Thus, although treating an infant with neonatal herpes is a relatively rare occurrence, managing infants potentially exposed to hsv at the time of delivery occurs more frequently. The red book is the preeminent resource on pediatric infectious disease. Neonatal herpes simplex virus infection is usually transmitted during delivery. Bacterial meningitis is more common in the first month than at any other time of life 1. Analyze maternal and neonatal factors to implement an appropriate pharmacotherapeutic regimen for the neonate exposed.
Staph pustulosis has become a fairly uncommon infection in newborns, but may initially present with very similarappearing lesions. In 80% to 90% of cases, the disease is acquired during the period beginning with the fifth month of pregnancy and extending to the twentyfifth day after birth the perinatal period via an infected maternal delivery tract or, if the fetus is in the uterus, by an ascending infection. Given maternal and neonatal factors, design a pharmacologic regimen for the newborn with congenital syphilis or at risk of hepatitis b virus infection. The virus is inactive at times, but it is incurable and is a lifetime infection. Herpes simplex virus hsv is a rare cause of neonatal keratoconjunctivitis, found in less than 1% of cases,ref4 and can be associated with a generalized herpes simplex infection. Red book is an indispensable reference for pediatricians and pediatric infectious disease specialists and is useful for family medicine and emergency medicine physicians as well. Childrens national medical center, washington, dc 1.
Kimberlin, who also is editor of the 2015 aap red book. Still, the infant has only a 2% chance of developing neonatal hsv disease. Neonatal herpes is a herpes infection in a young baby. Congenital varicella syndrome 2% if maternal infection at 2040 0. Although asymptomatic hsv infection is common in older children, it rarely, if ever, occurs in neonates. Disseminated infection should be considered in neonates with sepsis.
Oral acyclovir suppression and neurodevelopment after. Evaluation of suspected neonatal herpes simplex virus. Chairman, aap committee on infectious diseases dr mcniel of fort dodge, iowa writes. New guidelines for neonates exposed to hsv during delivery. Over the past 2 decades, therapies have been recommended by the american academy of pediatrics red book committee for the management of neonatal herpes simplex virus hsv and congenital cytomegalovirus cmv infections.
Recent articles in pediatric infectious diseases 1. Public health and school health professionals, medical residents, and students also will find it a highyield source of pediatric infectious disease and vaccine. Herpes simplex virus hsv is a common and often benign infection in humans. Red book pointofcare clinical decision support tool page. Red book pediatric infectious diseases clinical decision. A neonatal hsv infection can be devastating to an infant. A wide variety of tests are available for detecting herpes simplex virus infection, but only a subset are. Our infection committee noticed that in the new edition of the report of the committee on infectious disease red book that mothers with active genital herpes may now breastfeed infants. Newborns often present with nonspecific clinical findings, making timely and accurate diagnosis of infection critical.
Herpes simplex virus hsv infection of the neonate is uncommon, but genital herpes infections in adults are very common. Perinatal varicella american academy of pediatrics. Beyond the neonatal period, most primary hsv1 infections occur in infancy and childhood and are transmitted primarily by contact with infected saliva. Fortunately, it occurs rarely, with approximately 1,500 babies contracting the infection each year in the united states. Its caused by the herpes simplex virus, a highly contagious virus that can cause cold sores and genital ulcers in adults. Although uncommon, neonatal hsv can lead to significant mortality and long term morbidity, unless recognized and appropriately treated with acyclovir 37. The diagnosis of neonatal hsv can be difficult, but it should be suspected in. Red book 2009 report of the committee on infectious diseases. Herpes simplex red book 2018 red book online aap pointof. The application of pcr to csf samples has revolutionized the diagnosis of cns neonatal herpes disease 2225. Neonatal herpetic infections often are severe, with. In a recent large study of almost 60,000 women in labor, 57% of infants delivered to women with a firsttime hsv infection developed neonatal hsv disease compared with 2%.
Aap clarifies approach to babies born to women with. To make these tools more accessible and userfriendly at the pointofcare, the aap is pleased to introduce the new red book pediatric infectious diseases clinical decision support chart this allnew resource collects many of the most clinically useful tables, algorithms, and other. The risk of neonatal transmission in a large study was identified as 57% with firstepisode primary infection, compared with 25% with firstepisode nonprimary infection and 2% with recurrent genital hsv. What is the role of herpes simplex virus hsv in neonatal. Neonatal herpes simplex virus infections american family. Estimated rates of neonatal human herpes simplex virus nhsv infection vary across.
Congenital cytomegalovirus and neonatal herpes simplex. The risk of transmitting hsv to an infant during delivery is determined in part by the mother. The younger the baby, the more vulnerable they are to the harmful effects of infection. A positive csf pcr for hsv dna defines that patient as having cns involvement categorized either as cns disease, or. Eikenella corrodens as a causative agent for neonatal conjunctivitis. Breastfeeding and herpes american academy of pediatrics. Neonatal herpes simplex virus infection american academy. Description the red book, updated every three years by the committee on infectious diseases coid of the american academy of pediatrics aap, is a concise summary of over 200 pediatric infectious diseases and current aap recommendations regarding prevention, diagnosis, and management. The 2015 red book is the american academy of pediatrics authoritative guide to manifestations, etiology, epidemiology, diagnosis, and treatment of more than 200 childhood conditions it provides evidencebased guidance to practicing clinicians on pediatric infections and vaccinations based on the recommendations of the committee as well as the combined expertise of the cdc, the fda and.
