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Neonatal herpes, infection of newborns with herpes simplex virus type 1 or type 2 -- the causes of genital herpes and cold soresshould routinely be reported to health authorities, say experts. In a commentary published in the September issue of the journal Sexually Transmitted Diseases, some of the nations leading researchers in herpes infections point out that unlike all comparable health problems in newborns, neonatal herpes is a reportable condition in only seven states.
As a result, according to Dr. Hunter Handsfield, the lead author, an opportunity is missed for national surveillance that would enhance prevention and public awareness. Handsfield, an expert in sexually transmitted diseases and public health and a professor at the University of Washington Center for AIDS and STD in Seattle, described routine reporting and surveillance as long overdue.
A mild form of neonatal herpes causes a blistering skin rash and fever, but untreated cases progress to cause irreversible brain damage and often heart damage, liver disease, and other complications. Without treatment, neonatal herpes is fatal in 50 percent to 85 percent of cases and up to two-thirds of the survivors have lifelong disabilities. Death and disability remain common even with treatment, partly because the infection can be difficult to recognize, so that many infants do not get treated in time.
The report estimates that at least 460 cases and perhaps as many as 2,800 cases of neonatal herpes occur each year in the United States. By contrast, congenital rubella and HIV infection, syphilis, and gonorrhea in newborns all are less common than neonatal herpes. Yet these are reportable in almost all states and are tracked by the Centers for Disease Control and Prevention (CDC).
In its impact on affected families and the population as a whole, no comparable condition matches the havoc caused by neonatal herpes, said Handsfield. Most cases are due to HSV type 2, the virus that causes most cases of genital herpes, one of the most common of all STDs. The experience of the authors who regularly provide care to affected babies and pregnant women is that most marriages end in divorce in the wake of neonatal herpes. Can you imagine a bigger stress on a relationship than having a baby who dies or is disabled because of an STD in one or both parents? asked Handsfield.
Neonatal herpes has long been considered difficult to diagnose and prevent, probably contributing to attitudes about routine case reporting. According to the report, however, recent advances in diagnosis of HSV infections and in treatment have eliminated those barriers.
The authors believe other reasons reporting has not been routine include, misunderstanding by both the public and the healthcare establishment about the frequency of genital herpes and the breadth of the populations at risk, coupled with reticence of many healthcare providers and some public health agencies to forthrightly address the potential of diagnosing STD in persons seemingly at low risk.
The report calls on CDC to request reports of neonatal herpes cases from all states; on states to pass legislation and develop regulations requiring routine reporting; and on all healthcare providers, agencies, and professional societies to support this modest contribution to the national health agenda.
The reports other authors are Ann Waldo, JD, formerly with GlaxoSmithKline; Zane A. Brown, MD, a professor of obstetrics and gynecology at the University of Washington and an authority on herpes in pregnancy; Lawrence Corey, MD, a herpes expert at the Fred Hutchinson Cancer Research Center and University of Washington; Joan L. Drucker, MD, a herpes specialist with Medika LLC; Charles W. Ebel, a herpes prevention expert with the American Social Health Association; Peter A. Leone, MD, an associate professor of medicine and herpes researcher at the University of North Carolina; Lawrence R. Stanberry, MD, PhD, a professor of pediatrics and herpes expert at the University of Texas Medical Branch in Galveston; and Richard J. Whitley, MD, a professor of pediatrics and an expert in neonatal herpes at the University of Alabama at Birmingham.
Source: Lippincott Williams & Wilkins