Undoubtedly you've seen in the news media and all over social media the posts by all of the stressed out overly-panicked and ill-informed parents warning friends and family to stop kissing the babies. You know the ones I'm talking about. The freaked out parents terrorizing other parents, friends, and family members simply out of fear of the herpes HSV-1 virus because they KNOW just a kiss will kill their babies. If you dig a little, this not so nice trend of well-meaning PSAs caught traction in/or around 2016 in the news and on social media after stories like, "Wash Your Hands - Dad's Heartbreaking Warning to All New Parents After His Baby Girl Dies of Herpes at 3 Weeks Old," and has since terrified new parents - so much so that grandma and grandpa (or grammy and pawpaw as we say) can't kiss their own grandbabies.
Are there risks to newborns/infants contracting HSV from family or friends? Absolutely! But how at risk is your little bundle of joy?
Is Your Fear Rational? Let's Look!
While the herpes simplex virus (HSV) has been known to man since ancient times, it was not until the 18th century that the virus was identified as the cause of genital herpes (HSV-2). Neonatal HSV infection was not first recorded until the 1930s or 1940s (conflicting data was found) and the association between newborn disease and HSV-2 infection was identified in the late 1960s. HSV-1 is generally associated with cold sores or fever blisters, the small fluid-filled blisters that appear around the mouth, whereas HSV-2 is generally associated with genital herpes, although both HSV-1 and 2 can cause genital herpes.
With the evolution of our society in developed countries, particularly increasing sexual freedom associated with advances in birth control, and the emergence of sexually transmitted diseases, both horizontal (sexual partners) and vertical (mother to baby) transmission of HSV infection has become prevalent. Today, genital HSV infection exists in over 60 million Americans, most of child-bearing age, and results in the majority of the 1600 cases of neonatal herpes that occur yearly in the United States. (1)
An estimated 491.5 million people were living with HSV-2 infection in 2016, equivalent to 13.2% of the world’s population aged 15 to 49 years. HSV-2 is almost exclusively sexually transmitted, causing infection in the genital or anal area (genital herpes).
An estimated 3.7 billion people had HSV-1 infection during the same year – around 66.6% of the world’s population aged 0 to 49. HSV-1 is mainly transmitted by oral to oral contact to cause infection in or around the mouth (oral herpes). However, HSV-1 can also be transmitted to the genital area through oral-genital contact – during oral sex – to cause genital herpes. (3)
In fact, the incidence of neonatal HSV infections in the United States may reflect the decreasing prevalence of HSV-1 antibodies and, therefore, the absence of transplacental humoral immunity, which might confer protection to the fetus. (1).
Although babies can can catch HSV from close contact with an infected person, the greatest risk of baby catching HSV is from his or her own mother during vaginal delivery or even cesarean delivery in some cases. This is probably not what momma wanted to hear! Newborns (born) with HSV will require hospitalization for intravenous antiviral medication for 21 days. Even with antiviral treatment, some newborns can suffer death or brain damage from HSV infection depending on multiple factors, such as the type of infection.
"A study published in January 2017 in The Lancet Global Health states that 85 percent of herpes-infected newborns contract the disease from their mothers during delivery." (2) It is estimated that 1 newborn out of every 3,200 live births in the U.S. contracts HSV. Five percent will contract the virus in utero, 85% during the peripartum period, and 10% from either mom, another family member, or a caregiver during the postpartum period.
Newborns and infants who contract HSV can become very sick very quickly, and in the pre-antiviral medication era, most babies with HSV had very poor outcomes with significant rates of death (mortality). Luckily however, for today's babies with HSV infections that are localized to the eyes/skin/mouth, they are associated with no mortality. "For babies with skin, eye, and mouth infection, there were no deaths; 90% and 98% of vidarabine and acyclovir recipients, respectively, were developing normally at 2 years of age." (1)
Babies with the greatest and most dire prognoses are those with disseminated infection - those involving multiple organs, especially the lungs, liver, adrenal glands, and brain. "Mortality in the absence of (antiviral) therapy exceeds 80%; all but a few survivors are impaired. These babies appear not to receive transplacental antibodies." (1)
What Are the Symptoms of HSV in Newborns/Infants?
