Three Day Fever - Is It Dangerous?

Synonyms in a broader sense

Medical: Exanthema subitum, Roseola infantum, Sixth Disease

English: exanthem subitum, sixth disease


Three-day fever is a common infectious disease caused by viruses and mainly affects infants and young children. This is usually a harmless childhood disease that heals without consequences and leaves you with lifelong immunity.

Typically, several days of high fever is followed by a small speckled rash in three-day fever (Rash) that occurs as soon as the fever drops (rash after fever).

How dangerous is that

The three-day fever has a two-phase course, with the first phase being dominated by a high fever. In connection with the fever, due to the typical age of the patients, febrile convulsions may occur, which occur between the ages of 6 months and 6 years. These often frighten and frighten the affected parents when they first have an attack, but they are usually harmless and end after a few minutes with no remaining impairment to the child.
Three days after the onset of the fever, the second phase follows, which is determined by the typical skin appearance. These fade again after three days at the latest.
Only in the rarest of cases does a severe inflammatory course develop with the transition to meningoencephalitis (Inflammation of the meninges and brain tissue)

In most cases, the course of a three-day fever is rapid, uncomplicated and self-limiting.

If you would like more information on the topic of febrile seizures, we recommend the following articles: Febrile seizure

Forms of three-day fever

In most cases the disease takes its typical course with a high fever and a subsequent rash.

But it can also happen that a child has a high fever for a few days, which is caused by an infection with the causative agent of three-day fever (HHV-6), without getting the rash afterwards ("abortive form“).

In 20% of the cases there are no symptoms of the disease at all (asymptomatic form), the disease is "silent" without being noticed.

In older children, three-day fever can be as pronounced as mononucleosis (Epstein-Barr virus, Pfeiffer’s glandular fever) with symptoms of liver inflammation in the blood.

Epidemiology / incidence in the population

Three-day fever is predominantly found in children between the ages of 6 months and 3 years. Almost all children have had contact with the pathogen by the time they are 3 years old.

Also read: Three-day fever in babies - dangerous?

The viruses that cause the disease (HHV-6, HHV-7), are distributed worldwide and are only passed on from person to person.

Infection with the three-day fever occurs via droplet infection, usually through:

  • To cough,
  • Sneeze
  • saliva

Of the sick child who is inhaled by other children or ingested through the hands.

A few days before the symptoms appear (Symptoms) the child is contagious, usually not anymore after the rash appears.


The causative agents of three-day fever are the viruses Human Herpes Virus 6 (HHV-6) or less often Human Herpes Virus 7 (HHV-7).

Although they are in the same family as the better known herpes simplex virus (HSV), they do not cause the commonly known cold sores or genital herpes.

If a child is infected with the three-day fever via droplet infection, the pathogen cells in the salivary glands multiply in the body and after a few days (incubation period) the viruses enter the blood, distribute them in the body and thereby occur the characteristics of the disease (symptoms).

Like all herpes viruses, too HHV-6 and HHV-7 remain in the body for life (persist) and become active again (reactivation) if the immune system is weakened (e.g. immunosuppression). This leads to the recurrence of symptoms without getting infected again from anyone.

Repeated infection with the three-day fever as an adult can occur, but is not common, as it is assumed that the illness in childhood results in lifelong protection (immunity).

incubation period

The time between the virus entering the body and the onset of the first symptoms of three-day fever can be 5-15 days be.

During this time the virus tries to multiply itself by penetrating a body cell. It does this by smuggling its own genetic material into the genetic material of the human body cell (host cell). The virus first attacks the Salivary gland cells. It multiplies in these cells and can then reach the entire body via the blood. If so many viruses have emerged in this way that a certain threshold is exceeded, the body reacts to it and the Disease symptoms. The incubation period has come to an end with the onset of the first symptoms. A infection can occur in the last three days of the incubation period, but also until the rash disappears.


