{
  "abstract": "Objective Estimate the incidence of herpes simplex virus (HSV) infections in infants under 90 days in the UK and Ireland and describe clinical presentation and outcomes.Design Prospective population-based national surveillance study of infants <90 days with HSV infection, using British Paediatric Surveillance Unit (BPSU) methodology (August 2019–February 2022).Results 117 infants with confirmed HSV infection were identified (6.0 cases/100 000 live births (95% CI 4.9, 7.2)). One-third (34.5%) of infants were premature (<37 weeks) and the majority (81.4%) were born to women without a known/disclosed history of genital herpes. Neonatal HSV was classified as disseminated (32.5%), central nervous system (CNS) (35%) or skin, eye, mouth (SEM) (32.5%) disease. Median age at symptom onset was 8 days (IQR 5–13) in all infants (D8 SEM, D14 CNS, D6 disseminated). 56.7% of infants commenced aciclovir >24 hours after symptom onset. Infants with disseminated infections presented with non-specific signs of sepsis: 65.8% were afebrile and 73.7% had no SEM lesions. Median C reactive protein at presentation was 4 mg/L (IQR 1–14). Overall mortality was 23.9%, rising to 65.8% among infants with disseminated disease. Of the 41 infants with follow-up data at 24 months, 29.3% had neurodevelopmental impairment (11.8% SEM, 45% CNS, 25% disseminated).Conclusions Infants with neonatal HSV can present without fever, SEM lesions or elevated infection markers; treatment delay is subsequently common. Outcomes remain poor with high case-fatality rates and long-term morbidity. Clinicians should have a low threshold for empirically testing for and treating herpes in unwell neonates.",
  "authors": [
    {
      "affiliations": [
        "Academic Department of Paediatrics, Royal Alexandra Children’s Hospital, Brighton, West Sussex, UK"
      ],
      "name": "Julia R R Dudley"
    },
    {
      "affiliations": [
        "Academic Department of Paediatrics, Royal Alexandra Children’s Hospital, Brighton, West Sussex, UK",
        "University of Brighton, Brighton, UK",
        "Brighton and Sussex Medical School, Brighton, UK"
      ],
      "name": "Annalie Shears"
    },
    {
      "affiliations": [
        "Academic Department of Paediatrics, Royal Alexandra Children’s Hospital, Brighton, West Sussex, UK",
        "Neonatology, Homerton University Hospital, London, UK"
      ],
      "name": "Georgina Yan"
    },
    {
      "affiliations": [
        "Institute of Infection & Immunity & St George’s Vaccine Institute, City St George's, University of London, London, UK"
      ],
      "name": "Paul T Heath"
    },
    {
      "affiliations": [
        "Institute of Infection & Immunity & St George’s Vaccine Institute, City St George's, University of London, London, UK",
        "Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, London, UK"
      ],
      "name": "Shamez N Ladhani"
    },
    {
      "affiliations": [
        "Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, London, UK"
      ],
      "name": "Sonia Ribeiro"
    },
    {
      "affiliations": [
        "Academic Department of Paediatrics, Royal Alexandra Children’s Hospital, Brighton, West Sussex, UK",
        "University of Brighton, Brighton, UK",
        "Brighton and Sussex Medical School, Brighton, UK"
      ],
      "name": "Katy Fidler"
    }
  ],
  "title": "Herpes simplex virus disease in infants younger than 90 days: a British Paediatric Surveillance Unit study",
  "uid": "32a6ba0b-7335-5848-b958-f8420dba8ac9"
}