[Question #3079] Risk to child

39 months ago
I have an outrageous scenario that occurred and has been weighing on my mind. My concern is that my young daughter had a cold sore on her lip and was sitting next to her 2 month old sister whom I was changing. Just as I removed the diaper my oldest daughter accidentally sneezed. Her head was approximately 6inches from my baby's exposed genitals when she did this. I was stunned but quickly wiped my baby's bottom with a baby wipe, not knowing what else to do. My baby had a horrible diaper rash and her skin was already very irritated. I'm so concerned. This occurred a year and a half ago and it's still on my mind. What are the chances of her being infected from this? Her pediatrician said none at all, as did an infectious desease Dr we asked. No, we haven't seen obvious sores. But my other daughter's cold sores are very tiny, almost like cuts, so I'm worried it isn't obvious if it has shown infection or will show itself when she's older.
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
39 months ago
I definitely would agree with the pediatrician and ID doc that there is no risk at all of the cold sore virus being airborne and infecting your baby.  That's just not how this works at all.

Terri
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39 months ago
Thank you. Admittedly, I feel ridiculous asking. My issue was having PPA after birth and when the event occurred I looked into transmission expecting to learn that it had to be skin to skin but to my horror read on the CDC and mayo clinic website that it can spread from saliva (spitting while sneezing) if it hits open skin. Can you explain how my scenario doesn't match that infectious route? She was very close to her sister due to the position they were both in at the time, so she didn't just sneeze (spit) AT her but ON her in the area effected by the rash. I'm really just trying to understand how that is not applicable. Thank you for your time.
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
39 months ago
I just don't think that most experts would agree with the sneezing thing.  I have heard that that information is on those websites previously.
While I suppose there could be a tiny theoretical risk, there has never been a case of herpes reported from this source of infection that I am aware of.  Also, I believe that those statements were made before we had studies indicating that a certain amount of virus was necessary for transmission to another person, not just one viron.  I ran your question by Dr. Handsfield to see if his understanding was any different than mine and he said no risk, don't worry about it. 
Here's the other thing - this happened 18 months ago and if she had gotten herpes from this, you would most assuredly seen herpes symptoms within 2-10 days with blistering and you would have taken her into the pediatrician.  I honestly believe that your baby is just fine.rri

Terri
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39 months ago
Thank you.  For my last question, 1) what about latent responses where the person blister ers year's later due to stress or irritation to the area, it's not always 14 days later or obvious. Again, my daughter's sores on mouth  often look like cuts or chapping. I myself got a sore after drinking from my daughter when her lips were chapped. 2) How is that interaction with saliva any different? 3) Would it have helped that I immediately wiped the area down with a baby wipe? 4) does it make it harder for hsv 1 to take root in this area because it's not it's typical place of preference. I.e. you have to try harder to massage it in in this area? 5)  If you had seen this occur would you have even batted an eyelash? Am I completely overreacting
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
39 months ago
While many adults can contract herpes without symptoms, a baby, because of an underdeveloped immune system, would like have symptoms should they acquire herpes.  I'm not even clear, from your note, if your older daughter had actual cold sores.  Has she ever had an official laboratory diagnosis of HSV?  And have you with your sore?  IF herpes was present, it probably would have helped for you to wipe down the area but again, that is extremely unlikely.  If  I had had this happen with any  of my daughters, no, I wouldn't have batted an eyelash.  I do think you are overreacting.

Also, I would greatly appreciate it if you could send me the link to where they Mayo clinic and CDC say you can acquire HSV through sneezing?  All three of us experts would like to get to look at that and work on correcting this information.  Thanks so much in advance.

Terri
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39 months ago
I can't quickly find the site or PDF about sneezing but I found this that says it can be through utensils and towels. https://www.mayoclinic.org/diseases-conditions/cold-sore/symptoms-causes
I Know on a Westover heights Q and A this year you said it wasn't transmitted via towels (fomites) I know for sure my oldest has it, I was diagnosed my blood test after lesion was gone. I had previously tested neg twice before. I got it after sharing a straw with my daughter when her lips were chapped. So, you and HHH are firm that it's not transmitted via spit from sneezing due to low viron and it would have showed signs within the typical timeframe and have been very noticeable, given her young age.
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
39 months ago
I don't recall saying it wasn't transmitted via towels - in fact, I always say that people should use their own towels as towels can stay warm and moist.  I do disagree with it being transmitted via utensils.  I do think it could potentially be transmitted via lipsticks though that is also a bit of a stretch.  I'm glad to hear that you daughter was actually swab tested to determine that her lip issue is HSV.  It would be a shame to label her as having herpes when she only had chapped lips. 
We are both firm that sneezing is not a way to transmit herpes - yes - as is your pediatrician and ID doc.

Terri
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39 months ago
You likely won't respond, but see, that blows my mind that you don't think it's transferred via utensils. I know without a doubt I got it from my daughter after sharing a a straw with her. I typically don't share drinks in general and woke up the next morning (24 hours later) with a blister forming on the inside portion on my lip, exactly where the straw tip would touch it. And I certainly wasn't kissing her to have gotten it there. And yes, I know I didn't have it before because of 2 negative blood tests prior, one of which was just 1 month prior to incident. I'm trying very hard to reconcile my knowledge of this acquisition with your belief that spit from a sneeze is insufficient.
39 months ago
The above example is why I wanted to know about spitting into cuts (I may have had a cut on my lip while drinking from straw). 

Also about the timeline. You truly believe that I should have seen a breakout on my baby or if the breakout should have been overly obvious?? What about people that show years later and haven't had sex in 2-3 years. I guess I just need facts and scientific numbers to feel rest assured. Such as....

What is the virus load in spitting compared to kissing? What virus load is needed to transfer desease?

 I don't know how you can say you haven't seen a transfer from spit on utensils in all your years. Do you do studies like that? I do understand that the spit wouldn't last for several minutes I guess, but spit from a sneeze is instant. 

DR HHH was fully aware it was concern for spit in cuts NOT merely particles of snot, I was worried about right?

I'll purchase more questions if absolutely necessary. Really my questions are the just want numbers and scientific reasons behind your belief. Thank you.
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
39 months ago
Katie, when you signed up you agreed to three posts - an initial one and two follow ups.  It really isn't fair to others who post here to make exceptions for one person and not other so please renew, OK? 

Thanks

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