Facts & Statistics
Thankfully deaths such as Eibhlín's are extremely rare. As neonates (an infant less than four weeks old) are particularly vulnerable to any type of infection it is important to take extra care if you (or others coming into contact with them) have an active cold sore. There are a number of precautions you should take to reduce the risk of transmitting the virus to a baby. The following are tips which will reduce the risk:
If you or another visitor has an active cold sore DO NOT kiss the baby until the outbreak is healed. If you feel the tingle/other sensation of one coming on take this precaution also.
Use a physical barrier (e.g. topical cream/plaster) while the cold sore is active as a way to reduce the risk of transmission.
Ask visitors coming to see your baby if they have (or recently) had a cold sore.
Ask visitors and hospital staff if they have washed their hands prior to touching your baby.
Tell medical staff if you have a history of genital herpes so extra precautions can be taken towards the end of pregnancy/during birth.
When breastfeeding, if there are herpes lesions on the breast (which can occur after touching a cold sore and then the breast), express and discard the milk. Use formula until the lesions on the breast have healed.
HSV – The Facts
Human Herpes Simplex Virus (HSV) types 1 and 2 are part of the family of Human Herpes viruses. HSV-1 is the common cause of ‘cold sores’, that typically appear on the face, generally around the lips or nostril; however, depending on the initial site of infection they can affect the skin at any sites. Involvement around the nailbed is called a Herpetic Whitlow. HSV-2 is more commonly associated with painful blisters or ulcers in, or around, the genital area. The locations are not completely exclusive and either virus can affect any site. HSV viruses, once acquired, persist in the body in a dormant state even after the acute symptoms subside. The frequency at which they reactivate, (i.e with development of painful watery blisters) varies from individual to individual. Currently it is estimated that 3.7 billion people worldwide are infected with HSV-1.
Common symptoms of both types of infection include onset of tingling discomfort followed by development of painful blisters or ulcers at the site of infection. These frequently flare up at times of stress. People may also carry this virus yet never show symptoms (be asymptomatic).
HSV is spread by direct contact with a skin lesion, saliva, or genital secretions. The virus can spread from person to person whether symptoms are present or not, but it is most likely to spread during an active outbreak. The most common means of transmission include kissing, genital contact, or direct contact with another infected site (e.g. hands).
HSV & Neonates
Neonatal HSV is a very serious condition, and in some cases (as in baby Eibhlín’s) can be fatal. Typically, in 85% of cases, neonatal HSV is transferred from the mother to baby during delivery, so called vertical transmission. Infection of the baby during pregnancy occurs in a further 5%. However, in 10% of cases it is transferred from another person to the baby after birth, i.e. horizontal transmission, as happened in Eibhlín’s case.
HSV - The Statistics
Since Eibhlín's death we have discovered that acquiring accurate statistics in Ireland is difficult. This is in part due to the fact that neonatal herpes is not a notifiable disease in this country. We hope this will change in the future and will be calling for the Minister for Health to make this a reality.
Consequently, the best data we have are international data drawn from the US, UK and Australia:
US: 33 cases per 100,000 births
UK: Figures range from 1.65 – 17.5 cases per 100,000 births
Australia: Figures range between 3-33 cases per 100,000 births
The above statistics relate to fatalities from the virus: it is probable the true Irish figures are similar to those of the UK.
Irish HSV data from the National Virology Reference Laboratory (NVRL) have revealed the following cases where a laboratory diagnosis of neonatal HSV infection was made. From January 2005 through to December 2015 there were 10 cases of neonatal HSV infection of which 7 were female and 3 male. Eibhlín brings the total number of detected infections to 11 in this same timeframe. Although we have not been able to definitively classify the severity of disease in these cases, we do know that HSV was detected in the blood of 3 of these children, and the cerebrospinal fluid (CSF) of another 5.
A word of caution is needed with respect to the NVRL figures. While most hospitals do send samples on to the laboratory for testing they are not obliged to do so.Therefore the figures given concern those samples sent to the laboratory only.