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*The risk of transmission of infection to the neonate from an infected mother is high(30-50%) who have genital herpes at term and low(<1%) in mothers with prenatal history of recurrent herpes or who have genital HSV during the first and second trimester.<ref name="BrownSelke1997">{{cite journal|last1=Brown|first1=ZaneA.|last2=Selke|first2=Stacy|last3=Zeh|first3=Judy|last4=Kopelman|first4=Jerome|last5=Maslow|first5=Arthur|last6=Ashley|first6=Rhoda L.|last7=Watts|first7=D. Heather|last8=Berry|first8=Sylvia|last9=Herd|first9=Millie|last10=Corey|first10=Lawrence|title=The Acquisition of Herpes Simplex Virus during Pregnancy|journal=New England Journal ofMedicine|volume=337|issue=8|year=1997|pages=509–516|issn=0028-4793|doi=10.1056/NEJM199708213370801}}</ref><ref name="pmid23303485">{{cite journal| author=Pinninti SG, Kimberlin DW| title=Maternal and neonatal herpes simplex virus infections. | journal=Am J Perinatol | year= 2013 | volume= 30 | issue= 2 | pages= 113-9 | pmid=23303485 | doi=10.1055/s-0032-1332802 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23303485 }} </ref><ref name="pmid1849612">{{cite journal| author=Brown ZA, Benedetti J, Ashley R, Burchett S, Selke S, Berry S et al.| title=Neonatal herpes simplex virus infection in relation to asymptomatic maternal infection at the time of labor. | journal=N Engl J Med | year= 1991 | volume= 324 | issue= 18 | pages= 1247-52 | pmid=1849612 | doi=10.1056/NEJM199105023241804 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1849612 }} </ref> | *The risk of transmission of infection to the neonate from an infected mother is high(30-50%) who have genital herpes at term and low(<1%) in mothers with prenatal history of recurrent herpes or who have genital HSV during the first and second trimester.<ref name="BrownSelke1997">{{cite journal|last1=Brown|first1=ZaneA.|last2=Selke|first2=Stacy|last3=Zeh|first3=Judy|last4=Kopelman|first4=Jerome|last5=Maslow|first5=Arthur|last6=Ashley|first6=Rhoda L.|last7=Watts|first7=D. Heather|last8=Berry|first8=Sylvia|last9=Herd|first9=Millie|last10=Corey|first10=Lawrence|title=The Acquisition of Herpes Simplex Virus during Pregnancy|journal=New England Journal ofMedicine|volume=337|issue=8|year=1997|pages=509–516|issn=0028-4793|doi=10.1056/NEJM199708213370801}}</ref><ref name="pmid23303485">{{cite journal| author=Pinninti SG, Kimberlin DW| title=Maternal and neonatal herpes simplex virus infections. | journal=Am J Perinatol | year= 2013 | volume= 30 | issue= 2 | pages= 113-9 | pmid=23303485 | doi=10.1055/s-0032-1332802 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23303485 }} </ref><ref name="pmid1849612">{{cite journal| author=Brown ZA, Benedetti J, Ashley R, Burchett S, Selke S, Berry S et al.| title=Neonatal herpes simplex virus infection in relation to asymptomatic maternal infection at the time of labor. | journal=N Engl J Med | year= 1991 | volume= 324 | issue= 18 | pages= 1247-52 | pmid=1849612 | doi=10.1056/NEJM199105023241804 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1849612 }} </ref> | ||
====Transmission of infection==== | ====Transmission of infection==== | ||
*Exposure to the fetus from active genital herpes lesions during delivery, accounts for majority of neonatal herpes cases. <ref name="pmid12517231">{{cite journal| author=Brown ZA, Wald A, Morrow RA, Selke S, Zeh J, Corey L| title=Effect of serologic status and cesarean delivery on transmission rates of herpes simplex virus from mother to infant. | journal=JAMA | year= 2003 | volume= 289 | issue= 2 | pages= 203-9 | pmid=12517231 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12517231 }} </ref> | *Exposure to the fetus from active genital herpes lesions during delivery, accounts for majority of neonatal herpes cases. <ref name="pmid12517231">{{cite journal| author=Brown ZA, Wald A, Morrow RA, Selke S, Zeh J, Corey L| title=Effect of serologic status and cesarean delivery on transmission rates of herpes simplex virus from mother to infant. | journal=JAMA | year= 2003 | volume= 289 | issue= 2 | pages= 203-9 | pmid=12517231 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12517231 }} </ref> | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Aravind Kuchkuntla, M.B.B.S[2]
Synonyms and keywords: Fetal varicella syndrome, Congenital varicella-zoster syndrome, Varicella embryo-fetopathy, Varicella embryopathy, Varicella fetopathy, Fetal varicella-zoster syndrome
Overview
Historical Perspective
- In 1935, the first case resembling neonatal HSV, was described with the presence of intranuclear inclusion bodies in a premature infant in the liver and the adrenals.[1]
Pathophysiology
Pathogenesis
- The risk of transmission of infection to the neonate from an infected mother is high(30-50%) who have genital herpes at term and low(<1%) in mothers with prenatal history of recurrent herpes or who have genital HSV during the first and second trimester.[2][3][4]
Transmission of infection
- Exposure to the fetus from active genital herpes lesions during delivery, accounts for majority of neonatal herpes cases. [5]
- Intrauterine infection accounts for 5% of cases with neonatal herpes simplex.
