Can a child with erythema infectiosum (fifth disease) attend school?

Children with Fifth Disease (Erythema Infectiosum) Can Attend School

Children with fifth disease (erythema infectiosum) can attend school as they are no longer contagious once the characteristic rash appears. 1

Understanding Fifth Disease and Contagiousness

Fifth disease is a common childhood rash illness caused by human parvovirus B19 that follows a predictable pattern:

• The virus is highly infectious and spreads mainly through respiratory droplets during the prodromal phase (before the rash appears) 2
• By the time the characteristic "slapped-cheek" rash and lacy rash on the trunk and extremities develop, the child is no longer contagious 2
• The rash may be accompanied by mild symptoms such as low-grade fever or pruritus (itching) 1

School Attendance Recommendations

The timing of school attendance should follow these guidelines:

• Children can return to school once the rash appears, as they are no longer infectious at this stage 2
• No exclusion from school is necessary during the rash phase of the illness 1
• This approach differs significantly from other childhood illnesses like measles or rubella, which require exclusion periods 3

Special Considerations

For Pregnant School Staff

• Fifth disease can potentially cause complications in pregnant women, including fetal anemia and hydrops fetalis, though the risk is very low 4
• Pregnant teachers or staff members who are exposed should:
  • Consult with their healthcare provider to evaluate their immune status 4
  • If already immune (IgG positive), there is no risk to the fetus 4
  • If not immune, fetal surveillance through ultrasound may be recommended 4

For Immunocompromised Individuals

• Children with weakened immune systems or certain blood disorders (sickle cell disease, thalassemia) may require special consideration as parvovirus B19 can cause more serious complications in these populations 2
• These children should receive individualized guidance from their healthcare providers regarding school attendance during outbreaks 2

Common Pitfalls to Avoid

• Do not confuse fifth disease with other childhood rashes that require exclusion from school 1
• Do not exclude children unnecessarily once the rash has appeared, as this contradicts evidence-based guidelines and can lead to unnecessary school absences 2
• Do not overlook the potential risk to pregnant staff members, who should be informed about fifth disease outbreaks in the school 4

Management in School Settings

• Schools should notify parents and staff when cases of fifth disease occur, particularly to alert pregnant women who may need to consult their healthcare providers 4
• Standard hygiene measures should be reinforced, including:
  • Proper handwashing 2
  • Respiratory etiquette (covering coughs and sneezes) 2
  • Regular cleaning of frequently touched surfaces 2

In conclusion, fifth disease represents a common childhood illness where the period of contagiousness occurs before the characteristic rash appears. Once the rash is present, children can safely return to school without risk of transmitting the infection to others.