Tita Alan T N, Grobman William A, Rouse Dwight J
Center for Research in Women's Health, University of Alabama at Birmingham, Birmingham, Alabama 35233, USA.
Obstet Gynecol. 2006 Nov;108(5):1247-53. doi: 10.1097/01.AOG.0000236433.29679.9a.
Calls for universal antenatal type-specific herpes simplex virus (HSV) screening to prevent neonatal herpes have recently increased and would affect the four million pregnant women and their partners annually in the United States. We undertook this review to assess the appropriateness of such screening, making relevant comparisons to established antenatal human immunodeficiency virus (HIV) and hepatitis B virus (HBV) screening programs.
We conducted a full PubMed and bibliographic search for relevant literature in English available from 1966 through February 2006, using the terms "genital herpes," "neonatal herpes," "decision analysis" or "cost-effectiveness analysis," and "herpes and pregnancy" or "antenatal herpes screening." Comparison literature was obtained by replacing "herpes" with "HBV" or "HIV".
We appraised antenatal type-specific HSV screening using well-established criteria for a good screening program, which we articulated as questions. Of 455 articles we selected those that addressed at least one of the questions and were pertinent to the U.S. population.
TABULATION, INTEGRATION, AND RESULTS: We found that neonatal HSV is rare and its incidence is imprecisely defined. There is a lack of evidence supporting the effectiveness of interventions to prevent maternal acquisition of new infection in late pregnancy, which accounts for 60-80% of neonatal herpes. The consequences of universal screening are incompletely understood but include the potential for unnecessary cesarean deliveries and medical treatment, maternal psychosocial stress, and discord among partners. The available evidence indicates universal screening is not cost-effective. In contrast, antenatal HIV and HBV screening programs better satisfy accepted criteria for screening.
On the basis of this appraisal, universal antenatal type-specific HSV screening to prevent neonatal herpes does not adequately satisfy criteria of a good screening program, and we recommend against its adoption.
近期，要求进行普遍的产前特定类型单纯疱疹病毒（HSV）筛查以预防新生儿疱疹的呼声日益增高，这在美国每年将影响400万孕妇及其伴侣。我们进行此项综述以评估这种筛查的合理性，并与既定的产前人类免疫缺陷病毒（HIV）和乙型肝炎病毒（HBV）筛查项目进行相关比较。
我们对1966年至2006年2月期间可用的英文相关文献进行了全面的PubMed和文献检索，使用了“生殖器疱疹”“新生儿疱疹”“决策分析”或“成本效益分析”以及“疱疹与妊娠”或“产前疱疹筛查”等术语。通过将“疱疹”替换为“HBV”或“HIV”获取比较文献。
我们使用已确立的良好筛查项目标准对产前特定类型HSV筛查进行评估，这些标准以问题的形式阐述。在455篇文章中，我们选择了那些至少回答了其中一个问题且与美国人群相关的文章。
制表、整合与结果：我们发现新生儿HSV感染罕见，其发病率定义不精确。缺乏证据支持在妊娠晚期预防母亲获得新感染的干预措施的有效性，而妊娠晚期感染占新生儿疱疹的60 - 80%。普遍筛查的后果尚未完全了解，但包括可能进行不必要的剖宫产和医学治疗、母亲的心理社会压力以及伴侣之间的不一致。现有证据表明普遍筛查不具有成本效益。相比之下，产前HIV和HBV筛查项目更符合公认的筛查标准。
基于此项评估，为预防新生儿疱疹而进行的普遍产前特定类型HSV筛查不能充分满足良好筛查项目的标准，我们建议不要采用。
