Is Roseola Contagious? – An Infection that Affects Children Once in their Lifetime 

Overview

Roseola, also known as Roseola Infantum or Sixth Disease, is a fairly common infectious disease that affects newborns and toddlers. A study also suggests that the prevalence of roseola is 90% in children under two years.¹Mullins TB, Krishnamurthy K. Roseola Infantum. [Updated 2022 Aug 21]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK448190/ This condition presents with a high-grade and specific form of skin abnormality known as the Roseola rash.
Although it is a highly treatable disease if diagnosed properly. However, it brings adverse effects on patients who have compromised immune systems.
Head below to learn about its causes, symptoms, treatment, and home remedies.

What is Roseola?

It is a highly contagious viral disease that infects infants and toddlers once in their lifetime.
Research states that ²Tesini, B. L., Epstein, L. G., & Caserta, M. T. (2014). Clinical Impact of Primary Infection with Roseoloviruses. Current opinion in virology, 91. https://doi.org/10.1016/j.coviro.2014.09.013 the viral condition infects female children more than males. Also, it is more prevalent among younger siblings than the eldest child of the family.
The disease peaks during the fall and spring seasons. The virus responsible for roseola, human herpesvirus 6 (HHV-6), is transmitted through respiratory secretion, especially saliva, as well as respiratory droplets expelled during coughing and sneezing by an infected individual.

What Causes Roseola?

The main disease-causing agent of roseola infantum is human herpesvirus 6 variant B (HHV-6B). Occasionally, human herpesvirus 7 (HHV-7) initiates the infection. The virus usually spreads when the baby encounters the infected droplets. However, the virus remains inactive in the body until it finds a favorable condition to show its symptoms.

What is the Pathophysiology of Roseola?

Once the human herpesvirus 6 (HHV-6B)³Stone, R. C., Micali, G. A., & Schwartz, R. A. (2014). Roseola infantum and its causal human herpesviruses. International Journal of Dermatology, 53(4), 397–403. infects the body; it starts to reproduce in the white blood cells and saliva. Consequently, the virus interacts with the activity of certain enzymes responsible for maintaining the protective barrier between the brain and blood.
Later, the HHV-6B virus bypasses the weakened blood-brain barrier, affecting CNS activity, which can cause febrile seizures.
However, the HHV-6B virus has an incubation period of 9 to 10 days, ⁴De Bolle L, Naesens L, De Clercq E. Update on human herpesvirus 6 biology, clinical features, and therapy. Clin Microbiol Rev. 2005 Jan;18(1):217-45. doi: 10.1128/CMR.18.1.217-245.2005. PMID: 15653828; PMCID: PMC544175. where it multiplies its genetic material within the white blood cells. This is when the roseola symptoms might appear.
Even after the primary infection subsides, the virus stays in the body in an inactive form.

What are the Symptoms of Roseola?

The symptoms might not appear in the child for the first five to fifteen days. High fever is the first noticeable thing once the virus replicates in the body. Although, high-grade fever may go above 104F (40C) for three to five days. During this period, the infected child seems active and healthy.
However, a child may experience other symptoms throughout the fever spike that include:

• Fatigue
• Eye Infection
• Swelling around eyes
• Enlarged lymph nodes
• Irritability
• Loss of Appetite
• Diarrhea
• Flu-like symptoms such as cough, runny nose, and sore throat
• Presence of red spots on the soft palate and uvula, known as Nagayama spots

Upon the disappearance of fever, another classic roseola symptom tends to develop, which is known as Roseola rash ⁵Tesini BL, Epstein LG, Caserta MT. Clinical impact of primary infection with roseoloviruses. Curr Opin Virol. 2014 Dec;9:91-6. doi: 10.1016/j.coviro.2014.09.013. Epub 2014 Oct 14. PMID: 25462439; PMCID: PMC4267952.. This rash looks small, about 2 to 5 mm, rose-pink colored, and raised spots. Roseola rash first occurs on the trunk and then develops on the neck, limbs, and face. Additionally, the rash doesn’t itch and stays on the body for one to two days.
Moreover, a febrile seizure may follow after the sudden temperature rise. However, it is less likely to harm the child’s health and occurs rarely. However, prompt medical attention should be taken if the child has a seizure episode.

How to get Roseola Infantum Diagnosed?

Healthcare professionals diagnose it by looking at the patient’s symptoms. Also, the doctor might ask when the fever and febrile seizures begin alongside the patient’s medical history.
Furthermore, a clinical exam that includes evaluating the rash also helps the doctor to rule out other similar diseases, such as measles.

