HERPES SIMPLEX: PREGNANCY, NEONATAL RISK, HOST DEFENSE

新生儿单纯疱疹病毒感染的发病率正在平行增加。 随着生殖器HSV感染的增加。防止大多数人 新生儿单纯疱疹病毒感染取决于避免接触 在送货时携带病毒。如果存在损伤，通过以下方式交付 有剖腹产指征。不幸的是，大多数新生儿 感染是由接触无症状母亲引起的 单纯疱疹病毒的排泄，通常由无生殖器病史的妇女引起 疱疹。产前培养未能预测 既往复发妇女在分娩时无症状的脱落 生殖器疱疹以及许多婴儿的母亲 新生儿HSV无生殖器疱疹病史要求 解决新生儿单纯疱疹病毒问题的另一种方法。大多数生殖器 单纯疱疹病毒感染是由单纯疱疹病毒2型引起的。血清流行病学研究 由于HSV-1和HSV-2之间的交叉反应而受到阻碍 抗原直到血清学方法的发展才能检测到 针对HSV-2特异性糖蛋白的抗体。我们建议 调查单纯疱疹病毒病毒培养的价值 分娩，与母亲疱疹病史和HSV-2无关 妊娠早期和晚期的特异性血清学检测。过去或 最近的HSV-2感染将通过检测配对血清来确定 从第一次产前检查和妊娠28-32周开始使用 酶联免疫吸附试验检测HSV-2糖蛋白G抗体， 它具有HSV-2的特异性表位。单纯疱疹病毒2型感染的频率 连续妊娠合并或不合并妊娠的感染情况 生殖器单纯疱疹病毒病史及原发比例 将对感染情况进行评估。培养将从所有人那里获得 分娩时的母亲和婴儿(每年约5000人)。这个 贝壳瓶培养与单纯疱疹病毒抗原检测的敏感性和特异性 酶免疫渗滤法快速诊断流行性出血热 新生儿接触HSV将与标准组织进行比较 养殖技术。无症状脱发的频率 有或没有血清学证据的妇女分娩时的HSV 将确定过去或最近感染HSV-2的人数。这个 早产、低出生体重和/或有证据表明 新生儿宫内单纯疱疹病毒感染的研究 将评估HSV-2感染的血清学证据。大部分 新生儿单纯疱疹病毒的持续发病率和死亡率是由于 延迟诊断。虽然交付文化不会阻止 婴儿接触无症状的母体单纯疱疹病毒，鉴定 应允许早期诊断和立即 新生儿单纯疱疹病毒的抗病毒治疗。已知的婴儿暴露于 将监测无症状的孕妇HSV以确定 亚临床和临床型单纯疱疹病毒感染的频率。裸露 未感染HSV的新生儿将与HSV- 在研究期间转介的感染新生儿使用化验 对于HSV中和抗体，抗体介导细胞 细胞毒性和抗单纯疱疹病毒糖蛋白抗体。失败的原因是 产前培养用于预测和预防新生儿 在分娩时接触HSV使开发一种 理性看待新生儿单纯疱疹病毒感染问题

The incidence of neonatal HSV infections is increasing in parallel with the increase in genital HSV infections. Preventing most cases of neonatal HSV infections depends upon avoiding contact with the virus at delivery. If lesions are present, delivery by cesarean section is indicated. Unfortunately, most neonatal infections result from exposure to asymptomatic maternal excretion of HSV, often by women with no past history of genital herpes. The failure of antepartum cultures to predict asymptomatic shedding at delivery in women with past recurrent genital herpes along with the fact that many mothers of infants with neonatal HSV have no history of genital herpes requires another approach to the problem of neonatal HSV. Most genital HSV infections are caused by HSV-2. Seroepidemiologic studies have been hampered by cross-reactivity between HSV-1 and 2 antigens until the development of serologic methods which detect antibodies to HSV-2 specific glycoproteins. We propose to investigate the value of taking viral cultures for HSV at all deliveries, regardless of maternal herpes history, and of HSV-2 specific serologic testing early and late in gestation. Past or recent HSV-2 infection will be determined by testing paired sera from the first prenatal visit and 28-32 weeks gestation using an ELISA method to detect antibodies to the HSV-2 glycoprotein G, which has HSV-2 specific epitopes. The frequency of HSV-2 infections in consecutive pregnant women with or without a history of genital HSV and the proportion which are primary infections will be assessed. Cultures will be obtained from all mothers and infants at delivery (approximately 5000/year). The sensitivity and specificity of shell vial culture and HSV antigen detection by enzyme immunofiltration for rapid diagnosis of neonatal HSV exposure will be compared with a standard tissue culture technique. The frequency of asymptomatic shedding of HSV at delivery among women with or without serologic evidence of past or recent HSV-2 infections will be determined. The frequency of prematurity, low birth weight, and/or evidence of intrauterine HSV infections among neonates born to mothers with serologic evidence of HSV-2 infections will be assessed. Much of the continued morbidity and mortality of neonatal HSV is due to delayed diagnosis. While delivery cultures will not prevent the exposure of infants to asymptomatic maternal HSV, identification of exposed infants should allow early diagnosis and immediate antiviral therapy of neonatal HSV. Infants known to be exposed to asymptomatic maternal HSV will be monitored to determine the frequency of subclinical and clinical HSV infections. Exposed neonates who do not contract HSV will be compared with HSV- infected neonates referred during the study period using assays for HSV neutralizing antibody, antibody mediating cellular cytotoxicity and antibodies to HSV glycoproteins. The failure of antepartum cultures to predict and therefore prevent neonatal exposures to HSV at delivery has made it critical to develop a rational approach to the problem of neonatal HSV infections.