Incidence Of Neonatal Herpes Research Articles

Epidemiology of herpes simplex virus type 2 in Europe: systematic review, meta-analyses, and meta-regressions.

Herpes simplex virus type 2 (HSV-2) infection is a globally prevalent, life-long, sexually transmitted infection. This study characterized HSV-2 seroprevalence in Europe for various at-risk populations and proportions of HSV-2 detection in genital ulcer disease (GUD) and in genital herpes. Data on neonatal herpes and HSV-2's contribution to HIV transmission were also reviewed. Cochrane and PRISMA guidelines were followed to systematically review, synthesize, and report HSV-2 related findings. The search was conducted in PubMed and Embase databases up to February 20, 2022. Any publication reporting data on the outcome measures was included. Meta-analyses and meta-regressions were conducted. 211 relevant reports were identified, including 12 overall incidence measures, 294 overall (813 stratified by factors such as age and sex) seroprevalence measures, 13 overall (15 stratified by sex) proportions of HSV-2 detection in clinically diagnosed GUD, and 70 overall (183 stratified by factors such as age and sex) proportions of HSV-2 detection in laboratory-confirmed genital herpes. Pooled mean seroprevalence was 12.4% (95% CI: 11.5-13.3%) among general populations, 27.8% (95% CI: 17.5-39.4%) among men who have sex with men, 46.0% (95% CI: 40.1-51.8%) among people living with HIV and people in HIV discordant couples, and 63.2% (95% CI: 55.5-70.6%) among female sex workers. Most measures showed heterogeneity in HSV-2 seroprevalence. The pooled mean seroprevalence among general populations increased with age and was 0.65-fold (95% CI: 0.58-0.74) lower in men than women. Seroprevalence decreased by 1% per calendar year. Pooled mean proportions of HSV-2 detection in GUD and in genital herpes were 22.0% (95% CI: 15.3-29.6%) and 66.0% (95% CI: 62.9-69.1%), respectively. HSV-2 detection in genital herpes cases was 1.21-fold (95% CI: 1.10-1.32) higher in men compared to women and decreased by 1% per calendar year. Incidence of neonatal herpes indicated an increasing trend. Although seroprevalence is declining, a significant proportion of Europe's population is infected with HSV-2. HSV-2 accounts for approximately one-fifth of GUD cases and two-thirds of genital herpes cases. Findings support the need to invest in HSV-2 vaccine development, and sexual and reproductive health services. Qatar National Research Fund [NPRP 9-040-3-008] and pilot funding from the Biomedical Research Program at Weill Cornell Medicine in Qatar supported this study.

Influence of pre-gravid preparation on the course and outcomes of the pregnancy in genital herpes

Introduction. According to researchers from different countries, the incidence of neonatal herpes varies noticeably. Objective. Optimization of pre-gravid preparation of women with chronic recurrent genital herpes to reduce pregnancy complications and improve perinatal outcomes. Мaterials and methods. The study included 58 women with confirmed chronic recurrent genital herpes. Two groups were formed, the main group included 30 women receiving pre-gravid preparation, complex treatment with antiviral and immunomodulatory drugs, the comparison group was represented by 28 women receiving pre-gravid preparation and only antiviral drug. Evaluation of the effectiveness of the treatment of chronic genital herpes and the benefits of pre-gravid preparation were carried out by assessing clinical manifestations, determining the immune status, analyzing the characteristics of the course of pregnancy, childbirth, and perinatal outcomes. Results. As a result of the study, the available data confirm the feasibility of using complex therapy in the treatment of chronic recurrent genital herpes in combination with pre-gravid preparation. Conclusion. Pre-gravid preparation and specific treatment of women with chronic recurrent genital herpes improve the clinical status of patients, increase the interrecurrent period, reduce the severity of prodromal symptoms, the duration and intensity of relapses of the disease, and contribute more favorable course of pregnancy and improvement perinatal outcomes.

Update on Neonatal Herpes Simplex Epidemiology in the Netherlands: A Health Problem of Increasing Concern?