In the majority of cases, newborns/infants and young children who get HSV will only experience skin, eye and mouth symptoms, such as a rash, eye lesions, cold sores/fever blisters or ulcers without any complications. With or without obvious signs of infection, as previously described, you will want to watch for other symptoms of HSV infection that could include:
Being less active than normal (lethargic or floppy)
Excessive crying or fussiness
Fever higher than 100.4° (taken rectally)
Not waking up to eat
Seizures
If your baby/child experiences any of the above symptoms, contact your pediatrician immediately. Do not waste time posting on Facebook asking for mom advise - CALL THE DOCTOR!
For babies with skin, eye, and mouth infections, although there were no deaths; and 90% and 98% who receive antiviral therapy of vidarabine and acyclovir, were developing normally at 2 years of age, and most babies will be just fine with treatment - some babies can get sick very quickly, so don't risk it!
What Are the Potential Complications of HSV in Newborns/Infants If Not Treated?
HSV in older children and adults rarely becomes serious. However, because a baby’s immune system isn’t fully developed (even if breastfeeding), some can experience serious problems if HSV isn’t diagnosed and treated properly. Complications could include:
Encephalitis (brain infection)
Infection of the central nervous system
Organ failure or infection of the liver, lungs or kidneys
Meningitis (causes swelling of the brain and spinal cord)
Seizures
Vision problems, eye disease, or even blindness
It's a real concern for sure, but remember it is very rare. Although the death of an infant from complications related to an HSV-1 infection is very rare, these complications can cause brain damage, permanent disability and even death. This is why it’s important to learn about the symptoms so you can get medical treatment as soon as possible.
How To Protect Your Baby from HSV
The #1 thing you can do to protect your baby from HSV is to have an open, honest, and transparent conversations with your OB or midwife. If you have any previous history of HSV or are experiencing an outbreak, you need to take the responsibility of protecting your baby seriously, and you need to know what options are available to you for a safe delivery. Depending on your own individual circumstances, your provider will discuss options for either drug treatments available that would allow you to safely have a vaginal delivery, or you may need to deliver via cesarean to ensure the safety of your baby. Higher rates of cesareans are attributed to HSV infections - either because of mom's own choice or provider recommendation, but that's for another day.
The next best safeguard to protect your babies from HSV and all other viruses and bacteria, is to:
Have everyone thoroughly wash their hands before holding the baby. They can also use hand sanitizer after washing. It is 2021 after all.
Do not allow anyone WITH A COLD SORE on their face (mouth/lips) to kiss your baby. There it is! That's when you say, "Don't kiss my baby!"
HSV-1 or oral herpes is mostly asymptomatic and the majority of people don't even know they are infected and may not ever present with any symptoms (cold sore or fever blister). Can someone spread HSV while asymptomatic (without a sore)? Yes, but it is extremely rare!
Can my baby die from a cold sore? The death of an infant from complications related to an HSV-1 infection is extremely rare.
Can my baby catch HSV from grammy or pawpaw? It's a concern, but it is rare.
So, it's okay to give kisses - lots and lots of baby kisses!!!!
Who doesn't love baby kisses?
References:
Whitley, R. (1995). Herpes Simplex Virus Infections of Women and Their Offspring: Implications for a Developed Society. The National Academic Press. https://www.nap.edu/read/4772/chapter/13
Horsager-Boehrer, R., Kahn, J. (2017 August 22). Your Pregnancy Matters: How to Protect Your Baby From Herpes Infection. UT Southwestern Medical Center. https://utswmed.org/medblog/herpes-simplex-pregnancy-baby
Massive proportion of world’s population are living with herpes infection. (2020 May 1). World Health Organization. https://www.who.int/news/item/01-05-2020-massive-proportion-world-population-living-with-herpes-infection
Resources for more info:
James, S. H., Sheffield, J. S., & Kimberlin, D. W. (2014). Mother-to-Child Transmission of Herpes Simplex Virus. Journal of the Pediatric Infectious Diseases Society, 3 Suppl 1(Suppl 1), S19–S23. https://doi.org/10.1093/jpids/piu050
Cold sores: Overview. (n.d.). aad.org/public/diseases/a-z/cold-sores-overview
Cold sores: Overview. (2018). ncbi.nlm.nih.gov/books/NBK525782/
Cold sores in children: About the herpes simplex virus. (2017). healthychildren.org/English/health-issues/conditions/skin/Pages/Herpes-Simplex-Virus-Cold-Sores.aspx
Neonatal herpes (herpes in a baby). (2018). nhs.uk/conditions/neonatal-herpes/