Roseola vs. Measles Rash

Both roseola and measles look alike due to their raised and red spotty appearance. Although, there are some differences between how they present on the body. It includes:

• Roseola rash is more pink-red, whereas measles rash shows more reddish-brown coloration.
• The roseola infantum rash usually begins from the trunk and moves to other parts. On the contrary, measles rash develops first on the face and then spreads downwards.
• The children with roseola rash generally seem healthy and physically fit, while those with measles rash appear ill and physically exhausted.

How Is Roseola Treated?

Most children with roseola recover within one week after the fever begins. There is no specific treatment ⁶Stone RC, Micali GA, Schwartz RA. Roseola infantum and its causal human herpesviruses. Int J Dermatol. 2014 Apr;53(4):397-403. doi: 10.1111/ijd.12310. PMID: 24673253. for it.
However, healthcare practitioners might prescribe over-the-medications to manage the signs of fever and pain in children diagnosed with it. These medications include:

• Tylenol
• Ibuprofen
• Ganciclovir

Ganciclovir is an antiviral drug given to kids who have weakened immune systems.

How to Manage at Home?

Likewise most viral infections, this infection resolves after running its course. Children with roseola tend to get healthy once the fever subsides. Even the roseola rash is harmless and disappears within 1 to 3 days without using ointments or medicated creams.
To manage the child’s fever at home, these remedies may help:

• Plenty of rest
• The usage of lightweight clothes keeps the temperature regulated.
• Drink ample fluids to stay hydrated.
• Apply the lukewarm sponge to the forehead to minimize the discomfort caused by the fever.

How to Prevent Roseola Infantum?

Currently, there is no vaccine available to prevent it. Although maintaining a proper hygiene routine tends to lower the risk of getting roseola. Follow these steps to stay away from this infection:

• Washing hands before and after having food or using the restroom.
• Use hand sanitizers in the absence of handwash.
• Opt for a handkerchief or the crook of an elbow while coughing and sneezing.
• Avoid close contact with someone who is already infected with roseola infantum.

Is Roseola Worse in Adults?

It doesn’t affect adults much. Even its symptoms in adults are mild and resonate with the flu, such as fever, sore throat, runny nose, and cough. Likewise, in children, roseola in adults resolves easily without causing serious complications.

When to Call the Doctor?

Book an appointment with a doctor if the child experiences these symptoms:

• Shortness of breath and phlegm in cough, including other signs of pneumonia.
• Over 102° F (38.9° C) fever that persists for more than 24 hours.
• Nausea, vomiting, or diarrhea.
• Frequent episodes of seizures.
• Rash that is painful to touch and itchy.
• Passing dark-colored urine.
• Increased fatigue.

The Bottom Line

It is a fairly common pediatric condition that often heals itself without causing serious health concerns. It affects children with decreased immune response and is highly contagious. Therefore, it is necessary to maintain social distancing and proper hygiene once the child is diagnosed with it.

Refrences

• 1
  Mullins TB, Krishnamurthy K. Roseola Infantum. [Updated 2022 Aug 21]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK448190/
• 2
  Tesini, B. L., Epstein, L. G., & Caserta, M. T. (2014). Clinical Impact of Primary Infection with Roseoloviruses. Current opinion in virology, 91. https://doi.org/10.1016/j.coviro.2014.09.013
• 3
  Stone, R. C., Micali, G. A., & Schwartz, R. A. (2014). Roseola infantum and its causal human herpesviruses. International Journal of Dermatology, 53(4), 397–403.
• 4
  De Bolle L, Naesens L, De Clercq E. Update on human herpesvirus 6 biology, clinical features, and therapy. Clin Microbiol Rev. 2005 Jan;18(1):217-45. doi: 10.1128/CMR.18.1.217-245.2005. PMID: 15653828; PMCID: PMC544175.
• 5
  Tesini BL, Epstein LG, Caserta MT. Clinical impact of primary infection with roseoloviruses. Curr Opin Virol. 2014 Dec;9:91-6. doi: 10.1016/j.coviro.2014.09.013. Epub 2014 Oct 14. PMID: 25462439; PMCID: PMC4267952.
• 6
  Stone RC, Micali GA, Schwartz RA. Roseola infantum and its causal human herpesviruses. Int J Dermatol. 2014 Apr;53(4):397-403. doi: 10.1111/ijd.12310. PMID: 24673253.