Neonatal herpes simplex virus infections: is there a role for immunoglobulin in disease prevention and therapy?

Neonatal herpes simplex virus infections cause significant morbidity and mortality among infected babies, despite the availability of antiviral therapy. These infections manifest in one of three forms: skin, eye, and mouth involvement; encephalitis; or disseminated infection. The latter two forms of disease account for more than 50% of babies with neonatal herpes and are associated with mortality and severe morbidity rates that exceed 75% in infected children. Thus future therapeutic efforts must be directed toward improved disease outcome. One such effort is the evaluation of immunoglobulin products (humanized monoclonal antibodies, human monoclonal antibodies and hyperimmune globulin) as part of a concomitant therapeutic regimen for babies with encephalitis and disseminated infection. The logic for such an approach becomes especially apparent for babies with disseminated disease because little transplacental maternal antibody is received at the time of birth. Thus concomitant administration of antiviral therapy with antibody may improve disease outcome.