About the Herpes Simplex Virus in Children

Overview

Herpes simplex is a virus that, in most cases, causes nothing more serious than cold sores on the lips or lesions on the genitals. While the symptoms can be annoying and cause tremendous psychological stress, they generally do not cause serious physical harm. But in a few situations, herpes can take a different, and sometimes serious, course. Very young children are among the groups most likely to experience such problems.

Types

Herpes simplex comes in two types: herpes simplex 1, which is most closely associated with oral herpes; and herpes simplex 2, which is most closely linked with genital herpes. These are not hard-and-fast rules, because each type is capable of infecting either location. In any case, a newborn can catch herpes during birth from a mother who has a genital infection. Babies and toddlers, on the other hand, often catch herpes when they're kissed by relatives and family acquaintances who are infected orally. Herpes is transmitted via skin-to-skin contact, most often but not always when an active herpes lesion is present.

Neonatal Herpes

Herpes in a newborn can affect not only the facial area, but the entire body and the brain. Some infants develop skin, eye and mouth infection, known as SEM, from herpes. Others contract central nervous system disease. Central nervous system disease can include the brain, in which case it is called encephalitis. And though it is rare, it is also possible for infants to develop disseminated herpes, in which the virus infect organs such as the lungs and the liver.

Symptoms

SEM disease appears in a baby's first month of life as a blistered rash atop a red base. An infection involving the central nervous system may also cause a rash but it is also likely to cause symptoms such as a fever, seizures and general irritability. An infant with disseminated herpes infection will most often begin showing symptoms within the first few days of birth. Signs can include seizures, fever, jaundice and respiratory distress. The infant may also be irritable or lethargic.

Frequency

Neonatal herpes affects between 1 in 2000 and 1 in 5,000 live births, according to the University of Washington Academic Medical Center. In 50 percent to 70 percent of cases, the mother shows no signs of herpes lesions at the time she delivers, but is instead shedding the virus subclinically. About half of all neonatal herpes cases are disseminated herpes.

Risks

In a newborn, herpes of the face and eyes progresses to central nervous system or disseminated disease in about 70 percent of cases if left untreated, but only 5 percent to 20 percent of cases if treated early. Disseminated herpes is fatal in more than 80 percent of newborns who contract it if they are not treated and in about 57 percent of infants who are treated. Herpes that is localized to the central nervous system is fatal in about half of cases without treatment and about 10 percent of cases with treatment. Antiviral medications such as acyclovir are the first-line treatment for all types of neonatal herpes.