About one in six Americans between 19 and 49 years of age have genital herpes. Some of those adults endure the pain of recurrent outbreaks, but many infected with Herpes Simplex Virus 1 or 2 (HSV) are asymptomatic or have very mild symptoms. Up to 88% of those infected are unaware of their infection.The situation is very different at the start of life. Newborns who acquire HSV face a life-threatening infection that may be fatal and can produce mental retardation and other neurological problems in survivors.
The estimates of the prevalence of genital herpes among adults is based on work done in the National Health and Nutrition Survey (NHANES), but few population estimates exist that assess infant mortality due to herpes or analyze trends over time.
New work published in Pediatrics from Sampath et al. (10.1542/peds.2015-2387) compares infant deaths attributed to HSV, congenital syphilis (CS) and HIV using vital statistic data from New York City (NYC). The researchers used data from a 33-year period spanning 1981 to 2013, examining both deaths and stillbirths. Death rates were calculated using live births as the denominators.
Neonatal HSV was identified as the cause of death for thirty-four infants with a rate of 0.82 deaths/100,000 live births. CS deaths were identified in thirty-eight infants (0.92 deaths/100,000 births) and HIV deaths totaled 266 (6.33 deaths/100,000 live births). The neonatal HSV death rate in the last decade (2004-2013) was significantly higher than in the two earlier decades. Researchers found no CS deaths after 1996 and only one HIV-related death after 2004.
The researchers concluded that the increasing HSV-related deaths may reflect an increasing incidence of neonatal herpes. Another factor could be the increasing use of better testing for HSV, such as PCR testing. Use of those tests could have improved HSV diagnosis in infants or at autopsy. The NYC estimate may be an underestimate because neonatal HSV is not a reportable condition to public health departments. Given the prevalence of HSV in adults, it is very likely that increased surveillance for neonatal HSV will find more cases.
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2. Fanfair RN, Zaidi A, Taylor LD, Xu F, Gottlieb S, Markowitz L. Trends in seroprevalence of herpes simplex virus type 2 among non-Hispanic blacks and non-Hispanic whites aged 14 to 49 years--United States, 1988 to 2010. Sexually transmitted diseases. 2013; 40(11): 860-864.