This article provides an update on the incidence of neonatal herpes, guideline adherence by health care professionals (HCP) and trends in genital herpes simplex virus (HSV) infection during pregnancy in the Netherlands. Questionnaires were sent to all hospitals inquiring about numbers and characteristics of neonatal and maternal HSV infections, and guideline adherence between 2012 and 2015. Longitudinal trends were investigated from 1999 onward using survey data and Perinatal Registry of the Netherlands data (Perined). Trends were smoothed with Poisson regression splines. Risk indicators for neonatal and maternal HSV infections were examined with Poisson regression analyses. Neonatal herpes incidence was 4.8/100,000 live births based on survey data (2012-2015) and 3.4/100,000 based on Perined (2012-2014). Mortality rate was 23% (7/30). Neonatal herpes incidence increased slightly over time as did the prevalence of genital HSV infection among pregnant women. Non-Western ethnicity (Rate Ratio: 1.9; 95% confidence interval: 1.5-2.5) and age <20 years (Rate Ratio: 2.3; 95% confidence interval: 1.2-4.7) were associated with genital herpes during pregnancy. In Perined, none of the neonatal herpes cases had a mother diagnosed with an active genital herpes infection during pregnancy. Preventive measures to reduce vertical herpes transmission (such as cesarean section) were less commonly reported by HCP in 2012-2015 compared with 2006-2011. Neonatal herpes incidence in the Netherlands slowly increased over the last 15 years. An increased genital HSV prevalence during pregnancy or, to lower extent, the decreased guideline adherence by HCP may be responsible. A rise in asymptomatic maternal HSV shedding is also plausible, emphasizing the challenges in preventing neonatal herpes.

An HSV-2 Trivalent Vaccine Is Immunogenic in Rhesus Macaques and Highly Efficacious in Guinea Pigs.

A genital herpes vaccine is urgently needed to prevent pain and suffering, reduce the incidence of neonatal herpes, and decrease the risk of HIV acquisition and transmission that accompanies genital infection. We evaluated a trivalent HSV-2 subunit antigen vaccine administered with CpG and alum in rhesus macaques and guinea pigs. The vaccine contains glycoproteins C, D and E (gC2, gD2, gE2) to block virus entry by gD2 and immune evasion by gC2 and gE2. In rhesus macaques, the trivalent vaccine induced plasma and mucosa neutralizing antibodies, antibodies that block gC2 and gE2 immune evasion activities, and stimulated CD4 T cell responses. After intravaginal challenge, a self-limited vaginal infection of brief duration was detected by histopathology and immunohistochemistry in naïve, but not in trivalent immunized macaques. Vaccine efficacy was evaluated in female guinea pigs. Animals were mock immunized, or immunized with gD2, the trivalent vaccine or the trivalent vaccine followed by a booster dose of gD2 (trivalent + gD2). The trivalent and trivalent + gD2 groups were 97% and 99% efficacious, respectively in preventing genital lesions and both outperformed gD2 alone. As a marker of transmission risk, vaginal swabs were evaluated daily for HSV-2 DNA and replication competent virus between five and seven weeks after challenge. HSV-2 DNA shedding was reduced in all groups compared with mock. Shedding of replication competent virus occurred on fewer days in the trivalent than gD2 immunized animals while the trivalent + gD2 group had no shedding of replication competent virus. Overall, the trivalent group had genital lesions on < 1% days and shedding of replication competent virus on 0.2% days. The vaccine has outstanding potential for prevention of genital herpes in humans.

Infant Deaths Due To Herpes Simplex Virus, Congenital Syphilis, and HIV in New York City

Neonatal infection with herpes simplex virus (HSV) is not a nationally reportable disease; there have been few population-based measures of HSV-related infant mortality. We describe infant death rates due to neonatal HSV as compared with congenital syphilis (CS) and HIV, 2 reportable, perinatally transmitted diseases, in New York City from 1981 to 2013. We identified neonatal HSV-, CS-, and HIV-related deaths using International Classification of Diseases (ICD) codes listed on certificates of death or stillbirth issued in New York City. Deaths were classified as HSV-related if certificates listed (1) any HSV ICD-9/ICD-10 codes for deaths ≤42 days of age, (2) any HSV ICD-9/ICD-10 codes and an ICD code for perinatal infection for deaths at 43 to 365 days of age, or (3) an ICD-10 code for congenital HSV. CS- and HIV-related deaths were those listing any ICD code for syphilis or HIV. There were 34 deaths due to neonatal HSV (0.82 deaths per 100 000 live births), 38 from CS (0.92 per 100 000), and 262 from HIV (6.33 per 100 000). There were no CS-related deaths after 1996, and only 1 HIV-related infant death after 2004. The neonatal HSV-related death rate during the most recent decade (2004-2013) was significantly higher than in previous years. The increasing neonatal HSV-related death rate may reflect increases in neonatal herpes incidence; an increasing number of pregnant women have never had HSV type 1 and are therefore at risk of acquiring infection during pregnancy and transmitting to their infant.

