Materiały źródłowe

• #1 NEONATAL HSV INFECTION

  https://guidelines.stief.org.nz/herpes-neonatal-hsv-infection

  Neonatal herpes simplex virus (HSV) infection is a rare, but potentially fatal, disease of babies, that occurs within the first 46 weeks of life. […] Most neonatal HSV infections are acquired at birth, generally from a mother who experienced an unrecognised genital herpes infection during pregnancy. […] Rates of neonatal HSV infection vary between countries, being lower in Western Europe (1.15, 1.65 and 3.2 cases per 100,000 live births in France, the United Kingdom, and the Netherlands, respectively), intermediate in Scandinavia (6.5 cases per 100,000 live births in Sweden) and Canada (5.9 cases per 100,000 live births), and higher in the USA (9.6 cases per 100,000 live births). […] The incidence of neonatal HSV infection in Australia was stable over this time period but the number of HSV-1 infections was higher than that of HSV-2 infections.

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

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8946680/

  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. […] Despite advances in prevention, diagnosis, and treatment, neonatal herpes simplex virus (HSV) infection continues to result in significant mortality and long-term morbidity. […] The global estimate of the incidence of neonatal HSV is 10 cases/100000 live births or approximately 14000 cases/year, with 0.82 deaths/100000 births in industrialized countries. […] It has been 20 years since the Infectious Disease Collaborative Antiviral Study Group (ID-CASG) demonstrated the safety and efficacy of high-dose (HD) acyclovir for treatment of neonatal HSV.

• #1 Characteristics of neonatal herpes simplex virus infections in Germany: results of a 2-year prospective nationwide surveillance study | ADC Fetal & Neonatal Edition

  https://fn.bmj.com/content/107/2/188

  Characteristics of neonatal herpes simplex virus infections in Germany: results of a 2-year prospective nationwide surveillance study […] To assess incidence and burden of neonatal herpes simplex virus (HSV) infections and to explore possible transmission routes. […] A 2-year prospective nationwide surveillance study performed in 2017 and 2018. […] The 2-year incidence of neonatal HSV infections was 2.35 per 100000 live births (95% CI 1.69 to 3.02) and disease-specific mortality was 0.13 per 100000 live births (95%CI 0.04 to 0.21). […] Neonatal HSV infections are rare in Germany. […] Horizontal transmission via mothers and family members may be a possible source of neonatal HSV infection. […] An urgent need exists for extended HSV serology and direct virus detection in mothers, neonates, and family members to assess perinatal or postnatal HSV transmission.

• #1 Prevention and management of neonatal herpes simplex virus infections | Canadian Paediatric Society

  https://cps.ca/documents/position/prevention-management-neonatal-herpes-simplex-virus-infections

  Human herpes simplex virus (HSV) infection in neonates can result in devastating outcomes, including mortality and significant morbidity. All infants are potentially at risk for neonatal HSV infection. This position statement reviews epidemiology, transmission and risk factors, with a focus on intrapartum infection. […] Estimated rates of neonatal human herpes simplex virus (NHSV) infection vary across different regions of the world. In Canada, the infection occurs in approximately one per 16,500 newborns, which corresponds to approximately six per 100,000 live births. […] Transmission to newborns can occur with either genital herpes simplex virus (HSV) type 1 (HSV-1) or HSV type 2 (HSV-2). Worldwide, an estimated 75% of NHSV cases are caused by HSV-2 and 25% by HSV-1. […] The most common and important category of NHSV acquisition is intrapartum. Even for HSV-1, 75% of cases of NHSV are acquired during delivery from genital disease that is often newly acquired and asymptomatic.

• #1 Surveillance of neonatal herpes in the British… | F1000Research

  https://f1000research.com/articles/9-163

  Neonatal herpes simplex virus (HSV) infection is rare but potentially devastating and can result in neonatal death or serious disability. National incidence was estimated at 1.65/100,000 live births in an earlier British Paediatric Surveillance Unit (BPSU) study of births 1986-1991. […] A second surveillance study of neonatal HSV was undertaken through the BPSU 2004-2006, with follow-up information collected on surviving children in early childhood. […] Over the three-year period, 85 infants were reported with confirmed neonatal HSV, an estimated incidence of 3.58/100,000 live births (95% CI 2.86-4.42), about double that reported almost two decades earlier. […] Neonatal HSV infection remains rare although incidence doubled in the British Isles between the late 1990s and the mid-2000s.

• #1 912 Herpes simplex virus in infants under 90 days of age in UK and Ireland: results of the 2019–2022 BPSU study | Archives of Disease in Childhood

  https://adc.bmj.com/content/108/Suppl_2/A184

  Neonatal herpes simplex virus (HSV) infection is a rare but dangerous condition. Previous national British Paediatric Surveillance Unit (BPSU) studies, showed a doubling of incidence of neonatal HSV from 1.65 to 3.6/100,000 between 1991-2006. More recent data are required to inform future practice around prevention and treatment. This BPSU study aimed to define the: (1) current incidence of HSV disease and virus types in UK and Irish infants over a 2.5 year period, (2) types of HSV disease, (3) presentations and management, (4) source of transmission, (5) antenatal risk factors. […] Prospective surveillance of HSV infection in infants 90 days of age in UK and Ireland occurred between July 2019 and February 2022 via the BPSU. […] 242 cases were reported to BPSU, 25 were errors. 179 questionnaires were returned, 61 duplications were removed leaving 118 cases for analysis. Estimated incidence is 6.9 cases per 100 000 live births. 39/114 (34%) were born 37 weeks gestation. 39/118 (33%) had disseminated disease, 35% CNS and 32% skin/eye/mouth (SEM) infection. Median day of onset was 6 for disseminated, 8 for SEM and 14 for CNS infections. 61% with disseminated and CNS disease had HSV2 infections and 76% with SEM disease had HSV1. of those with disseminated disease, 18% had a fever and 26% had SEM lesions at presentation. Aciclovir was commenced in 113/118 but in only 40/118 (34%) on the day of presentation. Overall mortality was 24% but was related to disease type (66% with disseminated disease died compared to 7% of those with CNS infection), gestation (57% 28 weeks died compared to 19% 37 weeks) and admission and peak ALT.

