Infectious Diseases in an Age of Change The Impact of Human Ecology and Behavior on Disease Transmission (1995) / Chapter Skim
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Herpes Simplex Virus Infections of Women and Their Offspring: Implications for a Developed Society
Herpes Simplex Virus Infections of Women and Their Offspring: Implications for a Developed Society
Pages 171-188
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From page 171... ...
Neonatal HSV infection was not described until the 1940s (5, 6~; however, the association between newborn disease and genital HSV infection was not made until the late 1960s (1~. With the evolution of our society in developed countries, particularly increasing sexual freedom associated with advances in birth control, and the emergence of sexually transmitted diseases, both horizontal (sexual partners)
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From page 172... ...
INCIDENCE OF NEWBORN INFECTION Although centers in the United States caring for infants with neonatal HSV infections have observed fluctuations in disease incidence, the estimated rate of occurrence is approximately 1 in 2500 to 1 in 5000 deliveries yearly (7-9~. For unknown reasons, several countries worldwide, such as Africa and the United Kingdom, do not appear to recognize a significant number of cases of neonatal HSV infection in spite of the high prevalence of antibodies to HSV-2~10,11~.
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From page 173... ...
Collaborative Antiviral Study Group (CASG) indicate that the frequency of babies with neonatal HSV-1 infections is nearly 30% (161.
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From page 174... ...
The rate of acquisition of HSV-2 infection during pregnancy was 0.2% in Northern California and 2.5% in Birmingham, Alabama. MATERNAL GENITAL HERPES SIMPLEX INFECTIONS: CLINICAL AND VIROLOGIC PARAMETERS From the seroprevalence data, genital HSV infection in the woman pregnant or otherwise is common.
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From page 175... ...
For women with a past history of genital herpes, in a predominantly white, middle-class population, documented recurrent infection occurred in 84% of pregnant women (68~. Moreover, asymptomatic viral shedding occurred in at least 12% of the recurrent episodes.
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From page 176... ...
disseminated infection, which involves multiple organs, including central nervous system, lung, liver, adrenals, skin, eye, and/or mouth (7, 73~.Table 1 summarizes disease classification of 291 babies with neonatal HSV infections studied by the NIAID CASG. Disseminated Infection Babies with the worst prognosis for both mortality and morbidity are those with disseminated infection.
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From page 177... ...
Despite normal clinical examinations in early infancy, neurologic impairment has become apparent between six months and 1 year of life. The clinical presentation is similar to that associated with congenital toxoplasmosis or syphilis.
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From page 178... ...
Subsequent clinical trials have compared vidarabine to acyclovir for neonatal HSV infections. The NIAID CASG compared outcome for 202 babies with neonatal HSV infection who were randomly treated with
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From page 179... ...
Thus, no significant differences exist between acyclovir and vidarabine therapy for any form of neonatal HSV infection. Models of relative risk predicting patients at greatest likelihood for death or severe neurologic sequelae have been applied to the data, as
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From page 180... ...
Furthermore, neurologic impairment of babies with disease localized to the skin, eyes, and mouth emphasizes the need to further investigate pathogenic mechanisms and treatment options. COST—BENEFIT ANALYSES OF ANTIVIRA1L THERAPY The deployment of acyclovir in the treatment of neonatal HSV infections and recognition of enhanced survival but with persistent morbidity prompted a cost-benefit analysis of the value of antiviral therapy from a societal perspective.
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From page 181... ...
Virus type 1 NA 1 2 NA 14~t CNS, central nervous system; NS, not statistically significant (P > 0.05) ; NA, not applicable (no baby with disease confined to the skin, eyes, or mouth died)
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From page 182... ...
In addition to providing an objective assessment of the impact of antiviral therapy on this disease, the model provides an approach to defining the potential value of improvement for subsequent clinical trials, particularly those involving therapeutic interventions. PREVENTION OF NEONATAL HSV INFECTION With the increased awareness of serious neonatal HSV infection occurring as a consequence of maternal genital herpes, methods of prevention have attracted attention.
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From page 183... ...
It already has been established from the trials of suppressive acyclovir administered to individuals with frequently recurrent genital herpes that reactivation of virus can occur in spite of the administration of 200 mg of acyclovir three times daily (86~. It is not unreasonable to think that virus shedding could occur in women taking acyclovir for suppressive therapy for recurrent genital HSV infection during the last 4 weeks of gestation.
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From page 184... ...
Contemporary society has witnessed a series of devastating manifestations of herpes simplex virus infection~namely, genital herpes simplex virus infection and neonatal herpes simplex virus infection. With the evolution of society, particularly advances in birth control and increasing promiscuity, the seroprevalence of herpes simplex virus type 2 infections has increased worldwide, however, more so in developed societies.
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From page 185... ...
A & National Institute of Allergy and Infectious Diseases Collaborative Antiviral Study Group (1988)
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From page 187... ...
& National Institute of Allergy and Infectious Diseases Collaborative Antiviral Study Group (1992) Neonatal Herpes Simplex Virus (HSV)
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From page 188... ...
(1992) Treatment of Herpes Simplex Virus Type 2 Infections in Mice with Murine and Humanized Monoclonal Antibodies (MABS)
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