Whenever we admit a febrile infant in the first few days or weeks of life, we ask if we need to test and treat for potential neonatal herpes simplex virus (HSV). Yet what do we know about trends in the incidence of this virus and what happens to these infants once HSV has been identified? Mahant et al. (10.1542/peds.2018-3233) decided to investigate these questions using a retrospective longitudinal-cohort study involving a Medicaid claims multistate database from 2009 to 2015. The study found an increase in the incidence of HSV infection in the 2.1 million births studied from 3.4 per 10,000 births per year to 4.5 per 10,000 births. The authors followed those infants who did not die during their initial hospitalization for at least the next six months and provide information on emergency visits, readmissions and overall mortality in these children who were infected with HSV. They also provide data on costs per case and find it substantive ($87,602 per case on average over years studied).
The authors discuss why incidence rates might be increasing, which includes changing HSV susceptibility patterns in women of childbearing age and increases in oral sex behavior, but there are other explanations that might be considered, including better use of polymerase chain reactions to make the diagnosis or more universal screening for HSV in some areas. These latter explanations are offered by Drs. James Gaensbauer and Joseph Grubenhoff from the University of Colorado who provide an accompanying commentary (10.1542/peds.2019-0159). Not only do they raise some caution in regard to Mahant et al. suggesting an increased incidence of HSV, but they also discuss the risks and benefits of universal versus high risk screening and what the future may hold in faster, more predictive diagnostic tools that will enable us to know very quickly whether the virus is present and if acyclovir should be started. If you need an update on the state of neonatal HSV in this country and what the future may yield in terms of diagnostic strategies, treat yourself to this article and commentary and learn more.
