Roseola

Roseola is a common viral illness affecting babies and young children, usually between six months and three years of age. In New Zealand, approximately 75% of children will have been infected with roseola by the age of two years and almost all children by the time they enter kindergarten.

Also known as roseola infantum or sixth disease, roseola is usually a mild illness causing fever and skin rash. Treatment normally involves relieving symptoms while the illness runs its course.

Causes

Roseola is spread from person to person in respiratory fluids and saliva, or by direct contact with infected persons or items. It is commonly spread by coughing and sneezing.

Once infection with the virus has occurred, the incubation period (the time until symptoms appear) is 9–10 days. It is not known exactly how long a person is contagious for once they have been infected with the virus. They can be infectious even if no rash is present.

In contrast to other childhood viral illnesses that spread rapidly, such as chickenpox, roseola does not usually result in community outbreaks of disease.

Thorough and regular hand-washing and drying will help to reduce the spread of the virus, as will not sharing eating and drinking implements.

Roseola rarely occurs in adults, suggesting that infection during childhood provides in lifelong immunity to the disease.

Signs and symptoms

The first symptom of roseola is typically a high fever (up to 40ºC). The fever lasts for between three and five days. Often this is the only noticeable symptom, though some children may have a sore throat and/or a runny nose. They may also be tired and irritable.

After about five days, the fever starts to subside and a rash appears on the body. The rash usually starts on the chest, back and abdomen, then spreads to the arms and neck. It usually has flat pinkish-red spots or patches (though these may occasionally be raised) and is not normally itchy or uncomfortable. The rash lasts about 2–3 days, and then fades.It is possible to be infected with roseola but have signs and symptoms that are too mild to be noticed.

Diagnosis and treatment

Diagnosis is usually based on a person’s symptoms. A blood test can confirm the diagnosis but this is not done routinely when roseola is suspected.

Most cases of roseola require only supportive treatment. As the condition is caused by a virus, antibiotics will be of no benefit in combating it. There are no anti-viral medications available for treatment of roseola. Supportive treatment includes:

• Paracetamol to relieve fever

• Rest

• Tepid baths for high temperature

• Adequate fluid intake.

Complications

Roseola does not usually cause complications. However, some infants may experience seizures (febrile convulsions) if their temperature becomes very high. Fever-related seizures in otherwise healthy young children are usually brief and are rarely harmful; however, they should still be seen by a doctor.

In rare instances the illness can cause swelling of the lymph nodes, liver, and spleen. Very rarely, inflammation of the brain (encephalitis) can occur.

Roseola is of particular concern in people with weakened immune systems, such as those who have recently received a bone marrow or organ transplant. They have a higher risk of developing potentially serious complications from the infection, such as pneumonia or encephalitis.

Further information and support

For further information and support about roseola contact your GP, practice nurse, or:

PlunketLine

Freephone: 0800 933 922 (24 hrs a day, 7 days a week)

Website: www.plunket.org.nz

Healthline

Freephone: 0800 611 116 (24 hrs a day, 7 days a week)

Website: www.healthline.govt.nz

References

Gorman, C.R. (2018). Roseola infantum (Web page). Medscape Drugs and Diseases. New York, NY: WebMD LLC. https://emedicine.medscape.com/article/1133023-overview [Accessed: 19/08/20]
Mayo Clinic (2020). Roseola (Web Page). Rochester, MN: Mayo Foundation for Medical Education and Research. https://www.mayoclinic.org/diseases-conditions/roseola/symptoms-causes/syc-20377283 [Accessed: 19/08/20]
Ngan, V., Oakley, A. (2015). Roseola (Web Page). Hamilton: DermNet New Zealand. https://www.dermnetnz.org/topics/roseola/ [Accessed: 19/08/20]
O’Toole, M.T. (Ed.) (2017). Roseola infantum. Mosby’s Dictionary of Medicine, Nursing & Health Professions (10th ed.). St Louis, MI: Elsevier.

Last reviewed: August 2020

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