Neonatal herpes simplex is a rare but serious condition, usually caused by vertical transmission of herpes simplex virus from mother to newborn. Prevention and management of neonatal herpes simplex virus. After a person recovers from chickenpox, the virus stays dormant inactive in the body and can reactivate years later, causing shingles. Herpes, neonatal nord national organization for rare. Neonatal herpes simplex virus infections can result in serious morbidity and. These blisters break, crust over, and finally heal. The incidence of neonatal herpes simplex virus hsv varies between 1 in 3,000 to 1 in 20,000 live births, with an estimated 1500 cases occurring annually in the united states. In the absence of skin lesions, the diagnosis of neonatal hsv infection is challenging. Herpes type 2 genital herpes is the most common cause of herpes infection in newborn babies. Guidance on management of asymptomatic neonates born to.
Treatment is with highdose parenteral acyclovir and supportive care. The mortality rate has declined from almost 50 percent in the 1970s to contemporary rates of 7 to 18 percent 25. Management of infants born to women with hiv infection. Although the table of antiviral drug dosing in the 2012 red book still acknowledges that the fdaapproved dose in children.
Greatest risk for neonatal herpes infants born to women. Untreated neonatal hsv has only a 40 percent survival rate and even the early initiation of highdose. A typical sign is vesicular eruption, which may be accompanied by or progress to disseminated disease. Herpes simplex red book 2015 red book online aap pointof. To prevent pneumocystis jirovecii pneumonia, all infants born to women with hiv should begin trimethoprimsulfamethoxazole prophylaxis at age 4 to 6 weeks, after completing the infant arv regimen, unless there is adequate virologic test information to presumptively exclude hiv infection see the pediatric opportunistic infection guidelines. It provides evidencebased guidance to practicing clinicians. Thus, although treating an infant with neonatal herpes is a relatively rare. Among the most helpful and popular features of the red book are its tables, algorithms, charts, and graphs.
This book is a must for anyone seeing pediatric patients in a clinical setting. Diagnosis is by viral culture, pcr, immunofluorescence, or electron microscopy. Laboratory diagnosis of neonatal herpes simplex virus. Neonatal hsv has a high risk of mortality and significant neurologic disability among survivors, and timely initiation of treatment with acyclovir is needed to impact outcomes. Neonatal herpes simplex virus hsv infection pediatrics. Despite this seemingly low prevalence, neonatal hsv accounts for 0.
Despite advances in infant intensive care, neonatal meningitis remains a devastating disease. Pickering lk, baker cj, kimberlin dw, long ss, eds. Neonatal herpes simplex infections cancer therapy advisor. Pedsap 201 book neonatal an eiatric epsis 7 congenital infections 1. The diagnosis of neonatal hsv cns disease has been. The risk of neonatal acquisition of hsv is significantly higher with first episode primary and first episode nonprimary maternal infections when compared with recurrent genital infections 10. Neonatal herpes simplex virus infections american family physician.
Sensitivity of csf pcr in neonatal hsv disease ranges from 75% to 100%, and specificity ranges from 71% to 100% 23, 24. It should be on the desks of everyone who cares for children, from nurses and midlevel providers to physicians and trainees. Varicellazoster virus infections red book 2015 red. Neonatal herpes simplex virus hsv disease is a serious, lifethreatening condition that should be considered in neonates with fever, vesicular rash, culture negative sepsis, andor seizure activity. About 1 out of every 3,500 babies born in the united states contracts neonatal herpes.
Neonatal herpes infection is caused by a member of the herpesvirus family called herpes simplex virus hsv, a large double stranded dna virus. Around 1 in every 3,500 babies in the united states contract the infection. In newborn infants, herpes simplex virus hsv infection can manifest as. Meningoencephalitis in american academy of pediatrics textbook of pediatric care, 2nd edition. Neonatal herpes is caused by an infection of the newborn by the herpes simplex virus hsv. Neonatal infection with herpes simplex virus hsv occurs in 1 out of every 3200 to 10,000 live births, causes serious morbidity and mortality, and leaves many survivors with permanent sequelae. In nearly 90% of the cases of neonatal herpes simplex, the baby contracts the virus in the birth canal, but it is also possible to become infected in utero or just after birth. Neonatal herpes simplex uhl childrens medical guideline library. The outcomes of neonatal herpes simplex virus hsv disease are dependent on the extent of the disease. Acyclovir dosing in the neonatal period and beyond. In newborn infants, herpes simplex virus hsv infection can manifest as the following. Destination page number search scope search text search scope search text. An estimated 30 to 65 percent of pregnant women in the u.