• #1 Neonatal herpes – Wikipedia

  https://en.wikipedia.org/wiki/Neonatal_herpes

  Neonatal HSV rates in the U.S. are estimated to be between 1 in 3,000 and 1 in 20,000 live births. Approximately 22% of pregnant women in the U.S. have had previous exposure to HSV-2, and an additional 2% acquire the virus during pregnancy, mirroring the HSV-2 infection rate in the general population. […] The risk of transmission to the newborn is 30-57% in cases where the mother acquired a primary infection in the third trimester of pregnancy. Risk of transmission by a mother with existing antibodies for both HSV-1 and HSV-2 has a much lower (13%) transmission rate. […] A study in the United States from 2003 to 2014 using large administrative databases showed increasing trends in incidence of neonatal HSV from 7.9 to 10 cases per 100,000 live births and mortality of 6.5%. […] Another study from Canada showed similar results, with an incidence of 5.9 per 100,000 live births and a case fatality of 15.5%. […] A three-year study in Canada (2000-2003) revealed a neonatal HSV incidence of 5.9 per 100,000 live births and a case fatality rate of 15.5%.

• #1

  https://journals.lww.com/stdjournal/fulltext/2021/08001/assessing_the_burden_of_infant_deaths_due_to.2.aspx

  Despite advances in diagnosis and treatment, neonatal infection with herpes simplex virus (HSV) has a high case fatality rate. […] The national burden of neonatal HSV and associated deaths is unknown because this condition is not nationally notifiable. […] Nationally, 1591 deaths related to the infections of interest were identified: 1271 related to HSV (79.9%). […] Herpes simplex virus-related deaths increased significantly from 0.83/100,000 live births in 1995 to 1.77 in 2017. […] Nationally, HSV-related infant deaths exceeded those caused by HIV and CS and seem to be increasing. […] Infant deaths related to herpes infection are increasing in the United States and significantly exceed those related to other perinatal infections. […] Infection with herpes simplex virus (HSV) in the newborn period (neonatal herpes) can cause serious, life-threatening illness and long-term neurologic sequelae.

• #1

  https://journals.lww.com/stdjournal/Fulltext/2011/08000/Population_Based_Surveillance_for_Neonatal_Herpes.5.aspx?generateEpub=Article%7Cstdjournal:2011:08000:00005%7C10.1097/olq.0b013e31821b178f%7C

  Population-based data for neonatal herpes simplex virus (HSV) infection are needed to describe disease burden and to develop and evaluate prevention strategies. […] From April 2006 to September 2010, routine population-based surveillance was conducted using mandated provider and laboratory reports of neonatal HSV diagnoses and test results for New York City resident infants aged 60 days. […] Between April 2006 and September 2010, New York City neonatal HSV surveillance detected 76 cases, for an average incidence of 13.3/100,000 (1/7519) live births. […] Findings from 4 years of population-based surveillance for neonatal herpes in New York City show an incidence of 13.3/100,000 (1/7519) live births, and provide epidemiologic and prevention insights.

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

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8946680/

  Overall HSV-related mortality was 16%, with the highest mortality of 48.7% in the infants with DIS disease. […] Mortality for DIS infants was still 40.9% and only 55% of CNS infants were without obvious neurologic abnormalities at 24 months. […] Skin recurrences were significantly more common in infants infected with HSV-2 than HSV-1 (80% vs 54.5%, P = .02). […] Infants who had skin lesions at the time of initial presentation were more likely to have skin recurrences than those who did not: 76.2% vs 47.4%, P .02. […] Over the course of 4 decades, changes in the standard of care for diagnosis and management of neonatal HSV disease have led to improvements in timeliness of diagnosis and in outcomes. […] HSV-2 continues to cause more CNS disease and morbidity than HSV-1 infection. […] Oral antiviral suppression has led to decreases in early recurrences and need for re-hospitalization in the first 6 months of life. […] Future research should focus on prevention of perinatal infection in order to prevent the tragic outcomes of this infection for newborns and their families.

• #1 NEONATAL HSV INFECTION

  https://guidelines.stief.org.nz/herpes-neonatal-hsv-infection

  About 85-90% of neonatal HSV infections are acquired during labour (perinatally) through direct contact with infected genital secretions, 5% are acquired in utero, and 5-10% are acquired postpartum. […] The risk is greatest when a previously seronegative woman acquires genital herpes (HSV-1 or HSV-2) at or near the time of delivery. […] The risk of neonatal HSV infection is 50%, while vertical transmission rates of 25% are found in those with a non-primary first episode. […] High maternal titres of type-specific neutralising antibody are associated with a substantially lower risk and severity of neonatal infection. […] The highest risk of HSV transmission from a mother to a neonate is at delivery; contact with HSV-infected secretions in the birth canal accounts for the large majority of neonatal HSV infections.

• #1 Neonatal herpes encephalitis | MedLink Neurology

  https://www.medlink.com/articles/neonatal-herpes-encephalitis

  Neonatal infections are more likely to occur when the maternal genital infection is primary. […] Recurrent lesions are more likely to be associated with the presence of maternal antibody, which may play a role in limiting viral exposure to the fetus. […] If asymptomatic shedding occurs during primary infection the risk of neonatal infection is about 30%, but if shedding occurs during recurrent infection the risk drops to 0 to 3%. […] It is important to emphasize that more than 60% of herpes simplex virus-infected neonates acquired their infection from asymptomatically infected mothers. […] Prematurity also plays a role in susceptibility to infection. […] Although only 6% to 7% of infants are born prematurely, approximately 40% to 50% of reported neonatal herpes simplex virus infections occur in premature infants. […] There may also be a genetic predisposition to neonatal herpes infections.

• #1

  https://journals.lww.com/stdjournal/fulltext/2021/08001/assessing_the_burden_of_infant_deaths_due_to.2.aspx

  An inverse relationship was observed between age of the birthing parent and rate of HSV-related deaths; the rate decreased significantly from 4.17 deaths per 100,000 among parents younger than 20 years to 0.37 among parents 40 years or older. […] The mortality rate was significantly elevated among Black parents when compared with White and Hispanic/Latino parents. […] Most HSV-related infant deaths occurred during the first 15 days of life. […] The national trends observed in HSV-related infant mortality align with the findings from past investigations of neonatal herpes deaths in specific geographies. […] The disproportionate burden of infant deaths related to HSV, HIV, and CS among Black birthing parents can be explained by racism, which leads to poverty, unemployment, residential segregation, and inequitable access to health care. […] Despite the markedly elevated and increasing burden of HSV-related deaths in the United States, neonatal herpes receives limited public health attention and resources when compared with perinatal HIV and CS.