- Postnatal trasmission by contact with HSV shed from infected patients. It accounts for 10% of the cases.
Epidemiology and Demographics
- The annual incidence of neonatal herpes is estimated to be 10 cases per 100,000 livebirths.
Causes
- 85% of cases are caused by HSV type I
- 1%% of cases are caused by HSV type II
Differentiating Congenital Varicella Syndrome From Other Diseases
Natural History, Prognosis and Complications
Natural History
Complications
Diagnosis
History and Symptoms
Physical Examination
Laboratory Findings
Treatment
Medical Therapy
Surgical Therapy
Prevention
Primary Prevention
- Women without known genital herpes should be counseled to abstain from vaginal intercourse during the third trimester with partners known or suspected of having genital herpes.
- Pregnant women without known orolabial herpes should be advised to abstain from receptive oral sex during the third trimester with partners known or suspected to have orolabial herpes.
- Type-specific serologic tests may be useful for identifying pregnant women at risk for HSV infection and guiding counseling regarding the risk for acquiring genital herpes during pregnancy.
- All pregnant women should be asked whether they have a history of genital herpes. At the onset of labor, all women should be questioned carefully about symptoms of genital herpes, including prodromal symptoms, and all women should be examined carefully for herpetic lesions. Women without symptoms or signs of genital herpes or its prodrome can deliver vaginally. Although cesarean delivery does not completely eliminate the risk for HSV transmission to the neonate, women with recurrent genital herpetic lesions at the onset of labor should deliver by cesarean delivery to reduce the risk for neonatal HSV infection.
Secondary Prevention
- Suppressive acyclovir treatment late in pregnancy reduces the frequency of cesarean delivery among women who have recurrent genital herpes by diminishing the frequency of recurrences at term. However, such treatment may not protect against transmission to neonates in all cases.[6][7][8]
- Recommended Regimen : Acyclovir 400 mg orally three times a day OR Valacyclovir 500 mg orally twice a day, beginning from 36weeks of gestation.
References
- ↑ Hass GM (1935). "Hepato-Adrenal Necrosis with Intranuclear Inclusion Bodies: Report of a Case". Am J Pathol. 11 (1): 127–142.5. PMC 1910753. PMID 19970188.
- ↑ Brown, ZaneA.; Selke, Stacy; Zeh, Judy; Kopelman, Jerome; Maslow, Arthur; Ashley, Rhoda L.; Watts, D. Heather; Berry, Sylvia; Herd, Millie; Corey, Lawrence (1997). "The Acquisition of Herpes Simplex Virus during Pregnancy". New England Journal ofMedicine. 337 (8): 509–516. doi:10.1056/NEJM199708213370801. ISSN 0028-4793.
- ↑ Pinninti SG, Kimberlin DW (2013). "Maternal and neonatal herpes simplex virus infections". Am J Perinatol. 30 (2): 113–9. doi:10.1055/s-0032-1332802. PMID 23303485.
- ↑ Brown ZA, Benedetti J, Ashley R, Burchett S, Selke S, Berry S; et al. (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.
- ↑ Brown 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. PMID 12517231.
- ↑ Sheffield JS, Hollier LM, Hill JB, Stuart GS, Wendel GD (2003). "Acyclovir prophylaxis to prevent herpes simplex virus recurrence at delivery: a systematic review". Obstet Gynecol. 102 (6): 1396–403. PMID 14662233.
- ↑ Watts DH, Brown ZA, Money D, Selke S, Huang ML, Sacks SL; et al. (2003). "A double-blind, randomized, placebo-controlled trial of acyclovir in late pregnancy for the reduction of herpes simplex virus shedding and cesarean delivery". Am J Obstet Gynecol. 188 (3): 836–43. PMID 12634667.
- ↑ Scott LL, Hollier LM, McIntire D, Sanchez PJ, Jackson GL, Wendel GD (2002). "Acyclovir suppression to prevent recurrent genital herpes at delivery". Infect Dis Obstet Gynecol. 10 (2): 71–7. doi:10.1155/S1064744902000054. PMC 1784606. PMID 12530483.