Herpes is one of the infectious diseases, which manifests itself by an attack of the skin and mucous membranes by the so-called herpes simplex virus.
For adults, a herpes infection is harmless in most cases. Since the immune system of newborns is usually not yet trained enough to effectively fight the virus and prevent the spread of the pathogen, can develop serious events that can end in the worst case fatal. Especially during the first 4-8 weeks after birth, a herpes infection can be very dangerous.
The herpes infection is triggered by the herpes simplex virus, in which two types are distinguished. Type 1 shows preferential infestation of the skin and mucous membrane in the facial area and occurs mainly in adults and adolescents (cold sores). Type 2 causes mainly genital herpes and is mostly responsible for diseases of the fetus and newborn. These groups of viruses have the peculiarity that they can remain in the body after infection and the subsequent fight by the immune system and cause disease.
The common infection of a baby with herpes viruses is not extremely dangerous. However, complications are more common in newborns than in adults.
The complications of herpesvirus infection can be very dangerous in babies. If the herpes infection spreads through the bloodstream, a blood poisoning ( herpetic psi ) may develop. In addition, the viruses can infect the internal organs such as the lungs, liver and kidney via the bloodstream.
Particularly serious is involvement of the brain. The inflammation of the brain membranes can lead to seizures, vomiting and respiratory failure. As a result, damage to mental development can occur.
If other skin diseases, such as inflammatory neonatal eczema, are already present in small babies, an infection with the herpes virus can lead to a so-called eczema herpeticatum. Due to the previously damaged skin, the virus particles can penetrate faster and bubbles form.
If there is a primary infection of the mother during pregnancy and an infection of the bloodstream with the virus, the child can be infected in the womb via the mother cake. This can lead to disorders of the child's development as well as miscarriages and developmental defects.
A herpes encephalitis is a very serious complication that can occur especially in a herpes infection of newborns. Here, the virus spreads to the brain and leads here to a very life-threatening inflammation.
The first signs are initially unspecific and are described as flu-like. After this phase, accompanied by a mild fever, there is suddenly a rapid increase in body temperature, which is accompanied by confusion and disturbance of consciousness of the child.
If no treatment is followed, it can lead to a coma. Herpetic encephalitis is considered an absolute emergency in medicine. As soon as the disease is suspected, antiviral therapy is initiated immediately. Only then does the safe diagnosis with MRI and a lumbar puncture follow. In addition, an antibiotic is often given until a bacterial cause can be ruled out. If no signs of encephalitis are found, therapy can be discontinued immediately.
The herpes disease occurs as a result of the infection with the herpes simplex virus. The virus is highly contagious and can already be transmitted by kissing or sharing the drink (smear infection or droplet transfer).
There is also a 50% risk that a mother with a primary herpes infection will infect her baby during childbirth. In these cases, however, there is no great risk for the newborn, since during pregnancy, antibodies of the mother against the virus have been transferred to the child and it is thus well protected in the first weeks of life, which is referred to as nest protection.
However, if the mother does not contract herpes until shortly before birth, this nest protection is not guaranteed. The antibodies that are formed at this stage can not be transferred to the baby via the placenta.
Infection with herpesvirus type 1 occurs through close contact of the infected mother or infected people. Especially the kissing and caressing of the baby. The infectious virus particles contained in the typical cold sore can be quickly transferred to the mucous membranes of the baby.
Basically, the herpes simplex infection is considered a smear infection and is thus transmitted via body secretions such as saliva. Thus, there is a high risk of infection for the child, especially if parents have an open cold sore on the lip or in the mouth. By kissing the child or by sharing cutlery or glasses can thus be transmitted to the herpes virus.
Since a herpes infection can be dangerous especially in the first one and a half years of life of the child, parents with herpes during this time should take certain precautions to avoid infection of the child. These include covering the cold sore with patches or special creams and good hand hygiene. In addition, parents should avoid kissing their babies while having cold sores in the mouth area. On the breastfeeding of the child must not be waived, except when cold sores are also around the nipple.