• #1 Neonatal herpes simplex virus (HSV) infection: Clinical features and diagnosis – UpToDate

  https://www.uptodate.com/contents/neonatal-herpes-simplex-virus-infection-clinical-features-and-diagnosis

  Neonatal herpes simplex virus (HSV) infection causes serious morbidity and mortality and leaves many survivors with permanent sequelae. […] Strong clinical suspicion, timely diagnosis, and early antiviral treatment are critical to improving outcome. […] Neonates can acquire HSV infection by intrauterine, perinatal, or postnatal transmission of the virus. […] The fetus may be infected transplacentally or through retrograde spread through ruptured or seemingly intact membranes.

• #1 Prevention and management of neonatal herpes simplex virus infections | Canadian Paediatric Society

  https://cps.ca/documents/position/prevention-management-neonatal-herpes-simplex-virus-infections

  In most cases of NHSV infection, there is no known history of maternal genital HSV because mothers have never had or have never noticed external genital lesions. […] The category of maternal infection at time of delivery influences the likelihood of NHSV acquisition, presumably because mothers who have had an HSV infection transmit HSV-neutralizing antibodies to their infant across the placenta, provided that their infant is not born before 32 weeks gestation. […] Delivery by elective Cesarean section markedly reduces but does not eliminate the risk for newborn infection. […] Obstetrical procedures that can cause scalp abrasions or a break in the infants skin during labour and delivery may increase risk of NHSV transmission to a newborn infant. […] Intrauterine NHSV infections are rare, accounting for 5% of cases.

• #1 Digital Scholarship@UNLV

  https://digitalscholarship.unlv.edu/community_health_sciences_fac_articles/36/

  To explore the magnitude and descriptive epidemiology of neonatal herpes simplex virus (HSV) infection, the Centers for Disease Control (CDC) conducted an 18-month hospital-based surveillance study in which 184 cases were reported. […] Only 22% of mothers had a history of genital HSV infection and only 9% had genital lesions at the time of delivery. […] These data confirm previous observations that most mothers of infected neonates have no history of genital HSV and are asymptomatic at delivery. […] Furthermore this study suggests that intrauterine infection may be an important route of transmission and underscores the limitations of current prevention strategy.

• #1 Characteristics of neonatal herpes simplex virus infections in Germany: results of a 2-year prospective nationwide surveillance study | ADC Fetal & Neonatal Edition

  https://fn.bmj.com/content/107/2/188

  The actual incidence of neonatal HSV infections in Europe, especially in Germany, is insufficiently evaluated. […] Our study adds evidence to the possibility of postnatal HSV exposure. […] Neonates are at risk of acquiring HSV infections from family members or others with skin or mucous membrane infections. […] In summary, neonatal HSV infections are rare in Germany. The vast majority of infections are skin/mucous membrane infections with a mild clinical course and very good outcome. Nevertheless, HSV infections can be extremely severe in individual cases and cause permanent severe impairment. Horizontal infection within the family may be a possible transmission route.

• #1 NEONATAL HSV INFECTION

  https://guidelines.stief.org.nz/herpes-neonatal-hsv-infection

  The mortality rate of untreated CNS disease approaches 50%, with most survivors suffering severe neurological impairment. […] The mortality rate is highest in neonates with altered consciousness, seizures, disseminated intravascular coagulation, and prematurity. […] The poor prognosis associated with untreated neonatal HSV infection means that early diagnosis is essential and therefore, a high level of suspicion is required. […] Treatment with intravenous aciclovir decreases the mortality and morbidity associated with neonatal HSV infections. […] Long-term follow-up in survivors of neonatal HSV infection is important to monitor for longer-term sequelae. […] Infants at known high risk for neonatal HSV infection are those born to pregnant people who experience their first episode of genital herpes during late pregnancy.

• #1 Prevention and management of neonatal herpes simplex virus infections | Canadian Paediatric Society

  https://cps.ca/documents/position/prevention-management-neonatal-herpes-simplex-virus-infections

  The absence of skin lesions does not negate the possibility of an NHSV diagnosis. […] NHSV infection should be considered in neonates with sepsis syndrome, particularly when this condition is accompanied by liver dysfunction and even when there is no known history of maternal HSV and the infant has no skin vesicles. […] Infants who present with disseminated disease are less likely to survive than infants with SEM or CNS disease. […] Before antivirals, an estimated 85% of infants with disseminated HSV disease and 50% with CNS disease died. […] Early therapy with intravenous (IV) ACV improves the prognosis for all three presentations of NHSV. Therefore, infants should be started on IV ACV before laboratory confirmation of NHSV, as soon as the infection is suspected clinically. […] Follow-up is necessary to detect and manage adverse effects related to suppressive ACV treatment as well as for the neurodevelopmental sequelae of NHSV.

• #1 Neonatal herpes information and advice | Kit Tarka Foundation

  https://www.kittarkafoundation.org/neonatal-herpes-info-and-advice

  Neonatal herpes simplex virus (HSV) disease, also called 'neonatal herpes’ or 'neonatal HSV’, is a rare, but potentially fatal, disease which usually occurs in the first four weeks of a baby’s life. […] Early recognition and treatment of the virus has been shown to significantly improve babies’ chances of making a full recovery. […] Herpes simplex virus infection in a newborn baby is called neonatal herpes or neonatal HSV. It is typically divided into three categories: Infection of the skin, eyes and mouth (SEM), Infection involving the brain (central nervous system/CNS), Infection of multiple organs such as lung, liver, adrenal glands, brain and skin (disseminated). […] In young babies who have immature immune systems; HSV infections can spread rapidly if left untreated, causing irreversible cell damage which can lead to permanent disability or death.

