Neonatal herpes simplex is a rare but serious condition, usually caused by vertical transmission of herpes simplex virus from mother to newborn. Around 1 in every 3,500 babies in the United States contract the infection.[1]
Contents
1Signs and symptoms
2Cause
2.1Risk factors
2.2Transmission
3Treatment
4Epidemiology
5See also
6References
7Further reading
8External links
Signs and symptoms
Neonatal herpes manifests itself in three forms: skin, eyes, and mouth herpes (SEM) sometimes referred to as "localized", disseminated herpes (DIS), and central nervous system herpes(CNS).[2]
SEM herpes is characterized by external lesions but no internal organ involvement. Lesions are likely to appear on trauma sites such as the attachment site of fetal scalp electrodes, forceps or vacuum extractors that are used during delivery, in the margin of the eyes, the nasopharynx, and in areas associated with trauma or surgery (including circumcision).[3]
DIS herpes affects internal organs, particularly the liver.
CNS herpes is an infection of the nervous system and the brain that can lead to encephalitis. Infants with CNS herpes present with seizures, tremors, lethargy, and irritability, they feed poorly, have unstable temperatures, and their fontanelle (soft spot of the skull) may bulge.[4]
CNS herpes is associated with higher morbidity, while DIS herpes has a higher mortality rate. These categories are not mutually exclusive and there is often overlap of two or more types. SEM herpes has the best prognosis of the three, however, if left untreated it may progress to disseminated or CNS herpes with its attendant increases in mortality and morbidity.
Death from neonatal HSV disease in the U.S. is currently decreasing; The current death rate is about 25%, down from as high as 85% in untreated cases just a few decades ago. Other complications from neonatal herpes include prematurity with approximately 50% of cases having a gestation of 38 weeks or less, and a concurrent sepsis in approximately one quarter of cases that further clouds speedy diagnosis.
Cause
Risk factors
Maternal risk factors for neonatal HSV-1 include: White non-Hispanic race,[5] young maternal age (<25), primary infection in third trimester[6]
, first pregnancy, HSV (1&2) seronegative,[4][7] discordant partner,[8] gestation <38 weeks,[6] receptive oral sex in third trimester.[9]
Neonatal HSV-2 maternal risk factors: Black race,[10] young maternal age (<21),[4][6] discordant partner, primary or non primary first episode infection in third trimester,[11] four or more lifetime sexual partners,[10] lower level of education,[10] history of previous STD, history of pregnancy wastage, first viable pregnancy, gestation <38 weeks.[4][6]
Transmission
The majority of cases (85%) occur during birth when the baby comes in contact with infected genital secretions in the birth canal, most common with mothers that have newly been exposed to the virus (mothers that had the virus before pregnancy have a lower risk of transmission), an estimated 5% are infected in utero, and approximately 10% of cases are acquired postnatally. Detection and prevention is difficult because transmission is asymptomatic in 60% - 98%[12] of cases.
Treatment
Reductions in morbidity and mortality are due to the use of antiviral treatments such as vidarabine and acyclovir.[2][13][14][15] However, morbidity and mortality still remain high due to diagnosis of DIS and CNS herpes coming too late for effective antiviral administration; early diagnosis is difficult in the 20-40% of infected neonates that have no visible lesions.[16] A recent large scale retrospective study found disseminated NHSV patients least likely to get timely treatment, contributing to the high morbidity/mortality in that group.[17]
Harrison's Principles of Internal Medicine, recommends that pregnant women with active genital herpes lesions at the time of labor be delivered by caesarean section. Women whose herpes is not active can be managed with acyclovir.[18] The current practice is to deliver women with primary or first episode non primary infection via caesarean section, and those with recurrent infection vaginally, even in the presence of lesions because of the low risk (1-3%) of vertical transmission associated with recurrent herpes.