The three-day fever is mostly caused by the human herpes virus 6 (HHV6) and in rare cases by the human herpes virus 7 (HHV7). In the case of three-day fever caused by the human herpesvius 7, the occurrence of febrile convulsions is observed more frequently.


After the virus is absorbed into the body via droplet infection, it takes about 5-10 days for the disease to break out in the child (incubation period).

First, the child gets a high fever with temperatures of up to 40 ° C, which lasts for 3 to 5 days. The child feels exhausted and very sick, and may appear nervous and irritable. Febrile convulsions may occur during this phase of the illness; headache, cough, and swelling of the cervical lymph nodes may also occur. There is also inflammation of the mucous membranes (Enanthem), swelling of the eyelids (eyelid edema) or inflammation of the bowel (Enteritis) with abdominal pain in the child are not uncommon.

If the disease progresses with a three-day fever, in very rare cases pneumonia in the child (pneumonia), even less often to inflammation of the brain (Encephalitis) come.

After up to a week, the high fever often ends abruptly and appears shortly afterwards ("subito") A skin rash (exanthema) made up of small red spots, some of which can" converge "into larger spots.

Usually this non-itchy rash mainly affects the trunk and the arms and legs (extremities), while the face is usually spared. The child is no longer considered contagious after the rash appears. After 1-3 days, the rash with three-day fever usually disappears. The illness is then over and the child is healthy again.

Read more on the topic: When should I see a doctor with a fever?

Three-day fever with abdominal pain / diarrhea

When children are sick, many complaints are projected into the abdomen and the children complain of abdominal pain. This can also be caused as a non-specific immune response of the body by a swelling of the lymph nodes in the abdomen. A three-day fever can ultimately lead to stomach pain. In some cases, the children also suffer from diarrhea. However, the symptoms stop by themselves after a few days.

Read more on the subject at: Abdominal pain in children

Three-day fever with cough

In the course of the three-day fever, there may also be irritation in the throat area. Of course, this also provokes a cough. If the fever persists and the cough is increasingly productive with sputum, further clarification of the possible causes, such as e.g. pneumonia in the child. With three-day fever, however, the children are fine again within a few days.

How contagious is the three-day fever?

Three-day fever is a highly contagious, classic childhood disease. In most cases, the disease is passed on to the child from a healthy adult or from siblings who have had three-day fever themselves. Since the viruses remain in the body for life, such infections can also occur years or decades after the original infection. The transmission mainly takes place when the immune system of the parents or siblings is weakened (immunosuppression). The viruses are passed on to the child via droplet infection or infectious saliva (e.g. sneezing, coughing, speaking, kissing). With a period of 5-15 days between infection and the start of the three-day fever (incubation period), an infection that has taken place is often not noticed immediately. However, the sick child is also highly contagious 3 days before the onset of the fever. This risk of infection is present until the rash has ended. The problem is that you cannot prevent further infection in the time before the onset of symptoms because you are not yet aware of the disease. However, once the diagnosis of three-day fever has been made, social contact should be avoided as far as possible in order to avoid further infection of other people.

Anyone who has gone through the three-day fever is protected from further infection for practically a lifetime. Since it is a classic childhood disease that almost everyone goes through at a young age, almost every adult is immune.

Read more on this topic at: How contagious is the three-day fever? How do I know if my fever is contagious?


The Three-day fever The pediatrician can easily identify the typical course of fever and subsequent skin rash (Rash) be recognized.

A characteristic of the red spots on Exanthema subitum is that they fade when pressed with a finger and that they are not itchy.

These characteristics make it easy to distinguish three-day fever from other childhood diseases with a rash (e.g. measles, rubella, chickenpox, Ringlet rubella).

Thus, a laboratory blood test is usually not necessary.

If the rash has not appeared yet and the high fever is still ongoing, the doctor may do various tests to see if this is fever not caused by another infection.

In special cases, the three-day fever can be proven by determining antibodies in the blood.


