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Vilibic-Cavlek T, Belamaric M, Ferenc T, Navolan D, Kolaric B, Milasincic L, Antolasic L, Vujica Ferenc M, Vilibic M, Lukunic A, Bogdanic M. Seroepidemiology of Herpes Simplex Viruses Type 1 and 2 in Pregnant Women in Croatia. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:284. [PMID: 38399571 PMCID: PMC10890541 DOI: 10.3390/medicina60020284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Revised: 02/04/2024] [Accepted: 02/06/2024] [Indexed: 02/25/2024]
Abstract
Background and Objectives: Herpes simplex viruses (HSV-1 and HSV-2) are one of the most widespread causes of human viral infections. In Croatia, only two published studies have analyzed the seroprevalence of HSV infections in childbearing-aged and pregnant women (2005-2010), while more recent data are lacking. This study aimed to analyze the prevalence and risk factors for HSV-1 and HSV-2 infections among pregnant women in Croatia in the period from 2011 to 2021. Materials and Methods: This study included 667 pregnant women aged 16-45 years submitted for HSV-1 and HSV-2 serology testing. Serum samples were initially screened for HSV-1 and HSV-2 IgM and IgG antibodies using a commercial ELISA test with a confirmation of HSV-2-positive samples using an immunoblot assay. Results: The overall IgG seroprevalence rates were 69.9% for HSV-1 and 3.8% for HSV-2. A significant gradual increase in the HSV-2 seroprevalence with age was observed from 0.5% in participants under 30 years to 8.3% in participants above 40 years. The HSV-1 seroprevalence was stable up to 40 years (70.0 and 68.3%, respectively), with an increase to 86.1%, but this difference did not reach statistical significance. Area of residence (urban or suburban/rural), geographic region (continental or coastal), and obstetric history (normal pregnancy or unfavorable obstetric history) were not associated with HSV-1 and HSV-2 seroprevalence. Older age was found to be a significant risk factor for HSV-2 seropositivity in both univariate and multivariate risk analysis. Conclusions: HSV-1 infection is widely prevalent among pregnant women with a stable trend over time. However, a declining trend in the HSV-2 seroprevalence was observed compared to 2005-2010. Serological screening in pregnant women is important in identifying seronegative women who are susceptible to HSV infection as well as seropositive women who are at risk for genital herpes recurrence during delivery.
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Affiliation(s)
- Tatjana Vilibic-Cavlek
- Department of Virology, Croatian Institute of Public Health, 10000 Zagreb, Croatia; (L.M.); (L.A.)
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Marko Belamaric
- Teaching Institute for Emergency Medicine, 10000 Zagreb, Croatia;
| | - Thomas Ferenc
- Department of Diagnostic and Interventional Radiology, University Hospital Merkur, 10000 Zagreb, Croatia;
| | - Dan Navolan
- Department of Obstetrics and Gynecology, ‘Victor Babes’ University of Medicine and Pharmacy, 300041 Timisoara, Romania;
| | - Branko Kolaric
- Andrija Stampar Teaching Institute of Public Health, 10000 Zagreb, Croatia;
- Department of Social Medicine and Epidemiology, Medical Faculty, University of Rijeka, 51000 Rijeka, Croatia
| | - Ljiljana Milasincic
- Department of Virology, Croatian Institute of Public Health, 10000 Zagreb, Croatia; (L.M.); (L.A.)
| | - Ljiljana Antolasic
- Department of Virology, Croatian Institute of Public Health, 10000 Zagreb, Croatia; (L.M.); (L.A.)
| | - Mateja Vujica Ferenc
- Department of Obstetrics and Gynecology, University Hospital Centre Zagreb, 10000 Zagreb, Croatia;
| | - Maja Vilibic
- Department of Psychiatry, Sestre Milosrdnice University Hospital Center, 10000 Zagreb, Croatia;
- School of Medicine, Catholic University of Croatia, 10000 Zagreb, Croatia
| | - Adriana Lukunic
- Department of Microbiology, University of Applied Health Sciences, 10000 Zagreb, Croatia;
| | - Maja Bogdanic
- Department of Virology, Croatian Institute of Public Health, 10000 Zagreb, Croatia; (L.M.); (L.A.)