Epidemiology
Neonatal HSV rates in the U.S. are estimated to be between 1 in 3,000 and 1 in 20,000 live births. Approximately 22% of pregnant women in the U.S. have had previous exposure to HSV-2, and an additional 2% acquire the virus during pregnancy, mirroring the HSV-2 infection rate in the general population.[19] The risk of transmission to the newborn is 30-57% in cases where the mother acquired a primary infection in the third trimester of pregnancy. Risk of transmission by a mother with existing antibodies for both HSV-1 and HSV-2 has a much lower (1-3%) transmission rate. This in part is due to the transfer of significant titer of protective maternal antibodies to the fetus from about the seventh month of pregnancy.[4][20] However, shedding of HSV-1 from both primary genital infection and reactivations is associated with higher transmission from mother to infant.[4]
HSV-1 neonatal herpes is extremely rare in developing countries because development of HSV-1 specific antibodies usually occurs in childhood or adolescence, precluding a later genital HSV-1 infection. HSV-2 infections are much more common in these countries. In industrialized nations, the adolescent HSV-1 seroprevalance has been dropping steadily for the last 5 decades. The resulting increase in the number of young women becoming sexually active while HSV-1 seronegative has contributed to increased HSV-1 genital herpes rates, and as a result, increased HSV-1 neonatal herpes in developed nations. Recent study in the United States from 2003-2014, using large administrative database show increasing trends in incidence of neonatal HSV from 7.9 to 10 cases per 100,000 live births and mortality of 6.5%. Decreasing gestational age, African American race had higher incidence of neonatal HSV. After this can add another study from Canada showed similar results .. incidence of 5.9 per 100,000 live births and case fatality of 15.5%.[21] A recent three-year study in Canada (2000–2003) revealed a neonatal HSV incidence of 5.9 per 100,000 live births and a case fatality rate of 15.5%. HSV-1 was the cause of 62.5% of cases of neonatal herpes of known type, and 98.3% of transmission was asymptomatic.[12] Asymptomatic genital HSV-1 has been shown to be more infectious to the neonate, and is more likely to produce neonatal herpes, than HSV-2,[4][22] However, with prompt application of antiviral therapy, the prognosis of neonatal HSV-1 infection is better than that for HSV-2.
See also
Disseminated herpes zoster
Herpes simplex
Herpesviral encephalitis
TORCH complex
References
^Bloomberg News (July 14, 2009). "Neonatal herpes simplex". Boston Children's Hospital. Retrieved February 2, 2014.
^ abKimberlin DW, Whitley RJ (2005). "Neonatal herpes: what have we learned". Semin Pediatr Infect Dis. 16 (1): 7–16. doi:10.1053/j.spid.2004.09.006. PMID 15685144.
^Prober CG (1997). Long SS, Pickering LK, Prober CG (eds.). Herpes simplex virus. Churchhill Livingstone, New York. p. 1138.
^ abcdefgBrown ZA, Wald A, Morrow RA, Selke S, Zeh J, Corey L (2003). "Effect of serologic status and cesarean delivery on transmission rates of herpes simplex virus from mother to infant". JAMA. 289 (2): 203–9. doi:10.1001/jama.289.2.203. PMID 12517231.
^Xu F, Markowitz LE, Gottlieb SL, Berman SM (January 2007). "Seroprevalence of herpes simplex virus types 1 and 2 in pregnant women in the United States". Am. J. Obstet. Gynecol.196 (1): 43.e1–6. doi:10.1016/j.ajog.2006.07.051. PMID 17240228.
^Nahmias AJ (August 2004). "Neonatal HSV infection Part II: Obstetric considerations -- a tale of hospitals in two cities (Seattle and Atlanta, USA)". Herpes. 11 (2): 41–4. PMID 15955267.
^Baker DA (December 2005). "Risk factors for herpes simplex virus transmission to pregnant women: a couples study". Am. J. Obstet. Gynecol. 193 (6): 1887–8. doi:10.1016/j.ajog.2005.08.007. PMID 16325587.
^Nahmias AJ (August 2004). "Neonatal HSV infection Part I: continuing challenges" (PDF). Herpes. 11 (2): 33–7. PMID 15955265.
^ abcMertz GJ (December 1993). "Epidemiology of genital herpes infections". Infect. Dis. Clin. North Am.7 (4): 825–39. PMID 8106731.
^Gardella C, Brown ZA, Wald A, et al. (August 2005). "Poor correlation between genital lesions and detection of herpes simplex virus in women in labor". Obstetrics and Gynecology. 106 (2): 268–74. doi:10.1097/01.AOG.0000171102.07831.74. PMID 16055574.
^ abKropp RY.; Wong T; et al. (2006). "Neonatal Herpes Simplex Virus Infections in Canada: Results of a 3-Year National Prospective Study". Pediatrics. 117 (61): 1955–1962. doi:10.1542/peds.2005-1778. PMID 16740836.
^Kesson AM (2001). "Management of neonatal herpes simplex virus infection". Paediatr Drugs. 3 (2): 81–90. doi:10.2165/00128072-200103020-00001. PMID 11269641.
^Brocklehurst P, Kinghorn GA, et al. (1998). "randomised placebo controlled trial of suppressive acyclovir in late pregnancy in women with recurrent genital herpes infection". Br J Obstet Gynaecol. 105 (3): 275–80. doi:10.1111/j.1471-0528.1998.tb10086.x. PMID 9532986.
