[Question #1546] Neonatal HSV
95 months ago
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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
95 months ago
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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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95 months ago
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Terri Warren, RN, Nurse Practitioner
95 months ago
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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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95 months ago
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Terri Warren, RN, Nurse Practitioner
95 months ago
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Terri
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Terri Warren, RN, Nurse Practitioner
95 months ago
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Terri
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