Wednesday, July 25th, 2007
Fifth Disease: Common in Kids, Bad for Pregnant Moms
My wife recently awoke one morning with the mythical rosy glow of pregnancy splashed across her faceâ€¦ and an itchy rash over her torso. Her doctor quickly identified it as Fifth Disease.
It’s also called Slapped Cheeks Disease.
Fifth Disease is the fifth of six classic childhood rash-producing infections, the others being measles, scarlet fever, rubella, Dukes’ disease and roseola.
My 3-year-old daughter, my wife and I have contracted Fifth Disease. We had never heard of it. Here is what we’ve learned.
[Caution: Do not use this article for diagnosis or treatment. Contact your doctor!]
Fifth Disease is caused by an annoying little bug called Parvovirus B19, and the full disease name is Erythema Infectiosum. Sounds like a Harry Potter spell, doesn’t it?
The good news is that, despite the word “disease,” it is actually a temporary viral infection. It’s usually a mild sickness in kids, much harsher in adults, and in pregnant mothers, such as my wife, it can cause a miscarriage.
The virus is spread through respiratory secretions such as coughing or sneezing. After infection, the virus takes 4 to 14 days, sometimes as many as 20 days, before symptoms appear. First you may experience cold-like symptoms for a few days, then a skin rash hits. Once the rash is present, you aren’t contagious any longer.
In our case, we thought my daughter and wife caught a common cold, then I got it too just because I don’t like being the odd man out. A few days after we were “better,” my wife and I got the real Fifth Disease symptoms. More than a week later, our daughter did too.
The long incubation period makes it easy for an outbreak at school to last several months. Our daughter started preschool two weeks ago, and that’s how we figure it came to us.
Warm rosy cheeks are likely, and sometimes symptoms similar to a common cold. My daughter had the rose garden, but no adverse symptoms. A rash on her arms lasted one day, but most rashes in kids last 5 to 10 days.
Rashes can reoccur weeks or months later, caused by a reaction to the antibodies that have been built up in a person.
For all practical purposes, my daughter has been her usual spunky self. As illnesses go, this has been a cakewalk for her.
Thirty to fifty percent of US adults have been exposed to the virus in their childhood and are now immune. The virus can hit vulnerable adults hard.
I did not experience a rosy red face. Instead, I was greeted with achy joints, I’m told, similar to full-body arthritis. Standing up in the morning made the bottom of my feet hurt. Oh, and the itching. Arms. Legs. Hands. Feet. The aches lasted five days, but the itching is going on 10 days now. In the early days, scratching produced a lacy rash within minutes. Now the itch is just an annoyance with no unsightly marking. This affects me more psychologically because I’m the type of person who never gets sick, not even headaches. Tylenol? What’s that?
My wife had a rash for four to five days, and a persistent itch that still exists in her hands. She also has pregnancy-related nausea that wipes her out in the afternoons.
Anti-itch creams have helped us with moderate success. Symptoms can last up to a month.
If you read my redwood forest trip article posted on Monday, you may wonder how we went on a mini-vacation on Saturday while sick. My wife and I were over the major symptoms after being sick a week. We were no longer contagious on Saturday and felt up to the trip. Our daughter didn’t reveal her symptoms until Monday morning.
This linked chart from the UK Health Protection Agency lays out various risks to an unborn child, with the risk period being the first five months of pregnancy. Here are statistics on the potential for viral transmission to the baby:
- 0 percent before 4 weeks,
- 15 percent between 5 and 16 weeks
- 25 to 70 percent after 16 weeks
My wife is entering her fifth week of pregnancy.
At less than 20 weeks, an infected mother has a 9 percent greater chance of miscarriage than an average mother, which brings the threat to an infected mother to 15 percent.
In that same period, there is a 3 percent chance of hydrops fetalis, of which about 50 percent of affected babies die. Hydrops is an edema (swelling) in the baby from excess fluid in tissue where it shouldn’t be.
Our first hurdle is to not be in the 15 percent of situations where the baby gets infected. The second hurdle is not to be in the 3 percent that gets hydrops. If a miscarriage occurs, it would likely happen 4 to 6 weeks after exposure.
Because we’re in the fifth week of pregnancy and a fetus is not viable before 24 weeks, we have no intervention options for hydrops. Older babies can sometimes receive intrauterine blood transfusions.
Our next action is to get an ultrasound 4 weeks from now (roughly 4 weeks since my wife’s date of infection) to look for early signs of hydrops. This should be done with a “level 2″ ultrasound, requiring us to travel five hours to UCSF Medical Center.
If everything is OK, then we turn our worry to the larger unknown prospect that a viral infection early in pregnancy may cause some abnormality discovered at birth, or perhaps years from now.
One medical journal I read (JOGNN, #7 in the links found below) indicated there are generally no long-term problems. However, there have been some reported instances on a case-by-case basis of growth restriction (born small), liver problems, persistent anemia or heart muscle injury. I chalk it up to a big “they don’t know, needs more research” response.
I was fairly nervous about having our first daughter come out whole and perfect even though I had no real reasons to be concerned. I expect we’ll be in for a roller coaster ride with our second kid even though the statistical risk for us is small.
- Parvovirus B19 Infections
- Characteristics of parvovirus b19 infections in the UK
- Rashes in pregnancy – Health Protection Agency guidelines
- Fetal infection with Parvovirus B19 may cause neurodevelopmental delays (requires login, try BugMeNot)
- Clinical description of a baby developing water on the brain from Parvovirus B19
- Flow chart: Management of confirmed parvovirus B19 infection in pregnancy
- Parvovirus B19 in Pregnancy (requires purchase), from the Journal of Obstetric, Gynecologic and Neonatal Nursing by Deborah McCarter-Spaulding, RNC, MS, IBCLC. January/February 2002 article, Volume 31, No. 1
[Disclaimer: This article is my untrained interpretation of web pages I've read. I'm a writer, not a doctor. Please consult your care provider for up-to-date medical analysis and direction.]