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Poole CL, Kimberlin DW. Antiviral Approaches for the Treatment of Herpes Simplex Virus Infections in Newborn Infants. Annu Rev Virol 2019; 5:407-425. [PMID: 30265626 DOI: 10.1146/annurev-virology-092917-043457] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Herpes simplex virus (HSV) infections in newborns are associated with severe disease and death. Trials conducted by the Collaborative Antiviral Study Group have established the standard of care for the treatment of neonatal HSV disease with marked improvements in morbidity and mortality. We review the studies that have contributed to our understanding of the epidemiology and clinical course of neonatal HSV disease and discuss the landmark trials that have resulted in safe and effective treatment together with improved diagnostics. Although significant advances have been made, neonatal HSV disease continues to have an unacceptably high mortality rate with significant sequelae in survivors. Further research is urgently needed for prevention.
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Affiliation(s)
- Claudette L Poole
- Division of Pediatric Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama 35233, USA; ,
| | - David W Kimberlin
- Division of Pediatric Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama 35233, USA; ,
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Finger-Jardim F, Avila EC, da Hora VP, Santos PCD, Gonçalves CV, Mor G, de Martinez AMB, Soares MA. Herpes simplex virus type 2 IgG antibodies in sera of umbilical cord as a proxy for placental infection in asymptomatic pregnant women. Am J Reprod Immunol 2018; 79:e12824. [PMID: 29427299 DOI: 10.1111/aji.12824] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 01/17/2018] [Indexed: 12/15/2022] Open
Abstract
PROBLEM Herpes simplex virus type 2 (HSV-2) infection is one of the most prevalent diseases worldwide and is mainly sexually transmitted. When infecting pregnant women, HSV-2 is able to infect the placenta, can reach the fetus, and may affect the fetal development. We sought to determine the prevalence of HSV-2 infection and reactivation in asymptomatic pregnant women, the correlation between IgG in the maternal circulation and cord blood, and the correlation between circulating IgG, placental, and newborn infection (blood cord). METHOD OF STUDY Serum samples and placental tissues from pregnant women and umbilical cord blood samples from their newborns were collected. Anti-HSV-2 antibodies were identified by ELISA, and HSV-2 DNA was detected by nested PCR. RESULTS The seropositivity of IgG in pregnant women was 29.7% and IgM was detected in 1 woman (0.5%). In the umbilical cord of newborns, 33.1% were IgG-positive and IgM was detected in 2 samples (1.5%). A positive correlation between HSV-2 IgG titers in serum from pregnant women and cord blood samples was found (r = .36, P = .001). A difference between the positive and negative placental groups (maternal side) was found in titers of IgG in sera of umbilical cord, which were significantly higher in the positive placental group (P = .004). CONCLUSION We describe for the first time that newborns from mothers with HSV-2 placental infection have higher IgG titers in sera of umbilical cord, suggesting IgGs antibodies can be indicative of placental viral infection in asymptomatic women.
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Affiliation(s)
- Fabiana Finger-Jardim
- Molecular Biology Laboratory, School of Medicine, Universidade Federal do Rio Grande, Rio Grande, Brazil
| | - Emiliana Claro Avila
- Molecular Biology Laboratory, School of Medicine, Universidade Federal do Rio Grande, Rio Grande, Brazil
| | - Vanusa Pousada da Hora
- Molecular Biology Laboratory, School of Medicine, Universidade Federal do Rio Grande, Rio Grande, Brazil
| | - Paula Costa Dos Santos
- Parasitology Laboratory, School of Medicine, Universidade Federal do Rio Grande, Rio Grande, Brazil
| | - Carla Vitola Gonçalves
- Center for Obstetrics and Gynecology, School of Medicine, Universidade Federal do Rio Grande, Rio Grande, Brazil
| | - Gil Mor
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, CT, USA
| | | | - Marcelo Alves Soares
- Oncovirology Program, Instituto Nacional do Câncer (INCA), Rio de Janeiro, Brazil
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Picone O. [Genital herpes and pregnancy: Epidemiology, clinical manifestations, prevention and screening. Guidelines for clinical practice from the French College of Gynecologists and Obstetrician (CNGOF)]. ACTA ACUST UNITED AC 2017; 45:642-654. [PMID: 29146286 DOI: 10.1016/j.gofs.2017.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To analyze the consequences of genital herpes infections in pregnant women. METHODS The PubMed database and the recommendations from the French and foreign obstetrical societies or colleges have been consulted. RESULTS The symptomatology of herpes genital rash is often atypical (NP2) and not different during pregnancy (Professional consensus). It is most often due to HSV2 (NP2). Seventy percent of pregnant patients have a history of infection with Herpes simplex virus, without reference to genital or labial localization, and this is in most cases type 1 (NP2). The prevalence of clinical herpes lesions at birth in the event of recurrence is about 16% compared with 36% in the case of initial infection (NP4). In HSV+ patients, asymptomatic herpetic excretion is 4 to 10%. The rate of excretion increases in HIV+ patients (20 to 30%) (NP2). The