Roseola (Human Herpesvirus 6 and 7)—Child Care and Schools

What is roseola?

Roseola is a viral infection causing fever or rash in infants and children that primarily occurs between 6 and 24 months of age.

What are the signs or symptoms?

• High fever (temperature above 103 ?F [39.4 ?C] measured by oral, axillary, or rectal method) lasting 3 to 7 days, runny nose.

  • ? Often, the child is not very ill when fever is present.

• 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 fever and the rash; many children have no symptoms at all.

What are the incubation and contagious periods?

• Incubation period: 9 to 10 days.

• Contagious period: Children are most contagious before the rash appears. Once the rash is present, the risk of spreading is low. After infection, the virus is present in the saliva on and off for the rest of a person's life.

How is it spread?

• Respiratory (droplet) route: Contact with large droplets that form when a child talks, coughs, sneezes, or sings. These droplets can land on or be rubbed into the eyes, nose, or mouth. The droplets do not stay in the air; they usually travel no more than 3 feet 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.

• Most likely source of transmission to children is healthy adults. Saliva from three-fourths of adults without symptoms contains infectious herpesvirus 7.

How do you control it?

Use good hand-hygiene technique at all the times listed in Chapter 2 of Managing Infectious Diseases in Child Care and Schools: A Quick Reference Guide, 7th Edition.

Typical rash of roseola.

GEORGE NANKERVIS, MD

View of the lower cheek, neck, bare shoulder, and bare upper back of a child with a slightly raised pink, splotchy, rash. The small spots or patches vary in size and are most heavily concentrated on the upper back.

What are the roles of the educator and the family?

• Report the infection to the staff member designated by the early childhood education program or school for decision-making and action related to care of ill children and staff members. 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.

Exclude from educational setting?

No, unless

• The child is unable to participate and staff members determine they cannot care for the child without compromising their ability to care for the health and safety of the other children in the group.

• The child meets other exclusion criteria (see Conditions Requiring Temporary Exclusion in Chapter 4 of Managing Infectious Diseases in Child Care and Schools: A Quick Reference Guide, 7th Edition).

Readmit to educational setting?

Yes, when all the following criteria are met:

When exclusion criteria are resolved, the child is able to participate, and staff members determine they can care for the child without compromising their ability to care for the health and safety of the other children in the group