• #1 Disseminated Neonatal Herpes Caused by Herpes Simplex Virus Types 1 and 2 – Volume 13, Number 2—February 2007 – Emerging Infectious Diseases journal – CDC

  https://wwwnc.cdc.gov/eid/article/13/2/06-0907_article

  Disseminated neonatal herpes simplex virus (HSV) infection is characterized by progressive multiple organ failure and high mortality rates. It can result from infection with either HSV-1 or HSV-2. Neonatal herpes simplex virus (HSV) infection is among the most severe perinatal infections. Most (85%) neonatal HSV infections are acquired during delivery, although in utero (5%) and postnatal (10%) infections do occur. The risk for transmission to the newborn is much higher in women with primary HSV infections. Neonatal herpes can be localized to skin, eyes, and mouth (45% of cases), involve the central nervous system (30% of cases), or can cause disseminated infection involving multiple organs such as liver, lungs, adrenal glands, and brain (25% of cases). […] Disseminated infection is the most severe form of neonatal herpes, with a mortality rate of 85% for untreated neonates. It is usually observed when the infant is 59 days old; signs include irritability, seizures, respiratory distress, jaundice, bleeding diatheses, shock, and often vesicular exanthema. Early treatment with high-dose acyclovir reduces the mortality rate. Early recognition of disseminated infection is difficult because of nonspecific symptoms and signs of sepsis and because initiation of antiviral therapy is often delayed. The high risk for death requires prompt diagnostic evaluation that includes testing by HSV DNA PCR as the preferred method or virus culture.

• #1 Neonatal Herpes Simplex Virus (HSV) Infection – Pediatrics – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/pediatrics/infections-in-neonates/neonatal-herpes-simplex-virus-hsv-infection

  The mortality rate of untreated disseminated herpes simplex disease is 85%; among neonates with untreated encephalitis, it is approximately 50%. Without treatment, at least 65% of survivors of disseminated disease or encephalitis have severe neurologic sequelae. Appropriate treatment, including parenteral acyclovir, decreases the mortality rate in CNS and disseminated disease by 50% and significantly increases the percentage of children who develop normally. Even in infants who have been treated, however, neurologic and developmental sequelae are seen in 13% of those with disseminated disease and in 40 to 70% of those with CNS disease. […] […] Efforts to prevent neonatal transmission have not been very effective. Universal screening has not been recommended or shown to be effective, and most maternal infections with risk of transmission are asymptomatic. […]

• #1 Herpes Simplex Virus Infections of Women and Their Offspring: Implications for a Developed Society | Infectious Diseases in an Age of Change: The Impact of Human Ecology and Behavior on Disease Transmission | The National Academies Press

  https://nap.nationalacademies.org/read/4772/chapter/13

  The clinical presentation of babies with neonatal HSV infection is a direct reflection of the site and extent of viral replication. […] Neonatal HSV infection is almost invariably symptomatic and frequently lethal. […] 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. […] With the increased awareness of serious neonatal HSV infection occurring as a consequence of maternal genital herpes, methods of prevention have attracted attention. […] The prophylactic use of acyclovir has also been suggested in pregnant women who have a known history of recurrent genital lesions. […] Significant progress has been made in the diagnosis and management of neonatal HSV infection over the past two decades. […] The consequences of vertical transmission of herpes simplex virus from mother to child, resulting in neonatal herpes simplex virus infection, can be devastating.

• #1 Neonatal Herpes Simplex Virus Infection: Epidemiology and Outcomes in the Modern Era – PubMed

  https://pubmed.ncbi.nlm.nih.gov/34894240/

  Over the study period, the time between initial symptoms and diagnosis decreased. […] 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.

• #1

  https://journals.lww.com/stdjournal/fulltext/2021/08001/assessing_the_burden_of_infant_deaths_due_to.2.aspx

  However, the national burden of neonatal herpes infection has not been well characterized because the condition is not nationally notifiable, and few states and local jurisdictions conduct routine surveillance. […] The lack of recent and national data assessing neonatal herpes mortality remains a substantial knowledge gap that this investigation aims to address. […] Our primary objective is to characterize trends in HSV-related infant deaths across a wide time frame in the United States. […] The number of HSV-related infant deaths increased from 33 deaths in 1995 to 68 deaths in 2017. […] The death rate increased in parallel, with a significant rise from 0.60 deaths per 100,000 live births in 1996 to a peak of 2.07 deaths per 100,000 in 2011. […] Across the study period, a similar number and rate of HSV-related deaths occurred in infants assigned female and male sex at birth.

• #1 Neonatal Herpes – Health Protection Surveillance Centre

  https://www.hpsc.ie/a-z/other/neonatalherpes/

  Herpes simplex (neonatal) became a notifiable disease in Ireland in December 2018. […] In babies infection with herpes simplex virus is rare but can have devastating consequences as their immune system is not fully developed to fight off the virus.

• #1 Herpes simplex virus in infancy: Evaluation of national surveillance case capture : Find an Expert : The University of Melbourne

  https://findanexpert.unimelb.edu.au/scholarlywork/1925167-herpes-simplex-virus-in-infancy–evaluation-of-national-surveillance-case-capture

  Aim: As herpes simplex virus (HSV) in infancy is not a mandatory notifiable condition in Australia, completeness of ascertainment by the Australian Paediatric Surveillance Unit (APSU) has been difficult to evaluate to date. […] We evaluated case capture in Queensland (QLD) and Western Australia (WA) using statewide laboratory and clinical data and complementary surveillance data collected via the APSU. […] HSV polymerase chain reaction positive results in infants (03 months) from 2007 to 2017 were obtained from statewide public pathology providers in QLD and WA. […] A total of 94 cases of HSV disease.

• #1 Neonatal HSV disease in infants under 90 days of age. v1.0. – Health Research Authority

  https://www.hra.nhs.uk/planning-and-improving-research/application-summaries/research-summaries/neonatal-hsv-disease-in-infants-under-90-days-of-age-v10/

  We aim to do this through a study of all cases of neonatal HSV in infants under 90 days of age in the UK and Ireland over a 2 year period. We will do this by asking paediatricians to notify us of cases of neonatal HSV as they occur via a routine reporting source called the British Paediatric Surveillance Unit. This study will follow the BPSUs standardised protocols, ethical approval and governance which are in place for all studies such as these. […] The BPSU Orange Card system undertakes active surveillance of a number of disorders by requesting that participating clinicians notify the BPSU of cases on a monthly basis. This process is described in detail in subsequent sections.

