TP 76 Neonatal Herpes Simplex Virus Infection Is the UK Special Anymore?

Tuesday, June 10, 2014
Exhibit Hall
Emily Clarke, BSc(Hons) BM DMCC DLSHTM MSc MRCP(UK)1, Eleanor Shone, Medical Student2, Charlotte Wright, medical student3 and Raj Patel, FRCP1, 1Department of Sexual Health, Royal South Hants Hospital, Southampton, United Kingdom, 2Faculty Of Medicine, University of Southampton, Southampton, United Kingdom, 3Faculty of Medicine, University of Southampton, Southampton, United Kingdom

Background:  Neonatal herpes simplex virus (HSV) infection is associated with high morbidity and mortality. UK surveillance of neonatal HSV from 1986-1991 yielded 76 cases, with an incidence of 1:60,000 live births annually, approximately 50% of Europe, and 25% of the USA. Provisional data from 2004-2006 yielded 86 cases, approximately doubling the incidence. Anecdotal reports of further increases in central England were presented in early 2013. 

Methods:  The LabBase database of laboratory reports of neonatal HSV in England and the GUMCAD database of diagnoses in Genitourinary Medicine (GUM) clinics from January 2010-March 2013 were reviewed. A questionnaire about neonatal HSV was distributed to GUM and obstetrics physicians at national conferences. 

Results:  12 neonatal HSV infections were reported in January-March 2013, compared with 11 in October-December 2012. 66 cases were reported in 2012, 65 in 2011 and 44 in 2010, giving a 2012 incidence of 1:10,426 live births. Numbers of first episode genital HSV diagnoses among women reported from laboratories decreased slightly from 13,801 in 2010 to 13,167 in 2013, although reported diagnoses from GUM clinics between 2012 and 2013 increased from 18,744 to 19,311. 56 out of 113 physicians completing the questionnaire demonstrated basic knowledge of neonatal HSV, but 82.14% of these underestimated the vertical transmission rate with active HSV shedding at term.

Conclusions:  The UK incidence of neonatal herpes has risen significantly from 1:60,000 live births from 1986-1991 to 1:10,426 in 2012, although there is no evidence of a more recent increase. New UK guidelines for HSV in pregnancy are in the process of being published, and recommend conservative management with vaginal delivery for women with recurrences of HSV. Ongoing incidence of neonatal herpes must be observed to ensure that a further increase is not seen. Lack of physician knowledge of transmission rates may lead to over reassurance of patients.