When to use Diseases

[jabberwoky]

Simple question: when should the DM make the PCs roll dice so they don't get sick? I could imagine that in the Serpent's Skull Adventure Path disease may be a real fear as it's set in the jungle (and the players begin shipwrecked). But making players constantly make disease checks seems tedious and not a whole lot of fun.

Thus, in your experience, have you used disease in your campaigns or ignored it entirely?
And if you have used it, how did you use it?

[Kimera757]

1) When relevant to an encounter. If you're fighting a disease-using monster (dire rat, evil druid, etc) or in a horrid environment (otyugh lair, for instance) then it's relevant.

2) When relevant to the environment or scenario. Even though it would be realistic, I wouldn't use a disease when PCs visit a new city. Maybe not even a new continent (if there had been previous contact; diseases would have previously transferred and immunity selected for).

PCs entering a jungle might all have to make checks against malaria, with the Survival skill being used to keep the mosquitoes away. (Only at low-levels. High-level PCs aren't going to fail checks, and if they do will swiftly use Remove Disease anyway.)

3) If the PCs act particularly foolishly when it comes to disease. Visiting the night district would realistically cause disease exposure, but I wouldn't inflict it unless a PC keeps on doing it and doesn't say anything about protection. (The night district is a euphemism for... I don't need to go any further.)

[Weirdo]

In most campaigns it's a rare threat and mostly comes up when fighting a specific monster that spreads disease. At one point we set up a Web Shelter in an area where we were worried about malaria.

In one game I played in we passed through a swamp/jungle region where we had to make daily saves vs disease. The first time a PC caught something nasty it was interesting, the second time it was mostly annoying. It wasn't so much the rolling as the inevitable failure. I played the healer and it took a frustrating amount of magic resources to get rid of - three of my highest-level spell slots at the time (not to mention adding Remove Disease to my spells known list after the first trip).

Disease should be used sparingly - when exposed to monsters or particularly filthy conditions, or occasionally within a jungle adventure and then I recommend allowing a Survival check for a hefty bonus (or avoid making saves), or just telling your players to make sure someone's carrying insect netting.

Kimera757 wrote:

PCs entering a jungle might all have to make checks against malaria, with the Survival skill being used to keep the mosquitoes away. (Only at low-levels. High-level PCs aren't going to fail checks, and if they do will swiftly use Remove Disease anyway.)

Disease is not just a low-level problem. The above second infection was at level 9-ish. Not everyone has a fantastic fort save, and the fact that Remove Disease requires a caster level check against the disease's DC (18 for malaria) means that unlucky rolls can translate to 2-3 slots to remove the disease magically. 3rd level spell slots aren't irrelevant at 9th level, Clerics and druids only get 4 of them including a bonus spell for high Wis, and everyone else needs to spend resources (gold or a spells known/free research slot) just to be capable of casting it or else you're relying on expensive scrolls that also have a higher failure-to-cure rate. Woe betide the party without a full caster healer or the wealth to afford multiple emergency scrolls... and I hear Serpent's Skull is a low-wealth AP.

[Craig Frankum]

My GM uses it from time to time when living conditions are poor. Living in the slums, a swamp-ish or jungle area, camping in bad weather with poor protection from the elements. As for the weather, it was a dice roll as to what the weather was each day. As for the others, it was generally a save-a-week just to show the effects of long term exposure. The rest of the time, it falls to monsters or villain spells or effects to actually make us make a save.

[Brambleman]

The only time ive used disease so far, barring monster attacks, is during a jungle adveture. The party sloged through the river and damp and mud, and i used disease rolls to quickly instil a sense of foreboding and danger to the area. Once the mood was set, i backed off and let the PCs "acclimate."

[Weirdo]

Once weekly or first-entry-then-acclimatization are both good ideas for toning down environmental disease exposure in order to avoid it taking over your game.