There is a high risk of infection during the birthing process. Most babies acquire the virus during birth through the birth canal when the mother has genital herpes. If the virus rises as part of an infection in the vagina of the mother, it may also come with an early rupture of the membranes for transmission to the child.
A first infection of the mother during pregnancy may also lead to a transfer of the virus to the unborn child. If the virus affects the entire body of the mother, it can be transmitted via the placenta into the blood of the child. In this case, severe complications, massive malformations, and premature births are common.
The first signs of a present herpes infection in babies are varied and usually show up 1 to 26 days after the infection.
If there is an infection with type 1 herpesviruses, the skin and mucous membranes in the facial area are predominantly affected. It can cause very painful, small blisters in the oral cavity, which can quickly inflame and burst ( Read also: Herpes in the mouth). This inflammation can be transmitted through the thumb sucking in babies on the fingers. If the blisters in the mouth open, bad breath can develop.
In a further spread in the mouth, fever and swelling of the cervical lymph nodes usually occur. The babies are also disturbed by the fact that they become very restless, cry a lot and refuse to drink, because the blisters in the mouth are very painful.
If the first infection with the herpesvirus type 1 is over, the viruses stay for the time being in the ganglia, which are formed by nerve cells and present in the head area. They can be reactivated in case of a renewed weakness of the immune system. The cold sore is not common in babies, as this is usually a secondary infection.
In the case of infection with herpesvirus type 2, the skin and mucous membranes are affected in the genital area. Again, small blisters (on the labia or on the foreskin), which are on the one hand very painful and on the other hand may be accompanied by problems with urination and infections of the urethra.
Here, too, the babies can develop fever and swelling of the lymph nodes in addition to the aforementioned skin symptoms. If it comes to infection during childbirth, the first symptoms appear in the first weeks after birth. The babies often appear severely beaten and weak, have a rather greyish skin color, develop fever and refuse to drink.
The occurrence of herpes in the baby is usually not quite as clear to recognize, as in adults.
Although children may have the typical cold sores around the corners of their mouths and around their mouths, they may also have other symptoms. For example, an inflamed, runny nose or thick, red eyes that are more likely to think of conjunctivitis.
After infection with the herpes virus, vesicles form on the lip, which often spread to the mouth area. Herpes usually causes apthen in the mouth. These are painful inflammations of the mucous membranes in the mouth, which are less than a centimeter in size, and usually have a white tint.
They heal after about one to two weeks. If the infection is more severe, apthen pain can cause dysphagia and food denial in babies. For pain relief special ointments for the mouth with the active ingredients lidocaine or polidocanol can be applied to the appropriate place.
The symptoms of herpes recurrence are often weaker and are usually limited to blisters on the lip, which are accompanied by redness, itching and burning sensation. After the encrustation and subsequent healing, no scars remain. These recurrences are summarized under the term cold sores.
Also caused by herpesvirus type 1, infections can occur on the eye. In most cases, there is a carryover of the virus material by smear infection. Most of the small cold sores occur in the eyelid and often there is a participation of the cornea. The babies have flushed, watery eyes and can be very sensitive to light. There is a risk of scarring due to inflammation of the cornea. In the further course, a clear limitation of vision may develop and the child may go blind.
Cold sores, which are located on the butt or genital area of the baby, go back to the herpes simplex virus type 2. In a primary infection, these are usually larger, increased and associated with an increased body temperature. Relapses, which can occur again and again, are generally mild and often do not occur.
The diagnosis of herpes infection is a gaze diagnosis in most babies. The small blisters on the face, mouth or genital area are often very easy to recognize. If babies have symptoms that support the suspicion of herpes infection, they may be isolated by blood tests, oral and pharyngeal swabs or fluid in the blisters, or CSF virus DNA or viral components.
If a pregnant woman becomes infected and there is a chance that the virus will be transmitted to the unborn child, an amniotic fluid puncture may be necessary to detect the virus.
