Sexually Transmitted Diseases  >  Publications  >  Report of the Genital Herpes Prevention Consultants Meeting May 5-6, 1998

Report of the Genital Herpes Prevention Consultants Meeting May 5-6, 1998

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3. Preventing Neonatal Herpes

Although neonatal herpes appears to be infrequent, its severity warrants a better understanding of its incidence and epidemiology. In addition, cesarean section is a serious, costly procedure that is commonly performed to prevent neonatal herpes, but the proportion of cesarean sections attributable to maternal genital herpes is uncertain. Minimally, improved estimates of the number of neonatal herpes cases and of herpes-related cesarean sections should be obtained. Improved data systems are desirable in making such estimates; the lack of an ICD-9 code for neonatal herpes is a specific limitation.

The central recommendation was for demonstration projects in pregnant women to assess strategies to prevent both neonatal herpes and unnecessary herpes-related cesarean sections. The primary strategy for neonatal herpes prevention would be based on preventing initial infection near term, which carries the highest risk for perinatal transmission; the risk of transmission to the newborn from longstanding maternal infection appears to be low. Prevention should emphasize both HSV-1 and -2 and might require testing not only pregnant women, but also the sex partners of seronegative women. Because screening pregnant women would identify many subclinical HSV-2 infections, a possible unintended effect might be an increase in unnecessary cesarean sections. The overall utility of efforts to prevent either neonatal herpes or herpes-related cesarean section might differ substantially according to the background prevalence of HSV infection in the population.

CDC should develop guidelines or recommendations to reduce excess cesarean sections due to genital herpes (consensus and priority not stated).

CDC should explore the feasibility of requesting that states make neonatal herpes a reportable condition nationwide, combined with efforts to improve ancillary data tools (e.g., promoting a specific ICD-9 code for neonatal herpes) (high consensus, high priority).

CDC should undertake or support meta-analyses of available data on the frequency of HSV shedding at term (high consensus, high priority).

CDC should support or conduct demonstration projects to evaluate screening strategies for prevention of both neonatal herpes and unnecessary cesarean sections, conducted in both high- and low-prevalence populations (high consensus, high priority).

Partner-screening vs abstinence near term should be evaluated and compared as neonatal herpes prevention strategies (high consensus, high priority).

Mathematical modeling should be used to analyze the potential efficacy and cost effectiveness of strategies to prevent neonatal herpes and herpes-related cesarean sections (high consensus, high priority).

CDC should support demonstration projects of active surveillance for neonatal herpes (high consensus, high priority).

CDC should undertake or support research to determine the role of suppressive antiherpetic chemotherapy in preventing excess cesarean sections (consensus and priority not stated).

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