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Improved detection methods needed to prevent neonatal HSV
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VANCOUVER, British Columbia — In order to prevent herpes simplex infections in newborns, additional research is needed to identify women who are unknowingly shedding the virus at delivery.
According to Natalie O. White, DO, a neonatology fellow at Nationwide Children’s Hospital, current guidance that focuses primarily on aggressive evaluation and treatment of asymptomatic newborns delivered to women with active genital herpes simplex virus (HSV) lesions at delivery will likely not prevent most neonatal HSV infections.
White and colleagues, including Infectious Diseases in Children Editorial Board member Pablo J. Sanchez, MD, conducted the study to assess the utility of the current guidance on management of asymptomatic neonates born to mothers with active genital HSV lesions. They reviewed medical records of infants aged younger than 42 days who were diagnosed with HSV infection at either Children’s Medical Center in from December 2002 to August 2013 and at Nationwide Children’s Hospital from October 2001 to October 2013.
Pablo J. Sanchez
A diagnosis of HSV disease was found in 101 neonates and data on the mother’s infection status was available for 100 (95%) infants.
The records revealed that 7% of mothers had genital HSV infection either before pregnancy (n=1), at delivery (n=2), or unknown time (n=4).
“Only one mother had genital HSV lesions 3 days postpartum, and one mother was on acyclovir suppression at delivery after a positive genital HSV PCR, and the neonate developed CNS disease,” White said during her presentation.
HSV disease in these 100 infants was caused by HSV-2 in 57% of infants and HSV-1 in 43%; 14% were preterm (<37 weeks’ gestation). One infant was born with congenital HSV-2 infection and subsequently died, White said during her presentation.
Skin/eye/mouth disease was present in 38% (n=36) of 97 infants, followed by disseminated disease in 27% (n=26), and central nervous system disease (CNS) in 35% (n=35). Median age at presentation was 11 days.
“Current guidance that focuses on more aggressive evaluation and treatment of asymptomatic newborns delivered to women with active genital HSV lesions at delivery will likely not identify or prevent most neonatal HSV infections,” White concluded. “Research efforts must focus on identification of women who unknowingly are shedding HSV at delivery.”
For more information:
White NO. Abstract#2370.3. Presented at PAS 2014; May 2-6, 2014; Vancouver, Canada.
Disclosure: White reports no relevant financial disclosures.
Perspective
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David A. Kaufman, MD
This study nicely demonstrates the need for a rapid screening method to detect shedding once a mother is in labor. Similar to GBS and HIV perinatal infection, HSV antivirals could be used to attempt prevention of transmission from mother to baby. Unfortunately, we do not have a reliable rapid test, so alternative screening methods (such as HSV-1 and HSV-2 antibody levels in mother) could be performed at 36 weeks or earlier if there is preterm labor, cervical insufficiency, or rupture of membranes. With this information, HSV maternal and possibly neonatal prophylaxis, c-section, and timing of delivery could be studied for efficacy in preventing transmission and infection. We also need better study of maternal antiviral treatment, timing and dosing to possibly prevent transmission. Lastly, vaccine development in this area would help in preventing the spread of HSV for mother to child as well as decrease the number of adults with disease.
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