Roseola (Sixth Disease): Symptoms, Causes, Treatment


Roseola infantum is a viral illness that mostly affects infants and toddlers. Infected children generally have a high fever followed by the development of a rash.

Roseola (Sixth Disease)

Who might get roseola?

Anyone can get roseola, but the virus mostly affects children between the age of 6 months and 3 years. The virus is contagious, even before the rash develops, and can be spread through saliva or other respiratory droplets when an infected child coughs, sneezes or talks. After you have had roseola, your immune system forms defenses against it. For this reason, most people are unlikely to be infected twice.

What causes roseola?

Roseola is also called sixth disease because the human herpesvirus (HHV) type 6 most often causes the illness. Less frequently, it can also be due to HHV type 7 or another virus.

What are the symptoms of roseola?

Symptoms of roseola appear about ten days after infection. The first sign of illness is a high fever (often above 103° F or 39.5° C). This fever can last from three to seven days. Once the fever goes away, a rash often appears on their stomach that may spread to their back, neck and arms. It is made of pink or red spots and not itchy or painful. The rash can fade after a few hours but may be noticeable for one to two days.

Children with roseola may also develop cold- or flu-like symptoms, including:

  • Runny nose.
  • Slight cough.
  • Sore throat.
  • Swollen lymph nodes.
  • Upset stomach or diarrhea.
  • Seizure. This is generally a febrile seizure, or a seizure that is brought on by a quick rise in body temperature. This type of seizure is rarely harmful. However, you should call your doctor or seek emergency care if you believe that your child has had a seizure.

How long is roseola contagious?

After your child’s temperature is back to normal for 24 hours, your child is no longer contagious (even if the rash is still there). A normal temperature ranges between 97.5° F and 99.5° F (35.4° C and 37.5° C). A fever is a temperature at or above 100.4° F (38° C).

Is it possible to have roseola and not know it?

It is entirely possible that your child (or you as a child) had the virus that causes roseola without knowing it. Kids get fevers for lots of reasons. If your child does not get a roseola rash (two-thirds of kids don’t), you may chalk up the fever to some other illness and never know that your child has had roseola.

How is roseola diagnosed?

Your healthcare provider can diagnose roseola based on your child’s symptoms.

How is roseola managed or treated?

Roseola symptoms typically clear up on their own in about a week as the virus runs its course. Your healthcare provider may recommend giving your child acetaminophen or ibuprofen to bring down the fever. You shouldn’t need to treat the rash because it doesn’t itch or cause pain. Children who have weakened immune systems may need antiviral medications.

When should I call the doctor?

You should call your healthcare provider if your child experiences:

  • Difficulty breathing, cough or other signs of pneumonia.
  • Fever of 102° F (38.9° C) or higher for over 24 hours without any other symptoms.
  • Seizure.
  • Rash that is itchy or painful.
  • Nausea, vomiting or diarrhea.
  • Signs of dehydration, such as dark-colored urine and extreme fatigue.

What questions should I ask my doctor?

If your child has roseola, you may want to ask your healthcare provider:

  • How long will my child be contagious?
  • How long should my child stay home from day care or school?
  • What steps can I take to ensure other children or siblings don’t get infected?
  • What can I do to make my child more comfortable?
  • Should I notify my child’s day care or school about my child’s illness?
  • How long will the fever last? How long will the rash last?

How can I prevent roseola?

There is not a vaccine to prevent roseola. Good hygiene is the best way to keep others from getting the virus. You can lower infection risk by:

  • Avoiding close contact with someone who is infected.
  • Coughing and sneezing into the crook of an elbow.
  • Washing hands often and using hand sanitizers.

What is the prognosis (outlook) for people with roseola?

Most children recover from roseola without any long-term health issues. Children who have weakened immune systems due to cancer, autoimmune disease or other conditions may be at risk for pneumonia or other complications. Once infected, children develop an immunity to the virus, so they are unlikely to get it again.

About 10 to 15% of children with roseola experience febrile seizures brought on by a high fever. Febrile seizures typically last less than 15 minutes. They can be scary to witness, but are usually not harmful. These seizures are not a sign of epilepsy.

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