Roseola (sixth disease)

What is roseola (sixth disease)?

Roseola is a rash illness caused by a human herpesvirus 6 or 7. Roseola occurs mainly in children aged 6-24 months of age. Most children have had roseola before 4 years of age. Sometimes it is referred to as sixth disease, or exanthem subitum. 

Signs and symptoms

• High fever (often 103o F or higher) lasting 3-7 days.
• Seizures may occur with the high fever, although generally the child will appear otherwise well.
• Red, raised rash lasting from hours to several days that becomes apparent the day the fever breaks (usually the fourth day).
• Not every infected child will have a fever and rash. Many children have no symptoms at all.

Incubation period

9-10 days for human herpesvirus 6; unknown for human herpesvirus 7

Contagious period and spread

• Contagious period: After infection, the virus is present in the saliva for the rest of a person’s life.
• Spread through: Respiratory (droplet) route. Contact with large droplets that form when a child talks, coughs, or sneezes. These droplets can land on or be rubbed into the eyes, nose, or mouth. Most of the droplets do not stay in the air; they travel three feet or less and fall onto the ground.
• Nearly all children have had human herpesvirus 6 infection by the time they are 2 years old. Human herpesvirus 7 infection may occur later in childhood.

Public health reporting requirements

• Individual cases are not reportable to public health.
• Outbreaks are uncommon and unlikely but should be reported to public health.

Control of spread

Use good hand hygiene at all times. 

Treatment

There is no specific treatment other than supportive care.

Exclusion

None, unless the child/student meets other exclusion criteria, or the child is unable to participate and staff members determine they cannot care for the child/student without compromising the health and safety of others.

Role of teachers, caregivers, and family

• Report the infection to the staff member designated by the child care program or school for decision-making and action related to care of ill children. That person, in turn, alerts possibly exposed family and staff members to watch for symptoms. 
• Inform parents/guardians about the nature of the illness, and that, while the fever phase of the illness can cause concern, once the rash appears, the child is in the recovery phase.