Neonatal herpes infections in The Netherlands in the period 2006–2011

Objective: To monitor the incidence of neonatal herpes in The Netherlands between 2006 and 2011, as well as the adherence to the rather conservative Dutch prevention policy.Methods: Questionnaires were sent to all virology laboratories (n = 44), gynaecology and paediatrics departments of all hospitals in The Netherlands (n = 89). Questionnaires for the laboratories pertained to rates of proven cases of neonatal herpes; for the gynaecologists and paediatricians it pertained to rates of genital herpes during pregnancy and neonatal herpes, and their policy. For gynaecologists this concerned the risk of herpes simplex virus transmission in case of primary genital herpes during pregnancy or labour; for paediatricians it concerned the diagnostic policy in a neonate suspected of neonatal herpes.Results: For the period 2006–2011 38 cases of neonatal herpes were reported, yielding an incidence of 4.7 per 100 000 births. The estimated annual number of pregnant women with primary or recurrent genital herpes was 278. Of the responding gynaecologists and paediatricians, only 59% and up to 39%, respectively, reported a policy in accordance with the national guideline.Conclusions: The incidence of neonatal herpes in The Netherlands seems to have increased in the period 2006–2011. Combined with suboptimal guideline adherence this warrants strategies to improve awareness and subsequent adherence.

The incidence and presentation of neonatal herpes in a single UK tertiary centre, 2006-2013.

Neonatal herpes infection can have devastating outcomes for otherwise healthy babies. In the UK, the stated incidence is low at 1.65 per 100 000 live births, which is in contrast with an incidence of 33 per 100 000 in the USA. We aimed to discover the current incidence of neonatal herpes infection in our tertiary service, determine the timing of presentations, and to consider which presenting features could be used for early recognition and prognostication. All cases of neonatal herpes infection occurring in the last 8 years were reviewed, and those cases from an agreed population were used to calculate an incidence. The statistical associations between clinical features and death were examined. There were 57 291 live births between 2006 and 2012. Nineteen cases were identified including 10 from the study population (17.5/100 000 live births). There were nine deaths, all presenting later than 6 days of age. Independent predictors of death were haemodynamic instability, coagulopathy, bleeding and central nervous system features at presentation. All presentations occurred within 2 weeks of birth and were varied and often non-specific. Our incidence rate of 17.5 per 100 000 live births represents a significant increase and is much more in line with the higher incidence rates seen in the USA. The range of presentations shows the non-specific nature of this disease. We advocate a heightened awareness of this treatable disease in the UK, and encourage adoption of modern rapid diagnostic techniques and the wider inclusion of Aciclovir in treatment regimens for neonatal sepsis.

Neonatal herpes in Serbia: Is it a problem or not?

With 20-80% mortality, neonatal infection caused by herpes simplex virus (HSV) or neonatal herpes is among the most severe of all perinatal infections. The majority of neonatal HSV infections are acquired during delivery, although in utero and postnatal infections do occur. Primary maternal infection is associated with a high rate of transmission (~50%), compared to &lt;3% in infants of women with reactivated disease. Other factors that influence transmission include HSV type, premature delivery, etc. Clinical manifestations have been classified into three forms: skin-eye-mouth disease, CNS and disseminated disease. The diagnosis of neonatal HSV infection includes the detection of HSV DNA by PCR in samples from neonate and mother. The incidence of neonatal herpes differs widely between different countries. In Serbia, the data about neonatal herpes incidence are scarce. The results of our pilot study showed that the minimal estimation of the national incidence of neonatal herpes is 7.5 per 100 000. Therefore, the set up and implementation of a national neonatal herpes surveillance system might provide valuable information for the accurate assessment of disease burden and development of an effective prevention strategy in Serbia.

Neonatal herpes simplex virus infections in Switzerland: results of a 6-year national prospective surveillance study

A large variation in neonatal herpes incidence is observed in USA and Europe. Better knowledge of neonatal herpes epidemiology is important to inform local prevention strategies. Between 2002 and 2008, the Swiss Paediatric Surveillance Unit reported prospectively proven neonatal herpes simplex virus infections. During the study period seven cases were declared, for an incidence of 1.6/100 000 (95% CI 0.64–3.28/100 000) live births. This is one of the lowest incidences of neonatal herpes reported.

