cheek disease and other infections caused by parvovirus B19.
Once you've been infected you should develop a lifelong immunity and not experience any further symptoms.
In Ireland, the peak months for this condition are April and May but it can occur at any time during the year.

How common is slapped cheek disease?
Most adults in Ireland have had this infection at some point in their lives but may not have realised it. About 20% of people who get infected have no symptoms at all.
As you make antibodies during the infection, which protect you from future infections with this same virus, it is normal to have slapped cheek disease only once in a lifetime.
Approximately 50-70% of adults have had the disease and are immune. However, those who are not immune may be at risk from picking up this infection, particularly healthcare providers, childcare providers and teachers.

What are the symptoms?
Slapped cheek disease is most common in children aged four to 12 years, although it can affect anyone of any age. This infection usually starts with a fever and other flu-like symptoms, such as a sore throat and aches and pains.
A few days after these flu-like symptoms set in one or both of your child's cheeks will turn red and look as if they've actually been slapped. A red, lacy rash may appear on your child's body and limbs a few days later, with the upper arms and legs being the most common locations. The rash can be itchy and uncomfortable.
Occasionally, the rash on the face and body keeps fading and returning several times for up to four weeks. However, it is more common for the rash to come and go completely within a few days.
Patients are usually no longer infectious once the rash has appeared.
Although the rash can look quite dramatic, the illness itself is usually mild. You will usually not feel too ill. You may have a mild temperature (fever), sore throat and cold symptoms for a few days before the rash appears. Occasionally, mild pain and stiffness develop in one or more joints for a few days, although this is more common in adults than children.
Around one in five people who become infected with this virus do not develop any symptoms at all. Some people just have a fever and feel generally unwell, without any rashes.

Are the symptoms different in an adult?
The most common symptom of this infection in adults is joint pain and stiffness usually involving the hands, knees, wrists and ankles.
Half of all affected adults will also experience a rash, however, the 'slapped-cheek syndrome' is uncommon in adults and usually only affects around 1 in 10 people.
Other symptoms, such as a fever and sore throat, are rare in adults.
In most people, the symptoms of a parvovirus B19 infection will pass within one to two weeks. Although it is more unpleasant for adults, there is no real concern about people with slapped cheek. The joint pain in adults usually lasts one to two weeks, although 1 in 5 adults will experience recurring episodes of joint pain and stiffness for several months, sometimes years.

Are there complications with slapped cheek?
The disease is usually mild, but there are three high-risk groups in which the parvovirus B19 can cause a much more serious infection and trigger a range of complications:

Complications in children with blood abnormalities
In children with some types of hereditary anaemia (low level of red blood cells), such as sickle cell disease, beta-thalassaemia and hereditary spherocytosis, this virus can cause their anaemia to become suddenly much worse.
It is likely those affected will need to be admitted to hospital and given a blood transfusion. After having a blood transfusion, most people will make a full recovery.

Complications in people with a weakened immune system
If you have cancer, have had an organ transplant or have HIV infection, your immune system may be weakened. If a person with a weakened immune system is infected with slapped cheek disease, the virus can interfere with the production of red blood cells and cause symptoms of severe anaemia, a high temperature and a sense of feeling very unwell. A blood transfusion can be used to treat anaemia.

Complications in pregnant women
If a pregnant woman is exposed to this illness for the first time in her life, and she comes down with the symptoms of the illness, then there is a very small risk of a miscarriage. This risk is much greater during the first half of pregnancy (1 in 10).
However, the good news is that the vast majority of adults have acquired this infection at some point during their lives, and are therefore immune to it.
Even if you are infected, only 2 - 3% of infected pregnant women have an infected foetus. The infection results in the production of red blood cells being interrupted in the baby.
If you are pregnant and have been in contact with a person with the virus and are unsure of your immunity to it then your doctor may arrange for you to have a blood test.
Unfortunately, there is no cure for slap cheek so if you have been infected, it is likely that you will be given regular ultrasound scans so that the health of your baby can be carefully assessed.
Most pregnant women who have slapped cheek disease have healthy babies.

Is there a treatment for slapped cheek disease?
No. Simply treat any symptoms that are bothering you or your child.
If your child is uncomfortable from itching, your doctor may recommend an antihistamine or calamine lotion. If your child has a headache, temperature or aches and pains then painkillers such as paracetamol or ibuprofen will help.
There is no benefit of not going to school or work if you have this infection as you are only infectious before you develop the rash. However, if you are feeling unwell and have a high temperature, it is advisable to stay home and get some rest.
If you're in one of the high-risk groups and you have been in close contact with someone who goes on to develop slapped cheek syndrome, contact your GP for advice.

My child has slapped cheek disease, what can I do for them at home?
Keep your child comfortable in cool cotton clothing
Apply calamine lotion to the skin to relieve the itch
Keep your child's nails short to help prevent scratching and secondary infection
Ensure your children wash their hands regularly throughout the day
It may help to use cotton gloves, mittens or socks on smaller children or at night to stop scratching
Ensure they have plenty to drink
If your child has a fever, or is in discomfort, give paracetamol syrup, checking the bottle for correct dose for age
If your child has developed slap cheek let any friends, relatives or social contacts who are pregnant know so they can inform their doctor or midwife, who will do blood tests and monitor the pregnancy
Pregnant women who work in a childcare environment need to be aware of the virus.

Can you prevent the spread of slapped cheek disease?
It's very difficult to prevent the spread of the virus, as people are most contagious before their symptoms begin. A person with this virus is infectious during the incubation period, which is about two weeks before the rash or other symptoms appear. It is not contagious once the rash has appeared.
No vaccine is currently available for slapped cheek disease. Good hygiene and careful hand washing helps prevent spread of the disease, but there's nothing else you can do to stop it spreading.

Are there any tests for slapped cheek disease?
This viral infection is usually diagnosed by the appearance of the classical rash on one or both cheeks. However, many people with slapped cheek disease show no symptoms at all, therefore, the only way to definitively diagnose it is to have a blood test.
A blood test is rarely used in children since it is not very important to know for certain if a child has it. But the test can be done for pregnant women and people who have a weakened immune system or certain blood disorders, to test their immunity if they have been exposed to an person infected with the virus.
The blood test will show if they have the disease and can also show if they have had this disease in the past. If you have had the disease in the past - even if you did not develop any symptoms - then you will be immune to it.



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