Is Roseola Contagious?

Picture of a roseola rash. SOURCE: Image Source: Getty Images

Roseola (also termed the sixth disease, roseola infantum, and exanthema subitum) is a common viral infection that occurs mainly in children between 6-24 months of age. The virus that causes roseola is usually relatively benign because about two-thirds of children infected have no symptoms.

• When symptoms do occur, roseola begins with a high fever (102 F-105 F) that breaks in about three to seven days.
• When the fever breaks, a reddish or pinkish rash characteristic of roseola occurs all over the body (starting on the trunk and spreading to the arms, legs, and face) and lasts from a few hours to a few days.
• There is no specific treatment for roseola; however, the fever can be reduced with acetaminophen (Tylenol) and cool sponge baths.

Roseola is easily spread from person to person in day-care centers, preschools, and among siblings by contact with a person's respiratory secretions and/or saliva. Sharing items like cups or utensils and even toys that are sometimes chewed on by a child can spread the virus to other children easily. Those adults who have never been infected with HHV-6, too, may become infected, but the illness is not usually as severe in adults.

Transmission of the virus can occur through:

• Direct contact with an infected person, such as kissing or hugging
• Exposure to respiratory secretions from an infected person, such as through coughing or sneezing
• Contact with contaminated objects or surfaces, such as toys or doorknobs

It's important to note that not everyone who is exposed to the virus will develop symptoms. Some people may be asymptomatic carriers of the virus and can still spread it to others.

If someone has roseola, usually they become infected by other individuals (for example, the children in a day-care center or siblings). The key to the diagnosis of roseola is that when the fever stops, a non-itchy rash develops all over the body. This is not unusual for a child with roseola. However, if a child develops a high fever (102 F-105 F) and the fever does not go down, the child may develop more severe symptoms. The person, usually a child, has other symptoms that may include:

• Loss of appetite
• Mild diarrhea
• Irritability
• Slight cough with a runny nose but otherwise seems to be acting normal.
• Swollen glands in the neck

After the fever subsides, a rash usually appears on the trunk, spreading to the neck, arms, and legs. The rash consists of small, pink, or red spots that are not itchy and usually fade when pressed. The rash lasts for 1 to 2 days and then disappears.

Most individuals visit their physician/pediatrician to rule out other potential problems that may produce similar but more severe symptoms (for example, meningitis).

Roseola is contagious during the period of fever. It has an incubation period (from the time of exposure to the virus to symptom development) of about 5 to 14 days. The individual remains contagious until one or two days after the fever subsides. The roseola rash may still be present, but the child or individual is usually not contagious after the fever abates. Therefore, a person with roseola is contagious for approximately 5 to 7 days, but once the rash appears, they are no longer contagious. 

Roseola is caused by a common virus (belonging to the family of herpesviruses and termed HHV-6). This virus does not cause cold sores or genital infections. Most pregnant females (about 96%) are immune to HHV-6 so there are only rare reports of a mother contracting roseola and transferring the virus to the fetus, in which HHV-6 may cause problems like miscarriage or birth defects.

In general, once the fever has abated for about a few days after the fever has subsided, the person is usually cured and no longer contagious for roseola. The rash may linger on for a few days. Fortunately, most people are infected as a child and develop an immune response that renders them protected, usually for life, against roseola.

It's important to note that some people, particularly young children, may experience lingering symptoms such as fatigue or a mild rash for a few days after the fever has subsided. However, these symptoms are not contagious and are not indicative of ongoing infection.

If you or your child has a rash that doesn't improve after a few days or, more importantly, the individual has a fever of about 103 F or a fever less than 103 F that lasts for about one week, or if you or your child develops any seizures, slows or stops eating and drinking, or is not acting normal, the individual should be seen urgently by their physician or seen in a (pediatric) emergency department. If you aren't sure about what to do, contact your child's pediatrician or your physician immediately.