Seroepidemiology of herpes simplex virus type 1 and 2 in pregnant women in Switzerland: an obstetric clinic based study

Objective To assess the seroprevalence of herpes simplex virus type 1 (HSV-1) and type 2 (HSV-2) IgG antibodies and the seroincidence of HSV-1 and HSV-2 infections in pregnant women attending the maternity clinic of the University Hospital Lausanne. Study design Blood samples from 1030 women were taken at the usual pregnancy visit in the first trimester to assess the prevalence rate of IgG antibodies against HSV-1 and HSV-2 using a type-specific assay. A second blood sample was taken 6–8 weeks postpartum from returning women who were seronegative for HSV-2 or HSV-1 to assess the incidence of seroconversion (primary infection). Results The seroprevalence rates were 79.4% (95% CI: 76.9–81.9) for HSV-1 and 21.2% (18.7–23.7) for HSV-2 in women 14–46 years old. Type-specific serostatus patterns were as follows: 17.3% HSV-1/-2: +/+, 62.1% HSV-1/-2: +/−, 3.9% HSV-1/-2: −/+, 16.7% HSV-1/-2: −/−. Two hundred and sixty five women (59 of the 212 seronegative for HSV-1 (27.8%) and 265 of the 812 seronegative for HSV-2 (32.6%)) returned to the outpatient clinic for the post-delivery check and a second blood sample was obtained. One HSV-1 seroconversion was detected (HSV-1 seroconversion rate 2.4%/100 patient × year (95% CI: 0.06–13.4)) in a patient who had symptoms compatible with primary genital herpes. No HSV-2 seroconversion was detected (HSV-2 seroconversion rate: 0/100 patient × year (97.5% one-sided CI: 0–2)). Conclusion Compared to a previous population-based study, our study results suggest a rise in the prevalence of HSV-2 among pregnant women in Switzerland. The low incidence of seroconversion detected during pregnancy is consistent with the very low reported incidence of neonatal herpes in Switzerland. Condensation This study in a public hospital in Western Switzerland suggests an increasing prevalence of HSV-2, but a low incidence of primary infections in women of childbearing age.

Prevention of neonatal herpes

Neonatal herpes can occur when the neonate is exposed to herpes simplex virus in the maternal genital tract during labour. Attack rates are highest when the mother has a newly acquired infection and, therefore, does not have antibodies to protect the neonate. Even with early therapy, there is significant morbidity and mortality associated with neonatal herpes, suggesting that preventing neonatal herpes simplex virus exposure or early recognition of exposure is important. The incidence of neonatal herpes has not declined despite national guidelines for prevention. This suggests that the prevention guidelines need to be re-addressed.

The incidence of neonatal herpes in The Netherlands

Background In The Netherlands the incidence of neonatal herpes was 2.0–2.9 per 100,000 live births during the period 1981–1998. The low incidence warranted a rather conservative prevention policy. Objectives To monitor for potential changes in the incidence of neonatal herpes in The Netherlands between 1999 and 2005, which may affect the prevention policy. Study design Questionnaires were sent to all virological laboratories, the gynaecological and paediatric departments of every university hospital and half the number of the general hospitals in The Netherlands. The questionnaires pertained to the incidence of proven cases of neonatal herpes, the numbers of caesarean sections performed for the prevention of neonatal herpes and the numbers of pregnant women with genital herpes. Results In the period 1999–2005 33 cases of neonatal herpes were reported, yielding an incidence of 3.2 cases per 100,000 live births per year. The estimated annual numbers of pregnant women with genital herpes ranged from 200 to 240. Approximately 9 caesarean sections were performed annually to prevent neonatal herpes. Conclusions In The Netherlands neonatal herpes is still a rare condition. From the findings of this study it is concluded that it is not necessary to revise the Dutch guidelines for the prevention of neonatal herpes simplex infection.

Third trimester antiviral prophylaxis for preventing maternal genital herpes simplex virus (HSV) recurrences and neonatal infection

