From the Bureau of Sexually Transmitted Infections, New York City Department of Health and Mental Hygiene, Long Island City, NY.
Sex Transm Dis. 2021 Aug 1;48(8S):S4-S10. doi: 10.1097/OLQ.0000000000001458.
Despite advances in diagnosis and treatment, neonatal infection with herpes simplex virus (HSV) has a high case fatality rate. The national burden of neonatal HSV and associated deaths is unknown because this condition is not nationally notifiable. We investigated trends in HSV-related infant deaths compared with infant deaths from congenital syphilis (CS) and human immunodeficiency virus (HIV).
Linked birth-death files for infant deaths from 1995 to 2017 were obtained from the National Center for Health Statistics. These files include infants who were born alive and died in the first 365 days of life and exclude stillbirths. We searched death certificates for disease codes indicating HSV, CS, or HIV, and calculated the frequency and rate of deaths for each infection, overall, by infant sex, and birthing parent age and race/ethnicity.
Nationally, 1591 deaths related to the infections of interest were identified: 1271 related to HSV (79.9%), 234 to HIV (14.7%), and 86 to CS (5.4%). Herpes simplex virus-related deaths increased significantly from 0.83/100,000 live births (95% confidence interval [CI], 0.57-1.17) in 1995 to 1.77 (95% CI, 1.37-2.24) in 2017. In contrast, HIV-related deaths declined: 1.64/100,000 (95% CI, 1.27-2.10) in 1995 to 0.00 in 2017. There was a median of 3 CS-related deaths/year, with elevated frequencies in 1995 to 1996 and 2017 (n = 8). Herpes simplex virus-related death rates were elevated among infants born to birthing parents younger than 20 years (4.17/100,000; 95% CI, 3.75-4.59) and to Black parents (2.86/100,000; 95% CI, 2.58-3.15).
Nationally, HSV-related infant deaths exceeded those caused by HIV and CS and seem to be increasing. Our findings underscore the need for an effective HSV vaccine, test technologies enabling rapid identification of infants exposed to HSV at delivery, and a focus on equity in prevention efforts.
尽管在诊断和治疗方面取得了进展，但新生儿单纯疱疹病毒（HSV）感染的病死率仍然很高。由于这种疾病在全国范围内没有报告要求，因此我们并不了解新生儿单纯疱疹病毒感染和相关死亡的全国负担。本研究旨在调查 HSV 相关婴儿死亡与先天性梅毒（CS）和人类免疫缺陷病毒（HIV）相关婴儿死亡的趋势。
我们从国家卫生统计中心获取了 1995 年至 2017 年与婴儿死亡相关的出生-死亡关联文件。这些文件包括活产并在生命的头 365 天内死亡的婴儿，但不包括死胎。我们在死亡证明上搜索表明 HSV、CS 或 HIV 的疾病代码，并计算了每种感染的死亡频率和死亡率，包括总体情况、婴儿性别、分娩父母年龄和种族/民族。
全国共发现与感染相关的 1591 例死亡：1271 例与 HSV 相关（79.9%），234 例与 HIV 相关（14.7%），86 例与 CS 相关（5.4%）。HSV 相关死亡人数从 1995 年的 0.83/100,000 活产（95%置信区间[CI]，0.57-1.17）显著增加到 2017 年的 1.77（95%CI，1.37-2.24）。相比之下，HIV 相关死亡人数下降：1995 年为 1.64/100,000（95%CI，1.27-2.10），2017 年为 0.00。每年有 3 例 CS 相关死亡，1995 年至 1996 年和 2017 年的频率升高（n=8）。HSV 相关死亡的发生率在分娩父母年龄小于 20 岁（4.17/100,000；95%CI，3.75-4.59）和黑人父母（2.86/100,000；95%CI，2.58-3.15）的婴儿中较高。
在全国范围内，HSV 相关婴儿死亡人数超过了 HIV 和 CS 相关死亡人数，而且似乎还在增加。我们的研究结果强调需要一种有效的 HSV 疫苗、能够在分娩时快速识别暴露于 HSV 的婴儿的检测技术，以及关注预防工作中的公平性。
