The Red Plague (5e Disease)

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The Red Plague[edit]

Design Note: This is diseases is meant to be used with the dire diseases variant rule.

If you don't want to use those rules you can consider what I call a "greater diseases" to be the name of the sickness and the "lesser diseases" to be the side effects.

Contracting The Red Plague[edit]

The Red Plague is contracted from vampire's vampire spawn and ghouls and anything else already infected. It spreads if the blood of an infected creature is taken in by another creature. This happens most often by taking slashing or piercing damage, and some of the infected blood gets on an open wound. (Note: if a creature with this plague coughs on them Or is attacked by them its likely some of the blood will splatter).

Infection Saving Throw

If affected by blood splatter then the creature must make a DC 14 Constitution saving throw or become infected.

If infected blood is instead injected into a creature, then the creature must make a DC 18 Constitution saving throw with disadvantage.


Grater Sickness: The Red Plague: One rest after this sickness is gained the target gains the first 3 lesser sicknesses if one of them is removed then it’s replaced in 1d4 hours.

  1. Red marking: You are marked as an infected by the color red. Your veins turn red, and your blood, tongue, gums, and your under your fingers and just about anywhere that blood can color a body part become a deep red. Your blood is also thicker and sticky, and it stays red even long after its out of your body. You shall often cough up blood, your tears shall be blood and you will even piss blood. When you take slashing damage of 5 or more, your blood splatters out in a 5 feet Area of Effect splash.
  2. Red Hunger: Your body rejects anything that is not fresh, fleshy, raw and dripping with blood. (meaning you can't eat anything that isn't fresh, raw, bloody meat and if you don't eat you'll starve) If a creature goes 3 days without food and then they see or smell blood (not their own) they will have to make a DC 10 + (days gone without eating) Wisdom saving throw to resist attacking and trying to eat the bleeding thing/person. A creature can repeat the saving throw each turn to stop themselves.
  3. Red Mania. The target will start to think they must drink the blood of humanoid creatures, but the mind will make up its own reasons why (The GM can use voices, or fake meta info or even give them ability score increases or restore hit points from doing this. Do not just tell them that they want to drink blood (unless you want to). Try to play mind games to trick them into thinking it would be a great idea. Ex. You could have a totem barbarian learn from one of its totem spirits that he can gain power from eating the hearts of his foes. Or if a paladin really wants a cure, they could get a vision from their god detailing a specific humanoid creature for the cure (likely one of their foes’ blood is one of the ingredients.) Both the message from said god and/or sprit is fake. Feel free to even give them negative effects if they do not drink blood. If their mind deeply believes they will become weaker or slower because of the lack of blood, then it can lower ability scores. (have it be those that are most important to the Player Character, and have it get worse over time). If the player decides to ingest the blood of a humanoid creature, then the The Red Plague becomes a curse and is no longer curable as a sickness. A remove curse spell must be used on each of the lesser effects before the Red Plague can be removed, but every 1d4 hours after 1 of the lesser effects is removed it is returned. (You'd need to remove all the lesser curse effects and then the main curse to fully remove the cruse or else the main curse will just keep replacing the lesser curses faster than they can be removed)

After the Red Plague becomes a curse, these lesser effects are added.

  1. Red Thirst. If the effected see's or smells fresh blood they must make a DC 10+days without drinking blood of humanoids Wisdom saving throw. If they fail, they must attack the bleeding person and try to drink their blood and or eat their flesh. (they may repeat the saving throw once every 1d10 turns). If they do not snap out of it, they will keep eating flesh/and or drinking blood until the bleeding creature is dead and no more blood left. AND every day they do not drink blood/and or eat flesh from a humanoid being their maximum hit points are reduced by 5.
  2. Tooth and Claw: The infested gains (must grapple before using bite) (2d6 + str) piercing damage bite attack and 2d4+str slashing claw attack.
  3. The Red Change: If the infested resists the changes and only eats and/or drinks blood/flesh when they fail the Wisdom saving throws then they turn into a ghoul, but if they maintain self-control by choosing to drink blood then they turn in to a vampire spawn.

Each time They take blood/flesh of a humanoid creature, the next time they rest they gain a point of change. (each point should make them look a little bit more like the monster they are turning into but the way in which this happens is up to the GM) When they get 10 points they start to die.

Unless holy magic stabilizes them, they make a death saving throw every turn upon winning the death saving throws, new ones start the very next turn if they are stabilized by holy magic then this happens again the next time they eat flesh and/or drink blood. Should they die with 10 change points then the infested dies at this stage they rise as a ghoul, or vampire spawn.

To find out how long it takes for them to complete the transition roll 1d100:

1d100 Transition Rate
1-20 1d10 turns
21-40 1d10 hours
41-60 1d10 days
61-99 1d10 weeks
100 they leap up right away with full health and get to make one turn before combat starts

Optional Note! (if while dying the infested either eats the heart or drinks enough blood from a humanoid being to kill that person then they stabilize and they gain another change point. If they get 100 change points Then they turn in to a full on Vampire.)


The Red Plague can be cured according to the disease framework from dire diseases.

By using an effect or spell that cures all disease, you can remove the Red Plague greater disease.

You must then cure the lesser diseases with an effect or spell that cures all diseases, or cure yourself from each lesser disease individually.


You are infected with The Red Plague, and non-curse effects 1 and 2. To totally cure yourself, you must receive either 2 full cures for The Red Plague itself and both lesser diseases, or 1 full cure for The Red Plague and 2 lesser restorations for each lesser disease.

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