risk of HSV seroconversion during pregnancy is 1 to 5% (NP2), but can reach 20% in case of sero-discordant couple (NP2). Questioning is not always sufficient to determine the history of herpes infection of a patient and her partner (NP2) and the clinical examination is not always reliable (NP2). Herpetic hepatitis and encephalitis are rare and potentially severe (NP4). These diagnoses should be discussed during pregnancy and antiviral therapy should be started as soon as possible (Professional consensus). There is no established link between herpes infection and miscarriages (NP3). There appears to be an association between untreated herpes infection and premature delivery (NP3) but not in the case of treated infections (NP4). Herpetic fetopathies are exceptional (NP4). There is no argument for recommending specific prenatal diagnosis for herpes infection during pregnancy (Professional consensus). Condom use reduces the risk of initial infection in women who are not pregnant (NP3). There is no evidence to justify routine screening during pregnancy (Professional consensus). CONCLUSION There is a strong discrepancy between the prevalence of herpetic excretion at the time of delivery and the scarcity of neonatal infections. There is a lack of data on the impact of herpes infections during pregnancy in France. Fetal and maternal consequences are potentially serious but rare.
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Affiliation(s)
- O Picone
- Department of Gynaecology and Obstetrics, hôpital Louis-Mourier, hôpitaux universitaires Paris Nord, 147, rue des Renouillets, 92700 Colombes, France.
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Puhakka L, Sarvikivi E, Lappalainen M, Surcel HM, Saxen H. Decrease in seroprevalence for herpesviruses among pregnant women in Finland: cross-sectional study of three time points 1992, 2002 and 2012. Infect Dis (Lond) 2015; 48:406-10. [DOI: 10.3109/23744235.2015.1123290] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Abstract
Herpes simplex virus (HSV) 1 and HSV-2 infections are highly prevalent worldwide and are characterized by establishing lifelong infection with periods of latency interspersed with periodic episodes of reactivation. Acquisition of HSV by an infant during the peripartum or postpartum period results in neonatal HSV disease, a rare but significant infection that can be associated with severe morbidity and mortality, especially if there is dissemination or central nervous system involvement. Diagnostic and therapeutic advances have led to improvements in mortality and, to a lesser extent, neurodevelopmental outcomes, but room exists for further improvement.
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James SH, Kimberlin DW. Neonatal herpes simplex virus infection: epidemiology and treatment. Clin Perinatol 2015; 42:47-59, viii. [PMID: 25677996 DOI: 10.1016/j.clp.2014.10.005] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Herpes simplex virus types 1 (HSV-1) and 2 (HSV-2) are highly prevalent viruses capable of establishing lifelong infection. Genital herpes in women of childbearing age represents a major risk for mother-to-child transmission (MTCT) of HSV infection, with primary and first-episode genital HSV infections posing the highest risk. The advent of antiviral therapy with parenteral acyclovir has led to significant improvement in neonatal HSV disease mortality. Further studies are needed to improve the clinician's ability to identify infants at increased risk for HSV infection and prevent MTCT, and to develop novel antiviral agents with increased efficacy in infants with HSV infection.
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Affiliation(s)
- Scott H James
- University of Alabama at Birmingham, Children's Harbor Building 308, 1600 7th Avenue South, Birmingham, AL 35233-1711, USA
| | - David W Kimberlin
- Department of Pediatrics, University of Alabama at Birmingham, Children's Harbor Building 303, 1600 7th Avenue South, Birmingham, AL 35233-1711, USA.
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Herpes simplex virus 2 infection: molecular association with HIV and novel microbicides to prevent disease. Med Microbiol Immunol 2014; 204:161-76. [PMID: 25209142 PMCID: PMC7102243 DOI: 10.1007/s00430-014-0358-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Accepted: 09/01/2014] [Indexed: 12/17/2022]
Abstract
Infection with herpes simplex viruses is one of the most ancient diseases described to affect humans. Infection with these viruses produces vexing effects to the host, which frequently recur. Infection with herpes simplex viruses is lifelong, and currently there is no vaccine or drug to prevent or cure infection. Prevalence of herpes simplex virus 2 (HSV-2) infection varies significantly depending on the geographical region and nears 20 % worldwide. Importantly, HSV-2 is the first cause of genital ulcers in the planet. HSV-2 affects approximately 500 million people around the globe and significantly increases the likelihood of acquiring the human immunodeficiency virus (HIV), as well as its shedding. Thus, controlling HSV-2 infection and spread is of public health concern. Here, we review the diseases produced by herpes simplex viruses, the factors that modulate HSV-2 infection, the relationship between HSV-2 and HIV and novel therapeutic and prophylactic microbicides/antivirals under development to prevent infection and pathological outcomes produced by this virus. We also review mutations associated with HSV-2 resistance to common antivirals.