If newborns suspect that the herpes virus has infected the brain and has led to encephalitis, this can be checked by CSF or MRI and EEG.
A therapy that leads to the complete destruction of the herpes virus is not known. Also, no vaccine is available that can prevent infection with the virus. Since the virus remains in the body even after the symptoms have resolved, a new onset of weakness of the body's own immune system or in stressful situations can occur at any time.
In mild cases of herpes infection only the symptoms such as fever, itching and skin symptoms are treated.
If there is a spread of the virus via the blood and the development of herpetic psi or the infestation and the infection of other internal organs, an antiviral therapy via the vein is necessary for 2-3 weeks. The pathogenic viruses are thus prevented from further propagation. As an antiviral drug acyclovir is usually used. This alleviates the pain and the itching, prevents the further multiplication of the viruses and is intended to minimize possible consequential damage as far as possible. The crucial condition for the treatment of severe herpes infections is the initiation of treatment within the first 24h after symptom onset.
Therefore, in the case of encephalitis, antiviral therapy must be initiated in the event of suspicion. If it turns out that no herpes encephalitis is present, the antiviral therapy can be stopped immediately.
Only in a few cases is herpes treated with topical medications. This is especially the case with involvement of the eyes, such as conjunctivitis, which is treated with an ointment of aciclovir or other antiviral agents.
The duration of the herpes symptoms depends on the age and whether it is a reinfection or a reactivation of the virus. A primary infection associated with mild fever and fatigue usually resolves within two weeks.
In severe forms or complications such as herpetic encephalitis, the duration may vary greatly. Later, it usually comes only to reactivation of the herpes, which is associated with blistering. These heal after about a week by themselves and leave no scars.
If the present herpes infection of the baby is only a localized inflammation limited to a specific area of the skin or mucosa, the prognosis is good. Whereby, especially in small babies, due to the not yet fully developed defense system, one must always make sure that the infection does not spread further.
If the brain or other organs are affected by a herpes infection, the mortality rate in babies is about 50-80% despite adequate therapy. If the affected child survives the serious infection, there is still a high risk that it will retain permanent damage. These include, for example, a reduction in intelligence, mental disability, cramping or damage to the eyes.
Herpes is dangerous for children as long as their immune system is not fully able to effectively fight the virus and stem the infection. According to publications of the German Green Cross, herpes is dangerous for the baby, especially in the first six weeks, and can lead to serious illnesses. After that, the risk continues to decrease as the immune system becomes stronger. At around one and a half years, herpes is no longer a major threat to children with intact immune systems.
Prophylactically, the risk of herpes infection in the child can be minimized by paying attention to some important advice.
If the birth of a child is imminent and the mother is suffering from a genital herpes, the attending physician should perform a caesarean section to protect the baby from infection.
If you have an acute herpes infection you should generally refrain from visiting a baby until the acute phase has subsided, the blisters have dried out and the crusts have come off.
Suffering parents or people who are in close contact with the baby, on a cold sore, should be paid attention to wearing a surgical mask. Concerned parents can treat the cold sore with acyclovir cream and cover with a plaster.
It is also important to follow strict hygiene measures, such as the regular washing and disinfecting of the hands. In addition, it is essential to abstain from kissing and petting with the baby. Anything that can come in contact with the infectious bubbles, such as dishes, glasses or even towels, should not be shared with others.
Even when breastfeeding, a surgical mask should be worn. If the nipples of the mother are infected with cold sores, the child should not be breastfed for the time being.
The so-called nest protection describes the fact that newborns and babies in their first months of life are relatively immune to disease because they have received a part of the maternal immune system.
During pregnancy, some antibodies of the child's mother can also enter the body's bloodstream through the blood. Because the newborn's immune system takes months to self-manage illnesses, these maternal antibodies help protect the baby in the first few weeks and months.
However, the maternal antibodies do not last forever, but eventually die, which is why this protection evaporates over time.
Nonetheless, nest protection helps to effectively protect the baby against potential bacterial or viral diseases for the first time.