Prevention of HSV Morbidity in Pregnancy and the Newborn

生殖器疱疹的危害有哪些？生殖器疱疹的危害有哪些？ 在过去的几十年里，频率没有下降。然而，没有任何预防战略， 切实贯彻HSV传播的风险在新感染HSV-2或HSV-3的女性中最高。 生殖道中的HSV-1和血清阴性者; HSV-1血清阳性妇女的风险也很高 新获得HSV-2或HSV-1再激活的患者;已确诊HSV-2的女性风险较低 感染分娩时生殖器HSV脱落与HSV相对风险>300相关 传输我们已经建立了一种敏感和特异的HSV DNA PCR，可以在2 小时获得样品;测试正在完成验证研究，以便在 华盛顿大学医院临床实验室。我们建议使用该测定来开发一种 检测婴儿在分娩时暴露于HSV的策略，并评估实施的可行性 干预措施，以降低暴露的新生儿感染HSV-1和HSV-2的风险。具体目标1是 以确定新生儿在分娩时暴露于HSV的发生率。我们假设 通过PCR检测HSV DNA，结合HSV血清学检测（在孕妇中常规进行）， 华盛顿大学的妇女），将准确地确定暴露于HSV的婴儿的高风险与低风险 新生儿疱疹的风险医疗团队将利用这些信息来降低HSV的风险 通过产科实践（剖腹产，减少使用胎儿监护设备，使用IV 阿昔洛韦）或随后的管理HSV暴露的婴儿。具体目标2将评估 分娩时静脉注射阿昔洛韦，然后对新生儿口服阿昔洛韦， 一种治疗HSV-2血清反应阳性的分娩时排出HSV的妇女及其婴儿的方法， 在出生时接触HSV。我们假设，静脉注射阿昔洛韦给分娩的妇女将导致 治疗水平的阿昔洛韦在脐带血中，口服阿昔洛韦给新生儿将 通过临床和实验室测量评估是可行的，并且儿科医生和家长可以接受。 这种方法改变了目前预防新生儿疱疹的模式， 疾病的检测和管理的婴儿暴露于亚临床感染分娩。的 该项目将首次收集有关目前美国儿科学会HSV指南的数据 暴露的婴儿和开发工具，用于预防新生儿HSV，可以在多中心试验中进行测试。 新生儿疱疹是新生儿中的一种严重疾病。该项目将开发识别新生儿的工具 在出生时暴露于HSV的风险，并为有新生儿疱疹风险的新生儿提供最佳护理。

Neonatal herpes continues to be the most devastating consequence of genital herpes infections, with a frequency that has not declined in the last several decades. Yet no prevention strategies have been implemented. The risk of HSV transmission is highest among women who have newly acquired HSV-2 or HSV-1 in the genital tract and who are seronegative; the risk is also high among HSV-1 seropositive women who have newly acquired HSV-2 or reactivation of HSV-1; the risk is low in women with established HSV-2 infection. Genital HSV shedding at the time of delivery is associated with a relative risk of >300 for HSV transmission. We have developed a sensitive and specific HSV DMA PCR that can be resulted within 2 hours of obtaining the sample; the test is completing validation studies for implementation for routine use in the University of Washington Hospital Clinical Laboratories. We propose to use this assay to develop a strategy to detect the infant exposed to HSV at delivery and to evaluate the feasibility of implementing interventions to reduce the risk of HSV-1 and HSV-2 infections in the exposed newborns. Specific Aim 1 is to determine the incidence of exposure of the neonate to HSV at the time of delivery. We hypothesize that HSV DMA detection by PCR, in combination with HSV serologic testing (performed routinely in pregnant women at the University of Washington), will accurately define HSV-exposed infants at high versus low risk of developing neonatal herpes. This information will be utilized by the medical team to reduce the risk of HSV infection either through obstetrical practices (C-section, reduced use of fetal monitoring devices, use of IV acyclovir) or subsequent management of the HSV exposed infant. Specific Aim 2 will evaluate the feasibility of intrapartum intravenous acyclovir, followed by oral acyclovir to the neonate, as an approach for managing HSV-2 seropositive women who shed HSV at delivery and their infants who are exposed to HSV during birth. We hypothesize that IV acyclovir given to women in labor will result in therapeutic levels of acyclovir in the cord blood, and that oral administration of acyclovir to the newborn will be feasible, as evaluated by clinical and laboratory measures, and acceptable to pediatricians and parents. This approach shifts the current paradigm for prevention of neonatal herpes from the women with clinical disease to the detection and management of the infant exposed to subclinical infection at delivery. The project will for the first time collect data on current American Academy of Pediatrics guidelines for HSV exposed infants and develop tools for prevention of neonatal HSV that can be tested in multicenter trials. Neonatal herpes is a serious disease among newborns. The project will develop tools to identify newborns exposed to HSV at birth at risk and develop optimal care for newborns who are at risk for neonatal herpes.