^Brown ZA, Benedetti J, Ashley R, Burchett S, Selke S, Berry S, Vontver LA, Corey L (May 1991). "Neonatal herpes simplex virus infection in relation to asymptomatic maternal infection at the time of labor". N Engl J Med. 324 (18): 1247–52. doi:10.1056/NEJM199105023241804. PMID 1849612.
^Donda, K; Sharma, M; Amponsah, JK; Bhatt, P; Chaudhari, R; Okaikoi, M; Dapaah-siakwan, F (25 March 2019). "Trends in the incidence, mortality, and cost of neonatal herpes simplex virus hospitalizations in the United States from 2003 to 2014". Journal of Perinatology. 39 (5): 697-707. doi:10.1038/s41372-019-0352-7. PMID 30911082.
^Brown ZA, Gardella C, Malm G, Prober CG, Forsgren M, Krantz EM, Arvin AM, Yasukawa LL, Mohan K, Brown Z, Corey L, Wald A (2007). "Effect of maternal herpes simplex virus (HSV) serostatus and HSV type on risk of neonatal herpes". Acta Obstet Gynecol Scand. 86 (5): 523–529. doi:10.1080/00016340601151949. PMID 17464578.
…advances, neonatal HSV remains a clinical challenge. The clinical features and diagnosis of neonatal HSV infection will be reviewed below. The management, outcome, and prevention of neonatal HSV infection and …
…management and prevention of neonatal HSV infection will be reviewed here. The clinical features and diagnosis of neonatal HSV infection and non-neonatal herpes simplex virus infection are discussed separately: …
…cases of neonatal herpes simplex virus (HSV) infection are perinatally acquired. Affected newborns typically appear normal at birth, although many are born prematurely. Neonatal HSV infection usually develops …
… the risk of neonatal transmission. However, neither intervention fully eliminates the risk of neonatal herpes infection. Our approach to antiviral therapy for pregnant women with herpes simplex virus (HSV) …
…agents, but cytomegalovirus (CMV) and coxsackievirus occasionally can also be causative. Neonatal HSV infection is rare. It occurs before 42 days of age and primarily results from intrapartum exposure …
English Journal
Congenital neonatal herpes simplex retinitis.
Ames P, Agarwal-Sinha S.
Canadian journal of ophthalmology. Journal canadien d'ophtalmologie. 2019 Jun;54(3)e102-e105.
Congenital Cytomegalovirus and Neonatal Herpes Simplex Virus Infections: To Treat or Not to Treat?
, W W, R R, R R, .
The Pediatric infectious disease journal. 2019 Jun;38(6S Suppl 1)S60-S63.
Congenital cytomegalovirus infections are among the most common of the newborn in the developed world. These infections are the most common cause of sensorineural hearing loss. Studies utilizing ganciclovir and valganciclovir demonstrate improved hearing and Bailey Developmental scores. Because of t
Tools for the Diagnosis of Herpes Simplex Virus 1/2: Systematic Review of Studies Published Between 2012 and 2018.
Arshad Z, Alturkistani A, Brindley D, Lam C, Foley K, Meinert E.
JMIR public health and surveillance. 2019 May;5(2)e14216.
Herpes simplex virus (HSV)-1 and HSV-2 are common infections affecting the global population, with HSV-1 estimated to affect 67% of the global population. HSV can have rare but severe manifestations, such as encephalitis and neonatal herpes, necessitating the use of reliable and accurate diagnostic
The Tohoku Journal of Experimental Medicine 247(3), 149-152, 2019
… <p>Neonatal disseminated herpes simplex virus (HSV) infection is a severe disease with high mortality and morbidity; … On the 5th day of life, the patient received mechanical ventilation and was transferred to our neonatal ICU. …
… <p>Neonatalherpes simplex encephalitis (HSE) is a devastating disorder, although it can be treated. … Although a traditional polymerase chain reaction (PCR) did not detect herpes simplex virus (HSV) in the CSF on day 2, acyclovir administration was not discontinued, because MRI showed corticospinal tract lesions, which have recently been reported to be preferentially affected in neonatal HSE. …
Neonatal herpes is a herpes infection in a young baby. The younger the baby, the more vulnerable they are to the harmful effects of infection. It's caused by the herpes simplex virus, a highly contagious virus that can ...
Neonatal herpes simplex virus infections can result in serious morbidity and mortality. Many of the infections result from asymptomatic cervical shedding of virus after a primary episode of genital HSV in the third trimester.
Neonatal Herpes Simplex Virus (HSV) Infection - Etiology, pathophysiology, symptoms, signs, diagnosis & prognosis from the Merck Manuals - Medical Professional Version. ... Manifestations generally occur between ...