Neonatal Herpes Simplex Virus Infection: Epidemiology and Outcomes in the Modern Era

Abstract

Background: Over the past several decades, there have been advances in diagnosis and treatment of neonatal herpes simplex virus (HSV) disease. There has been no recent comprehensive evaluation of the impact of these advances on the management and outcomes for neonates with HSV.

Methods: Clinical data for initial presentation, treatment, and outcomes were abstracted from medical records of neonates with HSV treated at Seattle Children's Hospital between 1980 and 2016.

Results: One hundred thirty infants with a diagnosis of neonatal HSV were identified. Between 1980 and 2016, high-dose acyclovir treatment for neonatal HSV infection increased from 0% to close to 95%, with subsequent decrease in overall HSV-related mortality from 20.9% to 5.6%. However, even among infants treated with high-dose acyclovir, mortality was 40.9% for infants with disseminated (DIS) disease, and only 55% of infants with central nervous system (CNS) disease were without obvious neurologic abnormalities at 24 months. Over the study period, the time between initial symptoms and diagnosis decreased. Skin recurrences were more common with HSV-2 than HSV-1 (80% vs 55%; P = .02) and in infants with lesions at initial diagnosis (76% vs 47%; P = .02).

Conclusion: Changes in the standard of care for management of neonatal HSV disease have led to improvements in timeliness of diagnosis and outcome but mortality in infants with DIS disease and neurologic morbidity in infants with CNS disease remain high. Future research should focus on prevention of perinatal infection and subsequent recurrences.

Keywords: HSV; neonatal herpes; neonates.

Figure 1.

Advances in neonatal HSV diagnosis and management over time. Abbreviation: HSV, herpes simplex virus.

Figure 2.

Patterns in viral type (HSV-1 vs HSV-2) and disease classification (CNS, DIS, SEM) by decade. Abbreviations: CNS, central nervous system; DIS, disseminated; HSV-1, herpes simplex virus 1; HSV-2, herpes simplex virus 2; SEM, skin-eye-mouth.