• #1 Neonatal herpes encephalitis | MedLink Neurology

  https://www.medlink.com/articles/neonatal-herpes-encephalitis

  The most vulnerable infants are those whose mothers have primary or their first episode of genital herpes infection during pregnancy. […] The risk of neonatal infection is about 50% if the maternal genital lesions are primary, but the risk falls to only 4% to 5% if the maternal lesions are recurrent. […] Estimates of the incidence of neonatal herpes simplex virus encephalitis in the United States range from 0.1 to 0.3 per 1000 live births per year. […] A large-scale study utilizing a combination of physician-reported cases and electronic laboratory reports verified that neonatal herpes infections occur at a rate of approximately 0.3 per 1000 live births. […] Approximately 350 to 1100 cases are reported annually. […] Over the course of the past decade, the incidence of neonatal herpes infections has risen.

• #1 Herpes simplex virus infection in pregnancy and in neonate: status of art of epidemiology, diagnosis, therapy and prevention | Virology Journal | Full Text

  https://virologyj.biomedcentral.com/articles/10.1186/1743-422X-6-40

  Although high-dose of intravenous acyclovir for a sufficient period has been proven to be effective, neonatal HSV infection is still associated with high residual lethality and morbidity because acyclovir administration may suppress but not eradicate the virus in exposed infants. […] The high rate of undiagnosed or asymptomatic HSV infections complicate the prevention. […] The most effective measure to prevent perinatal herpes infections is to avoid viral exposure to the neonate when primary genital herpes develops in late pregnancy whereas the risk of severe neonatal infection is small in recurrent episodes. […] Neonates, born to women with active genital lesions, with a confirmed or suspected HSV infection should be isolated, managed with contact precautions to avoid direct contact with skin and mucosal lesions, excretions, body fluids and immediately treated with intravenous acyclovir.

• #1 Kit Tarka Foundation | Research

  https://www.kittarkafoundation.org/research

  Neonatal HSV disease occurs when a baby is infected in their first few days or weeks of life. Babies can be infected if their mother has the infection during their pregnancy or delivery, or if an individual with the infection comes into very close contact with the baby in their first weeks of life. Neonatal HSV disease is rare but is devastating. Many of the babies affected will die or will suffer from long-term neurological problems. […] However at the moment they do not have enough information about the number of cases of this disease in the UK, which babies are most at risk, ways they might be able to reduce those risks, how and when treatment is being given and how often later relapses are occurring. […] This study would provide that information and we hope could be used to identify areas of improvement in current practice and provide clarification for the development of guidelines, parental advice and junior doctor training, with the aim of achieving better outcomes for babies at risk of or with neonatal HSV disease.

• #1 THINK hands and no kisses: preventing Neonatal Herpes – Maternity & Midwifery Forum %

  https://maternityandmidwifery.co.uk/think-hands-and-no-kisses-preventing-neonatal-herpes/

  Neonatal herpes is a serious infection, which, in some cases, can be fatal. […] Neonatal herpes is a rare, and potentially fatal, disease which usually occurs in the the first four week of a babys life. […] Although rare, studies have shown that the incidence rate of neonatal HSV in the UK has been rising in recent years. […] Most neonatal herpes infections are transmitted from mothers and birthing parents with active genital herpes to their babies during delivery, however, a substantial proportion are contracted after birth from someone with an active herpes infection e.g. cold sore or herpetic whitlow on the finger. […] 60% of new and expectant parents dont know that herpes infections in young babies can be fatal. […] More than 1 in 6 parents would allow a person they dont know well to touch their baby without washing their hands.

• #1 Surveillance of neonatal herpes in the British… | F1000Research

  https://f1000research.com/articles/9-163

  These findings suggest that future research should explore the relationship between pre-term delivery and infant susceptibility, and also the role of postnatal acquisition of infection. […] Healthcare professionals and new parents must continue to be aware of this rare condition in order to enable prompt investigation and instigation of treatment.

• #1 Asymptomatic neonatal herpes simplex virus infection in mice leads to persistent CNS infection and long-term cognitive impairment | PLOS Pathogens

  https://journals.plos.org/plospathogens/article?id=10.1371/journal.ppat.1012935

  Neonatal herpes simplex virus (nHSV) is a devastating infection impacting approximately 14,000 newborns globally each year. nHSV infection is associated with high neurologic morbidity and mortality, making early intervention critical. Clinical outcomes of symptomatic nHSV infections are well-studied, but little is known about the frequency of, or outcomes following, subclinical or asymptomatic nHSV. […] Given the high prevalence of HSV infection in the adult population, asymptomatic HSV infection could be an unrecognized source of morbidity that may have lifelong implications for infected neonates. […] The incidence of asymptomatic nHSV has not been determined due to low rates of maternal testing, and because nHSV is often not diagnosed unless symptoms present. […] Our work links neonatal HSV (nHSV) acquisition to later-life outcomes by showing that even subclinical neonatal infections can lead to cognitive impairment in adult mice.

• #1 THINK hands and no kisses: preventing Neonatal Herpes – Maternity & Midwifery Forum %

  https://maternityandmidwifery.co.uk/think-hands-and-no-kisses-preventing-neonatal-herpes/

  1/3 of parents would not ask friends and family to wash their hands before holding their young baby. […] 45% of parents would allow friends and family to kiss their baby, but 52% of these would do so reluctantly. […] We are seeking support from midwives and other health professionals to remind new parents of the importance of good hygiene around young babies. […] Update from the latest BPSU HSV surveillance study.

• #1 912 Herpes simplex virus in infants under 90 days of age in UK and Ireland: results of the 2019–2022 BPSU study | Archives of Disease in Childhood

  https://adc.bmj.com/content/108/Suppl_2/A184

  UK incidence of neonatal HSV has doubled since the last national surveillance study and mortality remains high. Outcomes are particularly poor in premature infants. Early detection of disseminated disease is challenging as presenting features are non-specific, meaning treatment is commonly delayed. Raising awareness and national guidance on the management of this infection is required. Follow-up focusing on disease recurrence and morbidity at 12 and 24 months is ongoing.