Genital herpes simplex virus (HSV) infection is one of the most common viral sexually transmitted infections. The majority of women with genital herpes will have a recurrence during pregnancy. Transmission of the virus from mother to fetus typically occurs by direct contact with virus in the genital tract during birth. To assess the effectiveness of antenatal antiviral prophylaxis for recurrent genital herpes on neonatal herpes and maternal recurrences at delivery. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (January 2007), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2006, Issue 4), MEDLINE (January 1966 to February 2007) and EMBASE (January 1974 to February 2007; handsearched conference proceedings; reviewed bibliographies of all relevant articles for further references; and contacted experts in the field. Randomized controlled trials which assessed the effectiveness of antivirals compared to placebo or no therapy, on neonatal herpes and maternal disease endpoints among pregnant women with genital herpes. Two authors independently applied study selection criteria and extracted data. Seven randomized controlled trials (1249 participants) which met our inclusion criteria compared acyclovir to placebo or no treatment (five trials) and valacyclovir to placebo (two trials). The effect of antepartum antiviral prophylaxis on neonatal herpes could not be estimated. There were no cases of symptomatic neonatal herpes in the included studies in either the treatment or placebo groups. Women who received antiviral prophylaxis were significantly less likely to have a recurrence of genital herpes at delivery (relative risk (RR) 0.28, 95% confidence interval (CI) 0.18 to 0.43, I(2 )= 0%). Women who received antiviral prophylaxis were also significantly less likely to have a cesarean delivery for genital herpes (RR 0.30, 95% CI 0.20 to 0.45, I(2) = 27.3%). Women who received antiviral prophylaxis were significantly less likely to have HSV detected at delivery (RR 0.14, 95% CI 0.05 to 0.39, I(2) = 0%). Women with recurrent genital herpes simplex virus should be informed that the risk of neonatal herpes is low. There is insufficient evidence to determine if antiviral prophylaxis reduces the incidence of neonatal herpes. Antenatal antiviral prophylaxis reduces viral shedding and recurrences at delivery and reduces the need for cesarean delivery for genital herpes. Limited information exists regarding the neonatal safety of prophylaxis. The risks, benefits, and alternatives to antenatal prophylaxis should be discussed with women who have a history and prophylaxis initiated for women who desire intervention.

Neonatal Herpes Morbidity and Mortality in California, 1995–2003

Neonatal herpes infections can have serious consequences. Methods for monitoring the incidence of neonatal herpes have not been standardized. To use existing data to examine neonatal herpes-related morbidity in California. California hospital discharge and mortality data were used to identify neonatal herpes cases, defined as a herpes-related discharge diagnosis with an admitting age of 42 days or less, and neonatal herpes-related deaths. California birth data were used to identify pregnancies complicated by herpes and to determine cesarean section rates. The overall incidence of neonatal herpes was 12.1 per 100,000 live births per year, with no observable change from 1995 to 2003. Neonatal herpes-related mortality, which was estimated to be 0.8 deaths per 100,000 live births, also did not show significant change over time. Between 1995 and 2002, herpes complication in labor declined steadily from 0.23% to 0.09% of all labors (P <0.0001). Among pregnancies with herpes as a complication of labor, cesarean section rates increased from 72.2% to 78.3% (P = 0.01), whereas overall cesarean rates increased from 20.0% to 26.0% (P <0.0001). Existing data can be used to monitor the morbidity and mortality of neonatal herpes. Because the rate of neonatal herpes cases and deaths was stable from 1995 to 2003 despite a decrease in herpes complications in labor and an increase in cesarean rates, new interventions are needed to prevent neonatal herpes.

The potential role of suppressive therapy for sex partners in the prevention of neonatal herpes: a health economic analysis

Background: The development of suppressive therapy and type specific tests for herpes infections allow for screening to reduce the risk of neonatal herpes. Objectives: To assess the potential effectiveness, cost...

Seroprevalences of herpes simplex virus type 1 and type 2 among pregnant women in the Netherlands.

In the Netherlands 73% of cases of neonatal herpes are caused by herpes simplex virus type 1 (HSV-1), whereas in the United States a majority are caused by HSV type 2 (HSV-2). GOAL To understand this difference we undertook a seroepidemiological study on the prevalence of HSV-1 and HSV-2 among pregnant women. Type-specific antibodies to HSV-1 and HSV-2 were detected by enzyme-linked immunosorbent assay (ELISA) in serum samples from 1,507 pregnant women in Amsterdam, Rotterdam, and Nijmegen. The prevalence of HSV-1 was 61% in Nijmegen, 73% in Amsterdam, and 75% in Rotterdam. The prevalence of HSV-2 was 11% in Nijmegen, 35% in Amsterdam, and 27% in Rotterdam. The seroprevalence of HSV-1 and HSV-2 antibodies among pregnant women in the Netherlands shows significant geographical differences, which were attributed to ethnical variation. However, the epidemiologic differences did not correlate with the incidence of neonatal herpes in the Netherlands.

Herpes simplex virus epidemiology and ocular importance.