Against the three-day fever, too Exanthema subitum called, there is no causal therapy that is specifically directed against the virus and can fight it.
Antibiotics, for example, which are often used for infectious diseases, do not work with three-day fever, as antibiotics only work with diseases that are triggered by bacteria and not with diseases that are triggered by viruses, such as three-day fever .

Therapy can therefore only be taken to relieve the symptoms of three-day fever.
Since three-day fever is a harmless disease, despite its sometimes severe course, therapy measures do not necessarily have to be taken, because the child's immune system is usually able to fight the disease on its own.
The three-day fever often occurs without any symptoms, so that no treatment at all has to take place.

Ultimately, most of all children are infected with the three-day fever-causing herpes viruses by the age of three and thus usually achieve lifelong immunity. In most cases the fever will go away on its own after three to eight days at the latest.

Symptomatic therapy mainly includes antipyretic agents, such as the use of paracetamol, which has an antipyretic effect and can also be used well in children.
The drugs are often used in the form of suppositories. Some of them are also available in juice form, but suppositories have the advantage that if the child vomits, the suppository can still develop its effect, which is not the case with juice.

It is important that no drugs are given that contain acetylsalicylic acid, such as Aspirin®, because in rare cases this can lead to the complication of what is known as Reye's syndrome.
Read more about the rare complication of aspirin in children at this point: Reye syndrome

Reye's syndrome is a life-threatening complication that can lead to liver and brain damage. The general rule is that children under ten years of age should refrain from using atectyl salicylates, such as in aspirin, in the case of viral febrile infections, as otherwise there is a risk of Reye's syndrome.

Read more on the topic: Therapy for three-day fever

You might also be interested in: Fever suppositories for babies and children

Home remedies

In addition to a drug therapy you can also use tried and tested home remedies. For example on Calf wrap, which also help reduce fever.

Calf wraps should not be used if the person concerned has circulatory problems or cold feet. Only when the face, hands and feet are warm can calf wraps be used to reduce fever.
A cotton cloth is used for the calf wrap, which is dipped in warm water and then wrung out.
Then it is placed on the lower leg. One should make sure that the The temperature of the wrap is a maximum of two degrees lower than body temperature.
Because if the temperature is too cold, the skin vessels constrict and the body can no longer give off any heat. This mechanism is a normal protective device of the body in winter, for example, in order not to give off unnecessary heat to the outside.
After using the wrap for about ten minutes, the calf wrap should be changed. The third calf wrap then remains on the lower leg for a maximum of thirty minutes.

For children that are too young, leg wraps are usually not feasible because they are too restless for that. Instead, you can wash your body with water at body temperature.
It is important to observe the child and remove the compress immediately if there are signs of freezing. In general, it is especially important to make sure that the child or the person affected drinks enough, as the disease deprives the body of a lot of fluids.

Homeopathy for three-day fever

Since children with three-day fever are doing amazingly well, no therapy is usually necessary. Homeopathic remedies are therefore not absolutely necessary either. The disease will go away on its own as quickly as it came. If you still do not want to do without homeopathy, you can, for example, give Aconitum napellus, Belladonna atropina or Ferrum phosphoricum if you have a fever. If the fever lasts for more than five days, a pediatrician should be consulted. For the various accompanying symptoms of three-day fever, Pulsatilla pratensis can be used against coughs, Phosphorus against bronchitis, Bryonia alba against irritability or Rhus toxicodendron against pain in the limbs.


The time until the onset of the disease (incubation period) is one to three weeks. The fever that occurs then usually lasts for three to a maximum of five days. The subsequent skin rash ultimately disappears after about three days just as quickly as it appeared. The three-day fever is therefore also known as Exanthema subitum "sudden rash".


There is none vaccination to prevent the Three-day fever.

To prevent infection, one can only try to avoid contact of the child with an infected person, which is very difficult, however, since almost all people are carriers of the virus and the three-day fever even without any noticeable symptoms can expire.

Since the three-day fever is usually uncomplicated, it is not necessary to isolate a sick child.

