[Question #1546] Neonatal HSV

46 months ago

Hi, I feel a bit foolish for asking this question, nearly finished with medical school. That said, I am curious about neonatal HSV. While I recognize that most cases result from maternal HSV2 at birth, I wonder how much of a risk HSV1 poses in the time following birth before the child's immune system fully develops...My son was born two months ago, and I have since been shocked at how many people feel that it is acceptable to kiss him. Just last week, a friend of my partner's who often has visible cold sores, kissed our son on the lips. I politely asked him not to, yet he did it again. And one of his grandparents (who also has a hx of cold sores) continues to kiss him all over the face despite being kindly encouraged to stop. I am surprised by this, as it's my instinct to only kiss him on the head, and he is my son! All that said, I am curious how risky this is to the newborn? HSV1 is very common, but do we know anything about how likely it is to harm newborns in the same way HSV 2 can? (I saw one devastating case and know little about the epidemiology.)  At what age are newborns equipped to handle HSV infections without awful sequelae? Also, I haven't passed any immunity to my son, as by chance I know I am seronegative. (I had a type 4 hypersensitivity reaction this summer, and my PCP figured it was primary HSV1, but the swab and IgG/IgM were all negative, only later realizing it was mango.) So I am a bit concerned that my son, perhaps, is at greater risk from these well-intentioned holiday kissers, as I have passed on no antibodies? Finally, on a somewhat related note, do you know if a healthcare worker is more likely to be exposed to CMV than someone in the general population? During this pregnancy, I tested negative for CMV exposure as part of a large study. And now I wonder if I should be taking extra precautions to avoid a first exposure during a possible second pregnancy while working as a resident? Thank you.

Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
46 months ago
Good morning,
Some portion of neonatal herpes, perhaps 5-10%, is transmitted to children after birth, mostly by an adult with a cold sore kissing a child.  We, in Portland, OR, lost a newborn to HSV 1 from a grandfather kissing his grandchild when he had a cold sore.  The mom had no antibody (and subsequently got HSV 1 on her breast from her baby while breastfeeding).  So yes, absolutely cold sores are a significant risk to a newborn.  I asked a pediatric expert on herpes a while ago how old the baby would have to be to survive an HSV infection and he said 6 weeks, which surprised me, actually, I thought they would need to be older.  If I were you, I would absolutely stop people from kissing your baby on his mouth, especially if they have a cold sore present.  I mean, that is just ridiculous or completely uneducated, mostly likely the later.  In terms of our own situation, the traditional IgG test misses 30% of HSV 1 infections, so it's not a terrific test - the IgM is probably worse and should never be used to determine HSV infection- that problem is false positives.  Most adults in the US have CMV infection.  If you don't, and acquire it during pregnancy, you can infect your baby. About 1 in 150 births result in neonatal CMV but only about 20% of those babies will have difficulties.  I'm not sure exactly how would avoid getting CMV other than excellent hand washing techniques. 

Terri
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46 months ago
Thank you for your reply. I appreciate it, and devastating about the newborn you lost. I too am surprised that your colleagues answer was 6 weeks. My follow up questions would be, is the risk greatly diminished if people kiss the baby on the face (cheek, forehead, etc.) but not the lips? Also, do you know if healthcare workers, specifically, are at any/much greater risk for contracting CMV? Thank you!
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
46 months ago
I think kissing on the head, cheek, forehead is far less risky as the skin is thicker (assuming it is intact), yes.
I'm not an expert on CMV by any means, so take this as an opinion, not truth, but I would suspect since we are exposed to a wide range of people over a day, and some of their bodily fluids, we might be at greater risk of CMV acquisition.  Let me run your question about CMV by Drs. Hook and Handsfield - HSV is my area of expertise and I don't want to lead you astray with incorrect information about other herpes viruses.

Terri

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46 months ago
Thanks Terri, I appreciate you looking into that further. My last followup question is regarding transmission. I am guessing risk from any one 'kiss' is low? and 2) How long after a single exposure can I be pretty certain that my newborn did not acquire the virus? and 3) Would I know for sure that he was exposed? As in even if no cold sores were visible, would he likely have a fever if exposed?  Again, thank you! I really appreciate it.
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
46 months ago
I think one kiss is unlikely to infect him but it happens, though rarely.  If he was going to be infected, I think you would notice something within a week.  If no sores were present, the risk is lower but if infected in this way, the symptoms would be the same.

Terri
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Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
46 months ago
I spoke with Dr. Handsfield and he doesn't feel that you are greater risk of acquiring CMV just because you are a physician.  Just wanted to update you on that issue.

Terri
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