澳大利亚 1997-2011 年基于人群的新生儿单纯疱疹病毒感染监测。

Population-based surveillance of neonatal herpes simplex virus infection in Australia, 1997-2011.

机构信息

Discipline of Paediatrics and Child Health, Sydney Medical School The Marie Bashir Institute for Infectious Diseases and Biosecurity, The University of Sydney Department of Microbiology and Infectious Diseases, The Children's Hospital at Westmead Centre for Perinatal Infection Research, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.

Discipline of Paediatrics and Child Health, Sydney Medical School Centre for Perinatal Infection Research, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.

出版信息

Clin Infect Dis. 2014 Aug 15;59(4):525-31. doi: 10.1093/cid/ciu381. Epub 2014 May 20.

DOI:10.1093/cid/ciu381

PMID:24846638

Abstract

BACKGROUND

Neonatal herpes simplex virus (HSV) infection is uncommon, but mortality after disseminated disease and morbidity after encephalitis are high. For the last decade, increased dose and duration of acyclovir has been advised to prevent disease progression and recurrence. We sought to determine prospectively the epidemiologic, clinical, and secular trends of this condition in Australia.

METHODS

This was prospective national active surveillance for neonatal HSV disease through the Australian Paediatric Surveillance Unit from 1997 to 2011. Case notification triggered a questionnaire requesting de-identified data from the pediatric clinician.

RESULTS

We identified 131 confirmed cases of neonatal HSV disease in 15 years from 261 notifications (95% response). The reported incidence (3.27 cases per 100 000 live births overall; 95% confidence interval [CI], 2.73-3.86) was stable. Overall mortality was 18.8% (95% CI, 12.1-25.5); the mortality rate was significantly lower in the latter part of the study period, 2005-2011, compared with 1997-2004 (P = .04). There were significantly more young mothers (<20 years of age) compared with Australian birth record data (18.5% vs 4.8%; P < .001). HSV-1 infection was more common than HSV-2 (62.7% vs 37.3%; P < .001), and the rate of HSV-1 infections increased significantly over the surveillance period (P < .05). From 2002, most infants received high-dose acyclovir. The time from symptom onset to initiation of therapy in survivors did not change over time.

CONCLUSIONS

Mortality from neonatal HSV infection has fallen but remains high. HSV-1 is the major serotype causing neonatal disease in Australia. Young mothers represent an important target group for prevention.

摘要

背景

新生儿单纯疱疹病毒（HSV）感染并不常见，但播散性疾病后的死亡率和脑炎后的发病率都很高。在过去的十年中，建议增加阿昔洛韦的剂量和持续时间，以防止疾病进展和复发。我们旨在前瞻性地确定澳大利亚这种疾病的流行病学、临床和时间趋势。

方法

这是通过澳大利亚儿科监测单位从 1997 年到 2011 年进行的新生儿 HSV 疾病的全国性主动监测。病例报告触发了一份调查问卷，要求儿科临床医生提供匿名数据。

结果

我们在 15 年的时间里从 261 份报告中发现了 131 例确诊的新生儿 HSV 疾病病例（95%的应答率）。报告的发病率（总体每 100000 例活产儿 3.27 例；95%置信区间 [CI]，2.73-3.86）是稳定的。总体死亡率为 18.8%（95%CI，12.1-25.5）；与 1997-2004 年相比，研究后期（2005-2011 年）的死亡率显著降低（P =.04）。与澳大利亚出生记录数据相比，年轻母亲（<20 岁）的比例明显更高（18.5%对 4.8%；P <.001）。HSV-1 感染比 HSV-2 更常见（62.7%比 37.3%；P <.001），并且在监测期间 HSV-1 感染率显著增加（P <.05）。自 2002 年以来，大多数婴儿接受了高剂量阿昔洛韦治疗。幸存者从症状出现到开始治疗的时间没有随时间变化。