How often can you get a three-day fever?

The three-day fever is caused by the human herpes viruses 6 or 7. The spread of these viruses in the population is very high. Almost all children are infected by the age of three. The outbreak of the three-day fever occurs upon first contact with the virus. In many cases, the infection goes unnoticed without any symptoms. The virus then remains in the body for life, similar to the chickenpox virus. In the case of immunosuppression, i.e. suppression of the immune system by drugs or various diseases such as HIV or diabetes, the viruses can reactivate and cause a new disease.


A child who has three-day fever will usually recover within a week.
The disease is contagious, but not dangerous. There are only very few complications and also a child who has a three-day fever due to the rapid rise in temperature Febrile seizure does not retain any damage.

Febrile convulsions in three-day fever

In ten to fifteen percent of cases with a three-day fever, the rapid rise in fever leads to febrile convulsions, with rhythmic twitching of the muscles and a loss of consciousness in the child.
This condition is initially very frightening for the parents, but in principle the prognosis for a febrile seizure is very good. If there is a febrile seizure, the ambulance should be called so that the child can be treated as soon as possible.
Usually, in around 90% of cases, this type of epileptic seizure stops on its own. If the attack lasts longer than two minutes, medication must be used. For example with diazepam suppositories. Furthermore, you should take anti-fever measures, such as the administration of paracetamol as a suppository.
During the seizure, no attempt should be made to hold the child tightly in order to stop the seizure, as there is a risk of injuring the child.
At the latest if the febrile seizure does not stop quickly on its own, the emergency doctor or pediatrician should be called. A febrile seizure in the context of a three-day fever is usually a so-called uncomplicated febrile seizure, so that the development of the child is not impaired, or at least not significantly impaired.

Read more at this point under: Febrile convulsions in the child

Skin rash with three-day fever

A rash occurs not only with three-day fever, but also with many other childhood diseases, whether they are caused by viruses or bacteria. The interplay of the individual symptoms can often be used to distinguish them from one another. Many of them only appear sporadically, since you can and should vaccinate against them in order to avoid complications and consequential damage.
Diseases caused by viruses that are accompanied by a skin rash include measles, rubella, chicken pox or rubella. When infected with measles, large spots can be found on the child's body that merge. They are purple and slightly raised.
At the beginning, the rash is mainly found behind the ears, only then does it spread to the trunk and the arms and legs.
In addition, whitish spots on the mucous membrane in the area of ​​the molars, so-called Koplik's spots, are typical of a measles infection.
If the child has been infected with the rubella virus, you will find rather small spots that do not merge. They are pink and possibly also raised in places. This rash also starts behind the ears and on the face before spreading to the body.
If you are infected with rubella, you will also find swollen lymph nodes in the neck and behind the ears.

Chickenpox is also associated with a rash. This one has a completely different, very typical appearance. At the beginning you will find red spots all over the body and also on the scalp. In the course of the process, these become vesicles, which eventually burst and then crust. All three forms can be found next to each other on the body, which is why this appearance is also called "starry sky". In addition, if the child is sick with chickenpox, they will experience incredible itching all over their body.
A rash can also be found with an infection with the ringlets, but this is more like a garland. It is found mainly on the trunk and on the arms. Itching can also occur here. Measles, chickenpox, rubella and rubella are viral diseases that can be vaccinated against, with the exception of rubella.

Diseases caused by bacteria that have a rash include scarlet fever and impetigo contagiosa.
Scarlet fever has a finely spotted, slightly raised rash that feels like sandpaper when you run your hand over it. It starts in the groin and armpits before spreading further on the body. In addition, a raspberry-red tongue can be found when infected with scarlet fever.
Impetigo contagiosa is accompanied by superficial pus blisters. These can burst and then form so-called honey-yellow crusts.

As you can see, there are a number of teething troubles that, like three-day fever, are all accompanied by a rash, each of which appears different and has other additional symptoms.