• #1 Neonatal herpes simplex virus (HSV) infection: Clinical features and diagnosis – UpToDate

  https://www.uptodate.com/contents/neonatal-herpes-simplex-virus-hsv-infection-clinical-features-and-diagnosis

  Neonates can acquire HSV infection by intrauterine, perinatal, or postnatal transmission of the virus. […] Neonatal HSV infection causes serious morbidity and mortality and leaves many survivors with permanent sequelae. […] Strong clinical suspicion, timely diagnosis, and early antiviral treatment are critical to improving outcome. […] The fetus may be infected transplacentally or through retrograde spread through ruptured or seemingly intact membranes.

• #1

  https://www.autopsyandcasereports.org/article/doi/10.4322/acr.2018.050

  Herpes Simplex Virus infections (HSV) are ubiquitous. The neonatal HSV infection (NHSV) is rare. The incidence is estimated globally at only 10.3 per 100,000 births, but it can cause devastating disease in premature infants. […] We urge more awareness of this disease with continued surveillance; every effort should be taken to make an early diagnosis and thus prevent this devastating disease.

• #2 Neonatal herpes information and advice | Kit Tarka Foundation

  https://www.kittarkafoundation.org/neonatal-herpes-info-and-advice

  Neonatal herpes simplex virus (HSV) disease, also called 'neonatal herpes’ or 'neonatal HSV’, is a rare, but potentially fatal, disease which usually occurs in the first four weeks of a baby’s life. […] Early recognition and treatment of the virus has been shown to significantly improve babies’ chances of making a full recovery. […] Herpes simplex virus infection in a newborn baby is called neonatal herpes or neonatal HSV. It is typically divided into three categories: Infection of the skin, eyes and mouth (SEM), Infection involving the brain (central nervous system/CNS), Infection of multiple organs such as lung, liver, adrenal glands, brain and skin (disseminated). […] In young babies who have immature immune systems; HSV infections can spread rapidly if left untreated, causing irreversible cell damage which can lead to permanent disability or death.

• #2

  https://www.who.int/news-room/fact-sheets/detail/herpes-simplex-virus

  Neonatal herpes can occur when an infant is exposed to HSV during delivery. Neonatal herpes is rare, occurring in an estimated 10 out of every 100,000 births globally. However, it is a serious condition that can lead to lasting neurologic disability or death. The risk for neonatal herpes is greatest when a mother acquires HSV for the first time in late pregnancy.

• #2 Neonatal herpes – Wikipedia

  https://en.wikipedia.org/wiki/Neonatal_herpes

  Neonatal HSV rates in the U.S. are estimated to be between 1 in 3,000 and 1 in 20,000 live births. Approximately 22% of pregnant women in the U.S. have had previous exposure to HSV-2, and an additional 2% acquire the virus during pregnancy, mirroring the HSV-2 infection rate in the general population. […] The risk of transmission to the newborn is 30-57% in cases where the mother acquired a primary infection in the third trimester of pregnancy. Risk of transmission by a mother with existing antibodies for both HSV-1 and HSV-2 has a much lower (13%) transmission rate. […] A study in the United States from 2003 to 2014 using large administrative databases showed increasing trends in incidence of neonatal HSV from 7.9 to 10 cases per 100,000 live births and mortality of 6.5%. […] Another study from Canada showed similar results, with an incidence of 5.9 per 100,000 live births and a case fatality of 15.5%. […] A three-year study in Canada (2000-2003) revealed a neonatal HSV incidence of 5.9 per 100,000 live births and a case fatality rate of 15.5%.

• #2

  https://discovery.ucl.ac.uk/id/eprint/10113795/

  Surveillance of neonatal herpes in the British Isles 2004-2006. […] BACKGROUND: Neonatal herpes simplex virus (HSV) infection is rare but potentially devastating and can result in neonatal death or serious disability. National incidence was estimated at 1.65/100,000 live births in an earlier British Paediatric Surveillance Unit (BPSU) study of births 1986-1991. […] […] Over the three-year period, 85 infants were reported with confirmed neonatal HSV, an estimated incidence of 3.58/100,000 live births (95% CI 2.86-4.42), about double that reported almost two decades earlier. Over 40% of infants were pre-term compared with 25% in the earlier period. Just over 70% had central nervous system (CNS) or disseminated infection, and among these 54% had no skin, eye or mouth lesions noted. […]

• #2 Neonatal herpes encephalitis | MedLink Neurology

  https://www.medlink.com/articles/neonatal-herpes-encephalitis

  The most vulnerable infants are those whose mothers have primary or their first episode of genital herpes infection during pregnancy. […] The risk of neonatal infection is about 50% if the maternal genital lesions are primary, but the risk falls to only 4% to 5% if the maternal lesions are recurrent. […] Estimates of the incidence of neonatal herpes simplex virus encephalitis in the United States range from 0.1 to 0.3 per 1000 live births per year. […] A large-scale study utilizing a combination of physician-reported cases and electronic laboratory reports verified that neonatal herpes infections occur at a rate of approximately 0.3 per 1000 live births. […] Approximately 350 to 1100 cases are reported annually. […] Over the course of the past decade, the incidence of neonatal herpes infections has risen.

• #2 NEONATAL HSV INFECTION

  https://guidelines.stief.org.nz/herpes-neonatal-hsv-infection

  About 85-90% of neonatal HSV infections are acquired during labour (perinatally) through direct contact with infected genital secretions, 5% are acquired in utero, and 5-10% are acquired postpartum. […] The risk is greatest when a previously seronegative woman acquires genital herpes (HSV-1 or HSV-2) at or near the time of delivery. […] The risk of neonatal HSV infection is 50%, while vertical transmission rates of 25% are found in those with a non-primary first episode. […] High maternal titres of type-specific neutralising antibody are associated with a substantially lower risk and severity of neonatal infection. […] The highest risk of HSV transmission from a mother to a neonate is at delivery; contact with HSV-infected secretions in the birth canal accounts for the large majority of neonatal HSV infections.

• #2 Factsheet – Health Protection Surveillance Centre

  https://www.hpsc.ie/a-z/other/neonatalherpes/factsheet/

  Babies can become infected with HSV in the womb (~5%) around the time of birth through contact with HSV infected sections in the birth canal (~85%) or contact with the virus in the days after birth (10%). […] Many factors influence the risk of the baby getting an infection but the risk is greatest when HSV infection is acquired for the first time by the mother in pregnancy and particularly when the infection occurs in the third trimester close to the time of birth. […] If you are concerned that your baby may have an infection, seek medical advice as soon as possible. […] An antiviral medication (Aciclovir) is used for the treatment of HSV. […] Some babies, particularly those with SEM disease, will make a full recovery with treatment but the condition is much more serious if it has spread to the babys organs and may result in death even with treatment.

