The human herpesviruses are involved in a variety of diseases. Large-scale evaluation of the clinical and epidemiological importance of different herpesviruses requires high-throughput methods. Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) is a method that has a multiplex capacity enabling simultaneous detection of several viruses in a single sample. PCR-based methods for the multiplex detection of all known human herpesviruses were developed on the MALDI-TOF MS system. A variety of 882 archival samples, including bronchoalveolar lavage, conjunctival fluid, sore secretion, blister material, plasma, serum, and urine, analyzed for herpesviruses using PCR-based reference methods, were used to evaluate the MALDI-TOF MS method. The overall concordance rate between the MALDI-TOF MS method and the reference methods was 95.6% ( ؍ 0.90). In summary, the MALDI-TOF MS method is well suited for large-scale detection of all known human herpesviruses in a wide variety of archival biological specimens.The herpesviruses infecting humans include herpes simplex virus (HSV) types 1 and 2, varicella-zoster virus (VZV), Epstein-Barr virus (EBV) types A and B, cytomegalovirus (CMV), human herpesvirus 6 (HHV6) types A and B, HHV7, and HHV8 (Kaposi's sarcoma-associated herpesvirus). Herpesvirus infections in healthy subjects are often asymptomatic but can cause oral and genital lesions (HSV), chicken pox or shingles (VZV), infectious mononucleosis (EBV and CMV) (13), or roseola (HHV6) (19). In immunologically compromised hosts, herpes infections are more severe, causing pneumonia (CMV and HHV6) (1, 19), lymphoproliferative diseases (EBV) (19), Kaposi's sarcoma (HHV8) (19), or encephalitis (HSV-1) (6). Most herpesviruses have been reported to traverse the placenta (21), and intrauterine infections may cause birth defects (CMV) (19), premature delivery (VZV) (4), and fetal mortality (HSV) (21). Herpesvirus infections during pregnancy have also been associated with childhood acute lymphoblastic leukemia (EBV) (14).Common laboratory techniques in herpesvirus detection include antibody detection such as enzyme-linked immunosorbent assay (26), PCR (15,17,18,25,27), and dot blot hybridization (27). These techniques usually require separate methods for the detection of each herpesvirus and clinical information for selection of virus assay. Since most microbiological laboratories maintain large biobanks with clinical samples, large-scale evaluation of the clinical and epidemiological importance of different herpesviruses is today restricted only by cost and throughput considerations. There is therefore an increasing interest in rapid and large-scale herpesvirus detection, and methods for the multiplex detection of several herpesviruses have recently been developed using PCR and microarray techniques (8, 10, 23). Virus detection using the matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) system is a high-throughput technology with multiplex capacity that ha...