Scientists Probe Herpes in Neonates, C difficile Acquisition in Children
Authors: Bridget M. Kuehn
Journal: JAMA (2010)

A current strategy for preventing transmission of herpes simplex from mother to child may not always be effective, suggest findings from a multicenter case study of 7 neonates who developed herpes infection despite maternal antiretroviral suppressive therapy. The participating centers were the Children’s Hospital at Saint Peter’s University Hospital in New Brunswick, NJ; the University of Texas Health Science Center at San Antonio; and the Maine Medical Center in Portland. Physicians are increasingly using antiviral suppressive therapy in the final weeks of pregnancy to prevent the transmission of the virus, but few data have been available on how such therapy affects neonatal disease, explained Sweetha G. Pinninti, MD, a pediatric resident at the Children’s Hospital at Saint Peter’s University Hospital, noting that her group’s results were the first in the literature to document neonatal infections after such therapy. None of the mothers had active herpes lesions at delivery and 6 delivered vaginally. The findings should prompt physicians to be alert for the possibility of herpes infection in infants whose mothers have undergone antiretroviral suppressive therapy, said IDSA President Richard Whitley, MD, at an IDSA press briefing. “It’s not fail-safe,” noted Whitley, who directs the division of pediatric infectious diseases at the University of Alabama, Birmingham. Pinninti, who is now a fellow in pediatric infectious diseases at the University of Alabama, Birmingham, noted that randomized controlled trials have demonstrated that antiviral suppressive therapy can decrease clinical reactivations and viral shedding at delivery, but that none of the studies were large enough to assess the effect on neonatal disease. Prospective studies are needed to determine how often antiretroviral therapy fails to prevent transmission. In other work presented at the IDSA conference, data from a randomized controlled trial suggest that neonates with herpes may benefit from viral suppression even after their initial treatment regimen. All of the 74 infants in the trial received the current standard of care (intravenous acyclovir for 14-21 days); after this initial treatment, the infants were randomized to receive oral acyclovir or a placebo until the end point of repeated recurrence of skin lesions. Infants who reached this point were removed from blinded treatment. On average, the supression group took 2 months longer to reach this end point. The group randomized to receive ongoingsuppressive therapyhadhigher scores on the Bayley Scales of Infant Development Mental Scores at 12 months than those who received placebo. “Babies who have neonatal herpes shouldbestartedonantiviralsuppression oncethey’vefinishedparenteraltreatment for herpes simplex virus,” said David W. Kimberlin,MD,professorofpediatric infectious disease at the University of Alabama, Birmingham, who presented the findings at a press briefing. Kimberlin explained that the data indicate that suppressive therapy is both safe and effective. The incidence and magnitude of neutropenia did not significantly differ between the treatment and placebo group. However, Kimberlin cautioned that it would be prudent to watch for neutropenia in infants receiving suppressive therapy.