Roseola

Roseola is primarily caused by a virus called human herpesvirus 6 (HHV-6) and less commonly by human herpesvirus 7 (HHV-7).

• Roseola is a mild viral illness of sudden onset and short duration that most frequently affects young children.
• Roseola is most common in children 6 to 24 months of age, with the average age of infection at around 9 months of age.
• Less frequently, older children, teens, and adults may be infected.
• Roseola is primarily caused by a virus called human herpesvirus 6 (HHV-6) and less commonly by human herpesvirus 7 (HHV-7).
• Signs and symptoms of roseola include high fever, irritability, swollen glands (lymph nodes) in the front or back of the neck, runny nose, and diarrhea.
• Acetaminophen (Tylenol) can be used to treat the fever
• A rapidly rising fever may cause a seizure.
• No vaccine to prevent roseola

Roseola is primarily caused by a virus called human herpesvirus 6 (HHV-6) and less commonly by human herpesvirus 7 (HHV-7). These viruses are different from the viruses that cause genital herpes and cold sores, although they belong to the same family of viruses.

• While roseola is spread from person to person, the exact mechanism of transmission is not well defined.
• Experts postulate that respiratory secretions are most likely involved.
• The incubation period between virus exposure and the onset of symptoms (fever, etc.) is nine to 10 days

The signs and symptoms of HHV-6 (or HHV-7) infection vary depending on the age of the patient. Infants and toddlers routinely will develop a sudden high fever that lasts for three to five days. In addition, irritability, swollen glands (lymph nodes) in the front or back of the neck, runny nose, and possibly mild diarrhea may be present. Within 12-24 hours of the fever breaking, a rash rapidly appears.

The rash is mainly located on the neck, abdomen, and trunk/back but may extend to the extremities. The rash appears as separate, raised 3 mm-5 mm lesions (papules) or as similarly sized flat (macular) spots. The skin is mildly red in color and temporarily blanches with pressure. The rash is not itchy or painful. The rash is not contagious, and it lasts for one to two days and does not return.

Older children who develop HHV-6 (or HHV-7) infection are more likely to have an illness characterized by several days of high fever and possibly runny nose and diarrhea. Older children less commonly develop a rash as the fever abates.

Young children with roseola may have fever that is quite high (103 F-105 F). If the child is not uncomfortable, the fever need not be treated. It is not necessary to awaken a child to treat a fever unless advised to do so by your child's health-care provider. Acetaminophen (Tylenol and other brands) can be used to treat the fever. Aspirin should never be used for fever in children or adolescents. A rare but potential lethal disease (Reye syndrome) may develop as a complication of aspirin administration to children or teens.

A child with fever should be kept comfortable and not overdressed. Overdressing can cause the temperature to go higher. Bathing with tepid water (85 F) may help bring down a fever. Never sponge a child (or an adult) with alcohol; the alcohol fumes may be inhaled, causing many problems. If a child develops shivering during the bath, the temperature of the bath water should be raised.

A rapidly rising fever may cause a seizure (febrile convulsion). This may occur in patients with roseola during the febrile portion of their illness.

• Febrile seizures (convulsions associated with fever) are common in children between 18 months to 3 years of age.
• Studies indicate that approximately 10%-15% of children with roseola will have a febrile convulsion.

• While the seizure may look very frightening, it is usually quite harmless (benign).
• Febrile seizures are not associated with long-term neurological side effects or brain damage.
• Anticonvulsant medication is rarely prescribed either to treat or prevent febrile seizures.

A very important responsibility is to keep calm and help the child to the floor and loosen any clothing around the neck.

• Turn the child on one side so saliva can flow from the mouth.
• Protect his head against the hard ground by use of a cushion or pillow.
• Do not put anything in the child's mouth. It is impossible to swallow your tongue.
• Children are often drowsy and desire to sleep following a seizure.

After the seizure, you should contact the child's healthcare provider to determine if your child should be immediately examined.

Since the diagnosis of roseola is generally made by the characteristic history and physical examination findings, laboratory studies and/or radiologic evaluation are rarely necessary.

In the unusual case, laboratory testing exists to demonstrate the elevation of antibodies to HHV-6 (or HHV-7). This may be necessary if the patient's immune system is compromised.

Therapy for roseola is directed toward bothersome symptoms. Acetaminophen (Tylenol and other products) may be used to lower temperature. The rash requires no therapy. Once the fever is gone for 24 hours, the child may return to routine activities (for example, day care/preschool). Complications are rare with roseola except in children with suppressed immune systems. Individuals with healthy immune systems generally develop lifelong immunity to HHV-6 (or HHV-7).

If a child has a fever and a rash at the same time, the child should not go to day care/school and should be evaluated by their health-care provider. (Remember: The characteristic pattern for roseola is fever without rash; the fever resolves completely, and then within a short time, a characteristic rash develops.)

Prevention of roseola is difficult because during the incubation period (time between exposure to the virus and development of symptoms) the infected child is contagious but has no symptoms.

• General health awareness and avoidance of ill and febrile children will lessen the exposure risk to roseola and other infectious diseases.
• No vaccine exists to prevent roseola.
• Since this is a viral infection, antibiotics are of no value. Routine antiviral agents (for example, acyclovir) have minimal effect and are not recommended.

Over the years, roseola has had several different names including

• roseola infantum,
• roseola infantilis, and
• exanthem subitum.
• In the past, roseola was also called the sixth disease, underscoring the fact that it was one of the six childhood viral skin infections, and the illness lasts for approximately six days.

Other childhood diseases that were once known only by a numerical name include scarlet fever, measles, and German measles.