• #2 Digital Scholarship@UNLV

  https://digitalscholarship.unlv.edu/community_health_sciences_fac_articles/36/

  To explore the magnitude and descriptive epidemiology of neonatal herpes simplex virus (HSV) infection, the Centers for Disease Control (CDC) conducted an 18-month hospital-based surveillance study in which 184 cases were reported. […] Only 22% of mothers had a history of genital HSV infection and only 9% had genital lesions at the time of delivery. […] These data confirm previous observations that most mothers of infected neonates have no history of genital HSV and are asymptomatic at delivery. […] Furthermore this study suggests that intrauterine infection may be an important route of transmission and underscores the limitations of current prevention strategy.

• #2 912 Herpes simplex virus in infants under 90 days of age in UK and Ireland: results of the 2019–2022 BPSU study | Archives of Disease in Childhood

  https://adc.bmj.com/content/108/Suppl_2/A184

  Neonatal herpes simplex virus (HSV) infection is a rare but dangerous condition. Previous national British Paediatric Surveillance Unit (BPSU) studies, showed a doubling of incidence of neonatal HSV from 1.65 to 3.6/100,000 between 1991-2006. More recent data are required to inform future practice around prevention and treatment. This BPSU study aimed to define the: (1) current incidence of HSV disease and virus types in UK and Irish infants over a 2.5 year period, (2) types of HSV disease, (3) presentations and management, (4) source of transmission, (5) antenatal risk factors. […] Prospective surveillance of HSV infection in infants 90 days of age in UK and Ireland occurred between July 2019 and February 2022 via the BPSU. […] 242 cases were reported to BPSU, 25 were errors. 179 questionnaires were returned, 61 duplications were removed leaving 118 cases for analysis. Estimated incidence is 6.9 cases per 100 000 live births. 39/114 (34%) were born 37 weeks gestation. 39/118 (33%) had disseminated disease, 35% CNS and 32% skin/eye/mouth (SEM) infection. Median day of onset was 6 for disseminated, 8 for SEM and 14 for CNS infections. 61% with disseminated and CNS disease had HSV2 infections and 76% with SEM disease had HSV1. of those with disseminated disease, 18% had a fever and 26% had SEM lesions at presentation. Aciclovir was commenced in 113/118 but in only 40/118 (34%) on the day of presentation. Overall mortality was 24% but was related to disease type (66% with disseminated disease died compared to 7% of those with CNS infection), gestation (57% 28 weeks died compared to 19% 37 weeks) and admission and peak ALT.

• #2 Neonatal Herpes and the Urgency for Change

  https://herpescureadvocacy.com/neonatal-herpes-and-the-urgency-for-change/

  Neonatal herpes (nHSV), is a genital herpes infection that impacts newborns and is a serious health condition with devastating health outcomes. […] Neonatal herpes is not a reportable disease. However, surveillance data tells us cases are rising, with estimates of 2,000 per 100,000 live births. Surveillance estimates that 1,000 infants die annually in the US as a result of this infection. […] Current guidelines that recommend against testing for herpes simplex virus or genital herpes in pregnant mothers are putting infants and families at risk. […] With only 10-15% of women aware of their seropositive status, we have a dangerous loophole for occurrences of neonatal herpes. […] Guidance needs to evolve urgently, to recommend screening that protects newborn babies and alleviates these tragic outcomes. […] Considering the dire impact on these lives proves that more robust treatment and prevention strategies are essential and long overdue.

• #2 Neonatal HSV disease in infants under 90 days of age. v1.0. – Health Research Authority

  https://www.hra.nhs.uk/planning-and-improving-research/application-summaries/research-summaries/neonatal-hsv-disease-in-infants-under-90-days-of-age-v10/

  We aim to do this through a study of all cases of neonatal HSV in infants under 90 days of age in the UK and Ireland over a 2 year period. We will do this by asking paediatricians to notify us of cases of neonatal HSV as they occur via a routine reporting source called the British Paediatric Surveillance Unit. This study will follow the BPSUs standardised protocols, ethical approval and governance which are in place for all studies such as these. […] The BPSU Orange Card system undertakes active surveillance of a number of disorders by requesting that participating clinicians notify the BPSU of cases on a monthly basis. This process is described in detail in subsequent sections.

• #2 Herpes Simplex: Background, Microbiology, Pathophysiology

  https://emedicine.medscape.com/article/964866-overview

  HSV is the most common cause of genital ulcers in the United States. […] The prevalence of HSV infection worldwide has increased over the last several decades, making it a major public health concern. […] Overall, the mortality rate associated with herpes simplex infections is related to 3 situations: perinatal infection, encephalitis, and infection in the immunocompromised host. […] HSV-2 infections are clustered perinatally (from a maternal episode at delivery) and primarily once sexual activity begins. […] James SH, Kimberlin DW. Neonatal herpes simplex virus infection: epidemiology and treatment. Clin Perinatol. 2015 Mar. 42 (1):47-59, viii. […] Harris JB, Holmes AP. Neonatal Herpes Simplex Viral Infections and Acyclovir: An Update. J Pediatr Pharmacol Ther. 2017 Mar-Apr. 22 (2):88-93.

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

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8946680/

  Overall HSV-related mortality was 16%, with the highest mortality of 48.7% in the infants with DIS disease. […] Mortality for DIS infants was still 40.9% and only 55% of CNS infants were without obvious neurologic abnormalities at 24 months. […] Skin recurrences were significantly more common in infants infected with HSV-2 than HSV-1 (80% vs 54.5%, P = .02). […] Infants who had skin lesions at the time of initial presentation were more likely to have skin recurrences than those who did not: 76.2% vs 47.4%, P .02. […] Over the course of 4 decades, changes in the standard of care for diagnosis and management of neonatal HSV disease have led to improvements in timeliness of diagnosis and in outcomes. […] HSV-2 continues to cause more CNS disease and morbidity than HSV-1 infection. […] Oral antiviral suppression has led to decreases in early recurrences and need for re-hospitalization in the first 6 months of life. […] Future research should focus on prevention of perinatal infection in order to prevent the tragic outcomes of this infection for newborns and their families.

