Pink cheeks. That was the first hint that anything was amiss. Despite the gorgeous late Spring weather and the amount of recess time spent outdoors, the pink cheeks that would normally merit no more than a passing glance, made us look twice. Having given birth to three very fair-haired, fair-skinned children, the daily application of sunscreen at our home is as normal as the daily application of clean underwear. So, pink cheeks? Curious.
Three days later, after an outing to the Zoo, curiosity quickly turned to concern. Not only did our seven year old look sunburned, her face looked like she had been smacked repeatedly -- red, white, blotchy. She looked ill, but swore she felt just fine, a fact bore out by the absence of a fever and the presence of her good humor and abundant energy. OK, we thought, file this under "Keep An Eye on It".
That filing lasted approximately twelve hours.
When she awoke for school the next morning, we were horrified. In addition to the bright red face, she now sported a red and white mottled rash on both arms and legs. The rash itself was like none we had seen or treated before. Sure, we were more than familiar with diaper rash, prickly heat, heat rash and chicken pox, but this was new. Her skin was totally smooth, no bumps, lesions or eruptions -- and she was not extremely itchy.
As it was too early to call the pediatrician, I headed to the millenniumís next best source of medical information -- the Internet. I surfed for every rash related ailment I could think of, from psoriasis to scarlet fever. I was able to quickly rule out a vast number of rashes based on their descriptions and symptoms. Growing more frustrated by each fruitless click of the mouse, I finally struck gold at HealthlinkUSA.com. While their search engine pulled up a large list of many of the same items I had already surfed, there in the middle of the page I noticed the term "fifth disease".
Out of curiosity, I clicked on the link and began to read. Thirty seconds later, I had my diagnosis. Kendall had contracted a startlingly common virus, yet somehow my husband and I had never heard of it. I would soon learn that what was more common was that we were not alone.
Medical name: Erythema Infectiosum, slang name: Slap Face. Fifth disease is so named for being the fifth rash disease identified and described by physicians prior to the advent of modern vaccinations, rubella, measles, scarlet fever and roseola being the first four. In stark contrast to this quad of more serious and debilitating rash diseases, fifth, while alarming in view, is, on the whole, benign.
Dr. Barton Schmitt, Professor of Pediatrics at the University of Colorado School of Medicine, describes fifth as, "a very mild disease, seen predominantly in children ages 2 to 14, although adults may contract it, characterized by a bright red or rosy rash on both cheeks for one to three days ("slapped cheek" appearance) followed by a pink "lace-like" or "net-like" rash on the extremities. The "lacy" rash appears primarily on the thighs and upper arms." As for duration, he explains, "It comes and goes several times over a period of one to three weeks, especially after warm baths, exercise, and sun exposure. The rash does not itch."
The most frustrating factor with fifth is the ease and quietness with which it is contracted. Dr. Michael Bornstein, of Ibabydoc.com: "Fifth disease is contracted via respiratory droplets, much like the common cold. A simple sneeze, cough, etc. Unfortunately, there are very few symptoms ( low-grade fever, slight runny nose or sore throat) and some children display none prior to the onset of the rash, at which time they are no longer contagious."
So, not contagious once the rash appears? This was comforting in that we now knew Kendall was not seriously ill as originally feared. However, I was certain that if I sent her to school, they would immediately send her home based on her appearance. Upon contacting her school to report her absence, I asked the secretary if, on the off chance, they had ever heard of fifth disease or if other children had been reported with it recently. Her reply shocked me, "Oh that? Tons of kids have had that. Itís so common." Tons? As in many?
I then began to wonder how, being educated adults, with three children who have contracted many things in their little lives, we had never even heard of this. I had never heard friends speak of it. My childrenís pediatrician had never even alluded to it. It turns out that the biggest commonality of the disease is its anonymity. It seems that due to its benign nature and subsequent immunity -- once in a lifetime -- fifth disease is not exactly a candidate for the cover of Time Magazine.
In a global email survey of 1,689 parents, conducted by SanityCentral.com, the results were astonishing. When asked, "Have you ever heard of fifth disease?" A full 98% of respondents replied NO. Of the remaining 2% who had heard of it, all attributed their knowledge to one or more of their children having contracted it.
Karen B, of Monticello, Minnesota wrote, "My daughter had a very bad case as a toddler. I never received info on the disease from any official source like a school or daycare or even my clinic until she was diagnosed." And Karel S., of Toronto, Canada points out the lack of communication between parents and schools, despite its frequent occurrence, "I taught for nine years and no info was ever given out in the elementary school."
While fifth disease is universal (it is estimated that over 60% of adults have contracted it at some point in their lifetime) and basically harmless, Dr Schmitt stresses there is a concern for pregnant women, "The virus that causes fifth disease does not cause birth defects. Recent research has shown, however, that 10% of babies who are infected with fifth disease before birth develop severe anemia and 1% or 2% may even die. If you are pregnant and exposed to a child with fifth disease before the child develops the rash, see your obstetrician. He or she will take a sample of your blood for an antibody test to see if you have already had the disease and are protected from becoming infected again. If you do not have antibodies against fifth disease, your pregnancy will need to be monitored closely."
Survey respondent Carol D. of Cedar Rapids, Iowa adds, "My son had it when he was about two years old. I called his daycare to inform them, thinking they would post a note to inform the other parents. They did not. I later found out my sonís teacher was pregnant at the time and they never even told her she had been exposed. She was extremely upset, but thankfully everything turned out fine."
Faced with a disease so common that even social workers are trained to distinguish it from an actual slapped face, I decided to turn the silence of fifth on its ear. I took advantage of Kendallís period of evident rash, and the subsequent infection of our other two daughters. At every opportunity, I asked, then educated each parent with whom I had contact. Again, roughly 98% had never heard of it and were glad for the information.
So while we cannot prevent this common disease from occurring, make like a rash and spread the word. No parent should be the last person to learn about fifth disease.