To review the changing epidemiology of herpes simplex disease and correlate it with the epidemiology of ocular herpes simplex disease. A review of pertinent reports in the world literature about the epidemiology of herpes simplex and specifically about ocular herpes simplex. In developed countries, many individuals are reaching adolescence and adulthood without prior herpesvirus infection. Herpes simplex genital infection is increasing at a rapid rate in sexually active adolescents and adults, with about one in six adults now infected in the United States. Similar statistics are confirmatory worldwide in developed countries. Active herpes simplex infection is a risk factor for acquisition of human immunodeficiency virus. The Herpetic Eye Disease Study, as well as prior studies from Moorfields Eye Hospital and the Mayo Clinic in Rochester, Minnesota, provides us with the epidemiology of ocular herpes simplex. Recent studies suggest an older age of onset and perhaps overall more severe ocular disease as compared with the older literature. Herpes simplex is a significant health concern at present with genital infections increasing in epidemic proportions. This is also reflected in a rise in the incidence of neonatal herpes. Herpes simplex virus type 1 (HSV-1) infection is being acquired for the first time in an older age group. A significant and increasing proportion of genital herpes is caused by HSV-1. Serologic studies are no longer as useful in distinguishing orofacial herpes from genital herpes. More acute retinal necrosis syndrome cases are associated with HSV-2. Speculation about the future of ocular herpes is made based on this changing epidemiology.

Neonatal herpes in Denmark 1977-1991.

To prevent neonatal herpes, women in labor with genital herpes infection are still delivered by Cesarean section. This policy is currently being debated. The aim of this study was to determine the incidence of neonatal herpes in Denmark and to evaluate the prevention practice. All newborns with perinatal herpes in Denmark 1977-1991 were identified from hospital-records. Of 862,298 deliveries 136 possible cases were found but only 30 (22%) fulfilled the criteria for neonatal herpes. The incidence increased from 2.36 to 4.56 per 100,000 live births during 1977-1984 through 1984-1991. Three mothers (10%) had recurrent herpes at delivery, three (10%) had primary herpes, and five (17%) had oral herpes. Seven infants (23%) were delivered by Cesarean section. Nine (30%) only had cutaneous herpes, four (13%) had CNS herpes, nine (30%) had disseminated disease. Six (20%) did not have any sequelae. Four (13%) died. Six (20%) had serious neurological sequelae. Seven (23%) only had cutaneous recurrences. In seven cases (23%) information was insufficient. During a 15 year period in Denmark only one neonate had serious sequelae following a recognized maternal herpes recurrence. Four infants had a serious infection in spite of Cesarean section. This study does not support a policy of Cesarean section in case of maternal recurrent herpes simplex infection at delivery.

Neonatal herpes policy in the Netherlands. Five years after a consensus conference

In order to establish whether the recommendations of an in 1987 organized consensus conference about neonatal herpes policy in the Netherlands had been followed, an inquiry was held in January 1992 among gynecologists, pediatricians and microbiologists. Compared with the results of an inquiry that was held five years before, it was found that the incidence of neonatal herpes had not increased in the last ten years (approximately five cases annually or one per 35,000 neonates) despite the lower frequency of caesarean sections (more than 50 sections a year before 1987 and less than 10 sections a year after 1987). It is concluded that the consensus statements not only have been followed, but that they also proved to be sound.

Herpes simplex virus infections in the newborn

Neonatal infection caused by herpes simplex virus (HSV) is a serious disease associated with high morbidity and mortality. The precise incidence of neonatal herpes is not known because the disease is not subject to mandatory reporting, but estimates range from 1 per 3500 to 1 per 20,000 live births. 1 With the dramatic increase in incidence of genital herpes in the United States it is possible that the frequency of herpes neonatorum will show a corresponding rise. Newborns infected with HSV who do not receive antiviral therapy may have a fatality rate as high as 80%. 2 The small percentage of infants who survive the infection generally have severe neurologic sequelae. With the development of effective antiherpes agents it is anticipated that both the mortality and the morbidity will be significantly reduced in infants who are identified early and treated promptly. In contrast to cytomegalovirus, HSV very rarely crosses the placenta to cause an infection in utero. The vast majority of HSV-infected infants acquire the virus during the birth process. 3 This means that the infected infant who is identified soon after delivery has the greatest likelihood of a favorable outcome. The first sign of infection in most infants is characteristic skin vesicles, which should be an indication for immediate antiviral therapy. The objective of this report is to review the current state of epidemiology, pathogenesis, diagnosis, and management of neonatal herpes infections.