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James SH, Sheffield JS, Kimberlin DW. Mother-to-Child Transmission of Herpes Simplex Virus. J Pediatric Infect Dis Soc 2014; 3 Suppl 1:S19-23. [PMID: 25232472 PMCID: PMC4164179 DOI: 10.1093/jpids/piu050] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Accepted: 05/07/2014] [Indexed: 11/14/2022]
Abstract
Infections with herpes simplex virus type 1 (HSV-1) or type 2 (HSV-2), both alpha herpesviruses, are highly prevalent worldwide. Both HSV types commonly cause genital infection, which, when acquired or reactivated during pregnancy, carries with it the risk of transmission to the fetus or neonate. Women who acquire primary or first-episode genital herpes during pregnancy are at greater risk for transmitting the infection than are women with recurrent genital herpes. Because viral infection and reactivation are frequently asymptomatic, many affected women are unaware of their infection and risk of transmission to their infants. Neonatal HSV infection can have devastating long-term consequences, especially when the central nervous system (CNS) is involved. Treatment of affected neonates with intravenous acyclovir has improved outcomes but there is room for further improvement, especially in regard to CNS disease. Working with pregnant women to prevent mother-to-child transmission of HSV is an important component in reducing the overall disease burden of neonatal HSV infections.
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Affiliation(s)
- Scott H. James
- Department of Pediatrics, University of Alabama at Birmingham
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Robinson JL, Vaudry WL, Forgie SE, Lee BE. Prevention, recognition and management of neonatal HSV infections. Expert Rev Anti Infect Ther 2014; 10:675-85. [DOI: 10.1586/eri.12.55] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Avidity of antibodies against HSV-2 and risk to neonatal transmission among Mexican pregnant women. Infect Dis Obstet Gynecol 2013; 2013:140142. [PMID: 23986628 PMCID: PMC3748774 DOI: 10.1155/2013/140142] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Accepted: 07/02/2013] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To determine HSV-2 seroprevalence, risk factors, and antibody avidity among a sample of Mexican pregnant women. MATERIAL AND METHODS The avidity test was standardized with different urea concentrations and incubation times; the cut-off point was calculated to determine the low avidity (early infection). IgG antibodies against HSV-2 were detected from pregnant and postpartum women from Morelos, Mexico, and the avidity test was performed to positive samples. Multivariate regression logistic analysis was employed to evaluate demographic and sexual behavior characteristics associated with HSV-2 infection. RESULTS HSV-2 seroprevalence among Mexican women analyzed was 14.5% (333/2300), demographic factors (location of General Hospital, age, education level, and civil status), and risky sexual behaviors (STI self-report and number of sexual partners during last year) were associated with HSV-2 infection. Seventeen women were detected with low avidity antibodies (early infection) with a cut-off point of 66.1%. CONCLUSIONS HSV-2 infection was common among this group of women from Mexico; the avidity test detected women with recent infections, and these women were more likely to transmit HSV-2 to their neonates. Neonatal herpes has no epidemiological surveillance, the disease could be overlooked, and so more studies are needed to estimate the magnitude of neonatal infection.
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Abstract
Toxoplasma gondii, rubella, cytomegalovirus and herpes simplex virus have in common that they can cause congenital (TORCH) infection, leading to fetal and neonatal morbidity and mortality. During the last decades, TORCH screening, which is generally considered to be single serum testing, has been increasingly used inappropriately and questions have been raised concerning the indications and cost-effectiveness of TORCH testing. The problems of TORCH screening lie in requesting the screening for the wrong indications, wrong interpretation of the single serum results and in case there is a good indication for diagnosis of congenital infection, sending in the wrong materials. This review provides an overview of the pathogenesis, epidemiology and clinical consequences of congenital TORCH infections and discusses the indications for, and interpretation of, TORCH screens.
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Affiliation(s)
- Eveline P de Jong
- Department of Paediatrics, Juliana Children’s Hospital, HAGA Hospital, The Hague, The Netherlands
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