Read more on the topic: Rash with a three-day fever, rash with scarlet fever

Three-day fever on the face

Every childhood disease has a typical pattern of spread. In three-day fever, the rash is mostly concentrated on the trunk of the body. In rare cases it can spread to other parts of the body or even the face. Measles, rubella, or chicken pox are certainly also possible differential diagnoses.

Difference in three-day fever in babies compared to children

Three-day fever classically affects older infants and toddlers. The age range ranges from around six months to two years. Older children went through the disease at a young age without symptoms and no longer get the disease. At the beginning there is a high fever for mostly three days. During this period, febrile seizures are common in babies and children up to the age of six. If a febrile seizure occurs in older children, a further investigation should be carried out. Meningitis in children (meningitis) is an important and dangerous differential diagnosis.

The general condition with three-day fever is usually not reduced. The children do not feel as bad as one would expect with a high fever. Of course, babies are usually more limp than older children with a high fever and sometimes show restricted drinking behavior.
There are no major differences between babies and older children in terms of accompanying symptoms. The side effects are rather unspecific. Coughing, swelling of the cervical lymph nodes or eyelids, as well as gastrointestinal complaints such as diarrhea can occur. After the three febrile days, the temperature suddenly drops back to normal. At the same time, a rash of fine spots occurs, which can be found mainly on the trunk of the body. The rash is no different in babies and children. Depending on the age, other typical childhood diseases come into question for a rash, such as Measles, mumps and rubella. Even a drug rash can sometimes look like a three-day fever.

Three-day fever in pregnancy

Since pregnant women can come into contact with children with three-day fever, three-day fever plays a role in this pregnancy.

In most cases this is not a problem or a hazard, as almost 100% of all children get a three-day fever in the first year of life. The body forms during and after an infection Antibodies (Antibodies) against the virus, through this one remains protection (Immunity) to get a lifetime from being infected again. Therefore, the chances of a pregnant woman getting infected with three-day fever are extremely small. However, there are also very rare exceptions, for example if a pregnant woman has not produced any antibodies and is therefore not immune. In this case, the pregnant woman can become infected with three-day fever.
A confirmation that the pregnant woman has already gone through the disease in childhood and that there is therefore no danger for her or the unborn child can be provided by a Antibody test gain.

In the rare case of an infection in a pregnant woman, this is usually harmless, but it can also more complicated courses come, as there is a changed defense situation during pregnancy. Also one transmission infection to the unborn child is not ruled out and may well have a negative impact on that development affect the child.

If there are sick children in the immediate vicinity of a pregnant woman, it is important Hygiene measures to be observed (washing hands and disinfecting hands) and avoiding physical contact with them. It should not be forgotten, however, that infection can occur before the contact person has symptoms.

A Vaccination is not available either before pregnancy or in acute cases (if a close relative or the pregnant woman is ill), as there is no such thing.

In any case, a doctor should be consulted in order to prevent complications and the Pregnant Women's Health and des unborn child not to endanger.

Also read our topic: Fever during pregnancy


That is between the 6th month and the 3rd year of life Three-day fever the most common infectious disease with a rash (Rash) caused by a virus.

The "Sixth disease“ (Ringlet rubella are referred to as the "Fifth Disease") is one of the contagious Teething problems, is usually simple in its course and heals by itself (self-limiting). Therefore, treatment with medication is only useful for symptom relief.

At the onset of 3-day fever, children usually develop a high fever that can be over 39.5 ° C for up to a week.

The rapid rise in fever can cause 10-15% of the time Febrile seizure trigger. Signs that the child has a febrile seizure include passing out, twitching arms, legs, or face for 2-3 minutes, and emptying the bladder or bowels uncontrollably. In such cases a doctor should be called.

If the fever begins to decrease after a few days, the typical small-spotted red rash (exanthem) appears in the sick child, which persists for a few days and then disappears again by itself.

After the rash appears, the child is usually no longer contagious.

The three-day fever lasts about a week in total and is then over.