• #2

  https://discovery.ucl.ac.uk/id/eprint/10113795/

  Neonatal HSV infection remains rare although incidence doubled in the British Isles between the late 1990s and the mid-2000s. These findings suggest that future research should explore the relationship between pre-term delivery and infant susceptibility, and also the role of postnatal acquisition of infection. Healthcare professionals and new parents must continue to be aware of this rare condition in order to enable prompt investigation and instigation of treatment.

• #2 Asymptomatic neonatal herpes simplex virus infection in mice leads to persistent CNS infection and long-term cognitive impairment | PLOS Pathogens

  https://journals.plos.org/plospathogens/article?id=10.1371/journal.ppat.1012935

  This work, therefore, introduces a model that demonstrates a possible connection between nHSV and neurodegenerative disorders such as Alzheimers Disease. […] Our results are consistent with previous studies that showed cognitive decline, hippocampal neurodegeneration, and neuroinflammation in mice with recurrent HSV-1 infections. […] Our hypothesis is that even small perturbations during the neonatal period can affect neurodevelopment at a period in which the brain and immune system are rapidly changing. […] Our observation that HSV genomes and transcripts are detectable in the CNS of low-dose nHSV-infected mice at 6 mpi strongly supports a link between viral neuroinvasion and behavioral impairment. […] Maternal immunity, therefore, is crucial to protect against nHSV infection and its related sequelae, and there is ongoing work to develop therapeutic and prophylactic antibodies and vaccines to protect against nHSV.

• #2 Neonatal herpes simplex virus (HSV) infection: Clinical features and diagnosis – UpToDate

  https://www.uptodate.com/contents/neonatal-herpes-simplex-virus-infection-clinical-features-and-diagnosis

  Neonatal herpes simplex virus (HSV) infection causes serious morbidity and mortality and leaves many survivors with permanent sequelae. […] Strong clinical suspicion, timely diagnosis, and early antiviral treatment are critical to improving outcome. […] Neonates can acquire HSV infection by intrauterine, perinatal, or postnatal transmission of the virus. […] The fetus may be infected transplacentally or through retrograde spread through ruptured or seemingly intact membranes.

• #2 Neonatal herpes information and advice | Kit Tarka Foundation

  https://www.kittarkafoundation.org/neonatal-herpes-info-and-advice

  Early recognition and prompt treatment with antiviral medication is essential to save the baby’s life. Even if treated, a baby may suffer permanent brain damage or die. […] Babies can become infected in one of three ways: During a vaginal birth 'perinatal’: through contact with HSV infected secretions in the birth canal. This is the most common source of infection. Contact with the virus after birth 'postnatal’: through direct exposure to an active herpes infection on anyone who comes into close contact with the baby, including caregivers and healthcare professionals. In the womb 'in-utero’: through the placenta or cervix. This type of infection is rare, accounting for less than 5% of all neonatal herpes infections. […] It is important to remember that many people with HSV infections will have very mild symptoms, or often none at all, meaning that infections can be missed or put down to another cause. For this reason, some babies can be exposed to the virus before, during or after birth without it being realised. Therefore, it is essential that herpes infection is considered in all young babies who have signs and symptoms of being unwell so that essential treatment can be started as soon as possible.

• #3 Neonatal herpes (herpes in a baby)

  https://www.nhs.uk/conditions/neonatal-herpes/

  Neonatal herpes is a herpes infection in a young baby. The younger the baby, the more vulnerable they are to the harmful effects of infection. […] Herpes can be very serious for a young baby, whose immune system will not have fully developed to fight off the virus. […] Neonatal herpes, which is rare in the UK, is caused by the herpes simplex virus. […] A baby is most at risk of getting a herpes infection in the first 4 weeks after birth. […] Because newborn babies have underdeveloped immune systems, they can quickly become seriously ill after catching the virus. […] Very often the baby will not have any specific herpes symptoms, such as a rash. […] Sometimes neonatal herpes will only affect the baby’s eyes, mouth or skin. […] But the condition is much more serious if it has spread to the baby’s organs. […] Many infants with this type of neonatal herpes will die, even after they have been treated. […] If widespread herpes is not treated immediately, there’s a high chance the baby will die. […] If you’re pregnant and have a history of genital herpes, tell your doctor or midwife.

• #3 The Spanish Society of Paediatric Infectious Diseases guidelines on the prevention, diagnosis and treatment of neonatal herpes simplex infections | Anales de Pediatría

  https://www.analesdepediatria.org/es-the-spanish-society-paediatric-infectious-articulo-S2341287918300887

  The prognosis of newborns with skin, eye, and/or mouth disease in the high-dose acyclovir era is very good. Antiviral treatment not only improves mortality rates in disseminated and central nervous system disease, but also improves the rates of long-term neurodevelopmental impairment in the cases of disseminated disease. […] Interestingly, a 6-month suppressive course of oral acyclovir following the acute infection has improved the neurodevelopmental prognosis in patients with CNS involvement. […] Neonatal herpes is rare in developed countries, with an incidence that ranges between 1.65 and 3.2 cases per 100000 live births in European countries like the Netherlands or Switzerland. […] For reasons that remain unclear, the incidence of NH has historically been greater in the United States compared to the European average, ranging between 4 and 33 cases per 100000 live births.

• #3 Herpes simplex virus infection in pregnancy and in neonate: status of art of epidemiology, diagnosis, therapy and prevention | Virology Journal | Full Text

  https://virologyj.biomedcentral.com/articles/10.1186/1743-422X-6-40

  The risk of neonatal infection varies from 30% to 50% for HSV infections that onset in late pregnancy (last trimester), whereas early pregnancy infection carries a risk of about 1%. […] When primary HSV infection occurs during late pregnancy, there is not adequate time to develop antibodies needed to suppress viral replication before labour. […] Transmission of HSV from mother to foetus during pregnancy is uncommon; about 85% of perinatal transmission occurs during the intrapartum period. […] The newborn could be also infected by HSV-1, that may represent almost one-third of all new genital HSV diagnoses. […] The disease transmission to the newborn is dependent on the type of maternal genital infection at the time of delivery. In fact, neonatal herpes is much more frequent (50%) in babies from mothers with a primary HSV infection respect to babies from mothers with recurrent HSV infection (3%).

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