Iowa Infant Dies of Viral Meningitis Associated with Herpes Infection

Following the recent death of an Iowa infant who suffered complications after becoming infected with the herpes simplex virus type 1 (HSV-1) likely due to a kiss, health experts are reminding the public that the virus can spread easily to babies.

Oral herpes is a highly contagious virus that is spread via oral-to-oral contact, such as kissing. The World Health Organization (WHO) estimates that 3.7 billion individuals around the world have an HSV-1 infection, with the Americas having the lowest prevalence of the virus. HSV-1 is typically acquired during childhood and never goes away, though the infection is typically asymptomatic with most individuals unaware that they even have it. Visible symptoms of oral herpes appear as open sores or ulcers in and around the mouth, or sores on the lips known as cold sores. Less common is herpes simplex virus type 2 (HSV-2), a sexually transmitted infection affecting an estimated 417 million individuals worldwide. In rare cases, a woman infected with genital HSV-1 can pass the virus on to her baby during vaginal delivery, and less commonly, a baby can contract the virus through other forms of contact.

In recent news, a baby girl born in Iowa on July 1, 2017, died less than 3 weeks later of viral meningitis, an infection of the fluid surrounding the brain and spinal cord; the infection was caused by HSV-1. The baby’s parents and doctors say she became infected with the virus when she was less than a week old after being kissed by someone with HSV-1 who had a cold sore. The baby soon stopped eating and was unresponsive when her parents tried to wake her up. The parents took the infant to Blank Children’s Hospital in Des Moines, where doctors diagnosed the baby with meningitis from an HSV-1 infection, and the baby was transferred to University of Iowa Children’s Hospital. Neither of the parents tested positive for the virus, and said the infant likely picked up the infection from a visitor. The baby’s mother announced the infant’s death in a Facebook post on July 18, 2017.

“The majority of neonatal HSV occurs as a result of perinatal transmission, where an infant acquires HSV via the maternal genital tract,” says pediatric infectious disease specialist and Contagion ^® editorial advisory board member Kengo Inagaki, MD, of the University of Mississippi. Perinatal transmission accounts for about 85% of infant HSV cases, he notes. “It is believed that about 10% of neonatal HSV is acquired postnatally, from someone shedding HSV from the mouth who then kisses the baby, from exposure to HSV from a breast lesion, et cetera.”

Dr. Inagaki explains that the symptoms of HSV infection in neonates and young infants can vary. Herpes can result in skin, eye, or mouth (SEM) infections in some babies, and in more serious cases, it leads to central nervous system (CNS) disease, such as meningitis and disseminated disease. “SEM disease is the most common, and can progress to CNS or disseminated disease, and needs to be treated,” says Dr. Inagaki, noting that eye infections can lead to vision loss. “CNS disease can present with seizures, poor feeding, lethargy, and fever. It can result in permanent neurodevelopmental complications, although not all patients have sequelae. Disseminated disease can involve multiple organs, including CNS, liver, and lungs.” If left untreated, mortality due to CNS infection or disseminated disease can be high.

While doctors can take certain steps to prevent HSV transmission from mother to infant during birth, the American Academy of Pediatrics notes that parents, family members, or friends with cold sores must take extra precautions and avoid kissing infants, particularly with babies under 6 months of age who have weak immune systems. Dr. Inagaki notes that if there HSV lesions on the breast, a mother should avoid breastfeeding from that breast. An infant who has been infected with HSV may have a low grade fever and one or more small skin blisters, and symptoms can appear within 2 to 12 days of exposure to the virus. Parents are urged to call their pediatrician if such symptoms occur.