Characteristics of neonatal herpes simplex virus infections in Germany: results of a 2-year prospective nationwide surveillance study

Abstract

ObjectiveTo assess incidence and burden of neonatal herpes simplex virus (HSV) infections and to explore possible transmission routes.MethodsA 2-year prospective nationwide surveillance study performed in 2017 and 2018. All German paediatric departments (n=464 in 2017, n=441 in 2018) were contacted on a monthly basis to report potential cases of neonatal HSV infections. Infants with a postnatal age of ≤60 days and a positive HSV PCR or HSV culture from skin, mucous membrane, vesicles or conjunctival smear, blood or cerebrospinal fluid were included in the study.Results37 cases were analysed. 29 patients who exhibited no or only mild clinical symptoms were discharged home without organ damage or neurological abnormalities. Four patients showed significant neurological impairment, one patient required liver transplantation and two patients died during in-patient treatment. The 2-year incidence of neonatal HSV infections was 2.35 per 100 000 live births (95% CI 1.69 to 3.02) and disease-specific mortality was 0.13 per 100 000 live births (95% CI 0.04 to 0.21). Data on possible transmission routes were available in 23 cases. In 20 cases, an orofacial HSV infection was present in one or more family members. An active maternal genital HSV infection was reported in 3 cases.ConclusionNeonatal HSV infections are rare in Germany. Most infants have a benign clinical course, but some infants are severely affected. Postnatal HSV exposure may account for a considerable number of neonatal HSV infections.

Epidemiology of herpes simplex virus type 2 in Europe: systematic review, meta-analyses, and meta-regressions

“…Tens of studies have documented occurrence of neonatal herpes for over 4 decades in Europe in countries such as Denmark, 45 France, 43 Germany, 46 , 47 Ireland, 48 Israel, 49 , 50 , 51 the Netherlands, 52 , 53 , 54 , 55 , 56 , 57 , 58 Poland, 59 , 60 Russia, 61 Spain, 62 Sweden, 63 , 64 , 65 Switzerland, 66 Turkey, 67 and the United Kingdom (UK). 48 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 However, surveillance for this condition remains overall limited with no data being reported for the majority of countries in Europe.…”

“…In Germany, it was reported during 2017–2018 at 2.4 cases per 100,000 live births. 46 In Israel, it was reported during 2001–2007 at 8.4 cases per 100,000 live births. 51 In Poland, it was reported during 2014–2019 at 69.0 cases per 100,000 live births.…”

“…44 By type of infection, incidence in Europe was estimated at 5.2 cases per 100,000 live births for HSV-1 and at 3.8 cases per 100,000 live births for HSV-2. 44 Tens of studies have documented occurrence of neonatal herpes for over 4 decades in Europe in countries such as Denmark, 45 France, 43 Germany, 46,47 Ireland, 48 Israel, [49][50][51] the Netherlands, [52][53][54][55][56][57][58] Poland, 59,60 Russia, 61 Spain, 62 Sweden, [63][64][65] Switzerland, 66 Turkey, 67 and the United Kingdom (UK). 48,[68][69][70][71][72][73][74][75][76][77][78] However, surveillance for this condition remains overall limited with no data being reported for the majority of countries in Europe.…”

The role of Herpes Simplex Virus type 1 in oral diseases in children

“…Неонатальные инфекции HSV могут проявляться классическими симптомами (герпетические поражения кожи и слизистых оболочек, судороги), но симптомы также могут быть неспецифическими (лихорадка, плохое питье, вялость) или отсутствовать [45]. При отсутствии кожных поражений диагностика неонатальной инфекции, вызванной HSV, затруднена, в этом случае инфекция ограничивается глазами и/или слизистой оболочкой полости рта [42].…”

Herpes simplex virus infection among neonates suspected of invasive bacterial infection: a population-based cohort study

“…In the USA, neonatal HSV infection incidence reaches up to 70 per 100 000 live births,3–8 and a single-centre study found that HSV infection in hospitalised neonates was as prevalent as serious bacterial infections 9. In contrast, an incidence of up to 20 per 100 000 live births has been reported in European countries, Australia and Canada 10–16. In Denmark, the incidence of neonatal HSV infection was 3 per 100 000 live births in the 1980s and has not been investigated since then 17…”