Contagion 5e D&D – best uses and tips from an experienced DM

Today we are taking a closer look into a very versatile and fun-to-use level 5 spell. Contagion in 5e has a ton of possibilities and uses that are underlooked. We will be discussing the best uses, pros, cons and

What is Contagion 5e: Mechanics and Requirements


  • Casting time: 1 action
  • Level: 5
  • Range: Touch
  • Target: A creature within your reach
  • Components: Verbal, Somatic.
  • Duration: 7 days
  • Classes: Cleric, Druid

Spell Description

Your touch inflicts disease. Make a melee spell attack against a creature within your reach. On a hit, you afflict the creature with a disease of your choice from any of the ones described below.

At the end of each of the target’s turns, it must make a Constitution saving throw. After failing three of these saving throws, the disease’s effects last for the duration, and the creature stops making these saves. After succeeding on three of these saving throws, the creature recovers from the disease, and the spell ends.

  • Flesh Rot. The creature’s flesh decays. The creature has disadvantage on Charisma checks and vulnerability to all damage.
  • Mindfire. The creature’s mind becomes feverish. The creature has disadvantage on Intelligence checks and Intelligence saving throws, and the creature behaves as if under the effects of the confusion spell during combat.
  • Seizure. The creature is overcome with shaking. The creature has disadvantage on Dexterity checks, Dexterity saving throws, and attack rolls that use Dexterity.
  • Slimy Doom. The creature begins to bleed uncontrollably. The creature has disadvantage on Constitution checks and Constitution saving throws. In addition, whenever the creature takes damage, it is stunned until the end of its next turn.
  • Blinding Sickness. Pain grips the creature’s mind, and its eyes turn milky white. The creature has disadvantage on Wisdom checks and Wisdom saving throws and is blinded.
  • Filth Fever. A raging fever sweeps through the creature’s body. The creature has disadvantage on Strength checks, Strength saving throws, and attack rolls that use Strength.
contagion 5e dnd

Advantages and Drawbacks


  • Long Duration: With one touch, the target is already poisoned. However, once the three saving throws have failed, the duration for the spell lasts for 7 full days which is on the more prolonged side of how long a spell lasts. The disease will then continue to have effect for the next 7 days even if the party doesn’t encounter the creature within all those 7 days. 
  • Definitive after Three Rolls: After the three rolls, the creature is hit with a disease of the caster’s choice. The only way to cure it would be through magical means (certain spells such as lesser restoration), however, if the caster is using the spell correctly, the diseased creature wouldn’t really know that unless they have studied the spell. 
  • Choice of Disadvantage: The caster has an arsenal of options for which disease, and therefore type of disadvantage, the creature would have. Each disease has its own unique traits and the selection practically covers each of the ability scores. 
  • Gets Around Poison Immunity: There are some creatures who are immune to disease, but will remain poisoned for the duration until they fail all three saves. If the caster is unaware of the creature’s immunity to diseases, at least they may get the poison effect off. 


  • Easily negated: Depending on the luck of the player, the probability of being able to choose a disease against the creature is rather low. Instead of one roll to determine the effect, the creature would have to make three. Meaning, not only is the disease effect prolonged, but the caster will have to wait an entire three rounds to see if they fail or succeed in which they may have the opportunity to negate the effects of it magically and/or with sheer luck. 
  • No Range: In order to get this spell effect going in the first place, the caster will have to touch the creature they wish to disease. The casters who can use these spells are clerics and druids who are often in the backlines so unless it’s a stealth mission, there’s a high chance that they may not be able to use this spell in the first place. 
  • Non-damaging spell: The spell itself does not do damage but rather does an effect on a single creature. 
  • Disease Immunities: A lot of common monsters that players may find in their adventures are immune to both disease and poison. For example, undead and constructs which I find to be one of the most common encounters within adventures. 

Best Uses for Contagion 5e 

best uses for contagion in dnd

1. Repeated Encounters

If the party can see themselves pestering an NPC or creature multiple times within a week, this is a great spell to cast on them with the help of a little stealth or dexterous movement. Perhaps the NPC is sleeping, or maybe they are occupied with something else. Nothing beats getting creative with spells, after all.

Once the spell is casted, any future encounters for the next week will consist of disadvantage on certain checks and possibly additional negative effects towards them. By the time that they see the creature again, the caster will almost definitely have that spell slot regained from a long rest or two. 

2. Preventing Future Encounters

Let’s say that the party feels like they will soon be facing a powerful NPC. It can be a duel or maybe they have already figured out the NPC’s evil intentions. Why not make the NPC sick to their very core to rather stall the duel or fight? Or even better, prevent all of it from happening in the first place? That being said, this scenario would be a lot more common within a campaign setting rather than a one-shot, though. 

3. Boss Fights

Oftentimes during boss fights, the players may try to do something a little tricky other than combat to make sure that they have the upper hand against them. The spellcaster may try to touch the boss in some way before the fight or during to have them roll the saving throws.

Since the spell doesn’t require concentration, once the spell is cast, the caster can still do damage in  the upcoming turns while letting them and their team have a better time against the boss. This also helps when synchronizing with the party on spells and attacks (for example: spells that require the creature to make saving throws for damage). 

Advice and Final Thoughts 

As stated previously, this spell is better suited for campaigns rather than one-shots since it’s a great setup strategy spell made for future prospects.

One-shots are usually in one to two day in-game time spans while campaigns can go on for years both in-game and in real life. When considering this spell, it would be best to use it against NPCs or creatures that they party may have a hard time against.

It’s not exactly for all scenarios since it’s situational and may be difficult for the spellcasters (druids and clerics) to get off. Try to figure out what your character is getting yourself into before considering the spell. 

Contagion FAQ

Is Contagion contagious?

For the most part, it’s up to the DM. There’s a lot of mixed reactions to this question within DM’s for the answer to this question. Some say that since it’s a magically sourced disease, the disease should stay within the affected creature. Others may say that because it causes a normal disease, it can be spread like a pandemic. Personally, I feel as if the spell shouldn’t be contagious unless the DM wishes to build a small side plot story on a pandemic that has befell a village or city just for the sake of saving the DM some sanity. 

Does Dispel Magic get rid of Contagion?

There is a lot of confusion when it comes to this question due to people saying that it’s a magically sourced disease versus it causing a normal disease. For the most part, people and myself agree that Dispel Magic should unfortunately get rid of the spell effects, since it sources from magic. However, not a lot of creatures may be familiar with necrotic spells, especially so if the spell is done discreetly. If the spell is casted discreetly, the creature may dismiss it as a normal disease that has, unfortunately, befell them.