There are six diseases of children that cause red rashes. The first three are measles, scarlet fever and rubella (or German measles) and they were the first ones to be recognised as discrete illnesses and not variations of each other and individually named. Measles and rubella can be somewhat difficult to differentiate and up to the 1980s, there were doctors in T&T who were confusing them, hence the stories one hears of grandparents who had measles three times.
Scarlet fever vanished when the bacteria that caused it in the early part of the 20th century became less toxic. This is not uncommon, as most germs prefer not to kill their host. This ends their life cycle, so the natural evolution of a germ is towards less pathogenicity. The latest example of this is the COVID-19 virus.
Measles and rubella were almost eliminated by the Measles-Mumps and Rubella vaccine, the MMR. However, after people began mistrusting public health officials after the mess they made of the COVID vaccine programme, MMR vaccination levels have declined and measles is making a comeback. Since Rubella is included in that shot, so will German measles. We may start seeing the blind, deaf and brain-damaged children of congenital rubella from women who never had the MMR vaccine or never had rubella until they became pregnant. This is exciting news for ophthalmologists, hearing aid companies, neurologists and the Lady Hochoy Home in Cocorite. Rubella also causes subtle cases of brain damage, so the mad house in St Ann’s should probably be preparing for an influx of cases.
So what is this “Fifth disease” business? The three mentioned above were the first identified as separate entities in the 19th century. Then three others, which were hiding among those three, popped up, at least two of them did because the fourth, Dukes disease, was finally dropped from the textbooks in the 1960s, when it was shown to be variations of scarlet fever or rubella. But there it is, it was the “Fourth disease.” The next one to be discovered was called “Fifth disease.” It’s caused by a virus, Parvovirus B19 and that one is still with us.
There’s also a “Sixth disease,” roseola infantum. It is a badjohn little disease because it causes fever fits, which are harmless but scare the living daylights out of parents. Older folks knew of fever fits as “wom fits” and that’s not a deliberate letter left out.
Fifth disease is interesting because it is quietly making a comeback, here and around the world. On August 13, the CDC issued a health advisory to notify healthcare providers, public health authorities and the public about increases in the disease in the USA. The proportion of children aged five to nine, with antibodies against the virus increased from 15 per cent in 2022 to 40 per cent in June 2024. Since March 2024, nine European Union countries have also reported increased detection of the virus, Parvovirus19.
I believe I have seen four cases so far in October but we do not routinely test for it in T&T. We do not because it is not usually a dangerous disease but then we did test children for COVID even though COVID is not usually a dangerous disease for children, something we knew by October 2020. That did not stop the public health officials continuing to frighten parents with talk about death for the following two years.
It’s interesting because, apart from the ungainly “fifth disease” name, it is also called erythema infectiosum, which immediately scares parents, “it infectious” as if most childhood diseases are not infectious. To compound matters, it is known as “slapped cheek disease” because of the characteristic rash which appears on the cheeks and looks as if the child was repeatedly slapped. In “advanced” countries, social workers have been called in to investigate the possibility of child abuse.
Erythema infectiosum is transmitted by respiratory droplets, unlike COVID, which is transmitted by respiratory aerosols and which we also knew by October 2020 but which was not admitted to the public until two years later, so it can be stopped by wearing a mask or following the six-foot rule (droplets spread for about six feet).
However, once the characteristic cheek rash appears, after four or five days of fever, body pain and malaise, adults and children are no longer contagious, so the mask is useless and cannot be recommended, unless you are trying to live inside a bubble, something only mentally disturbed or local public health experts try to do.
Indeed, more than 70 per cent of adults have antibodies by age 40 and these antibodies protect against reinfection.
One hopes one will not ever hear of advice from public health officials to “protect yourself against human parvovirus 19.”
