新生儿单纯疱疹病毒感染1例

报告1例新生儿单纯疱疹病毒感染。患儿男，出生时全身已有广泛的皮损，表现为红斑、瘀斑，水疱和血疱，水疱发生在红斑的基础上。血清特异性单纯疱疹病毒抗体阳性，皮损活检后经电镜检查找到单纯疱疹病毒(HSV)颗粒、心脏B超检查示动脉导管未闭和卵圆孔未闭。经积极的抗感染和支持疗法治疗无效，患儿最终死于肺部感染和多器官功能衰竭。     

Serologic herpes testing in the real world: validation of new type-specific serologic herpes simplex virus tests in a public health laboratory

BACKGROUND: Serologic testing for herpes simplex virus type-2 (HSV-2) is being implemented in sexually transmitted disease (STD) clinics. GOAL: To determine the performance characteristics of two HSV-2 type-specific serologic assays in a public health laboratory. STUDY DESIGN: Sera stored from a cross-sectional study were tested with the Meridian Diagnostics and Focus Technologies HSV-2 ELISA tests and a type-specific strip immunoblot assay (Chiron Corp.) was used as the reference standard. RESULTS: Prevalence of HSV-2 infection in this sample was 44%. Compared to the reference standard, the sensitivity of the Meridian Diagnostics HSV-2 test was 95.5% (95% CI 83.3, 99.2) and specificity was 98.2% (95% CI 89.0, 99.9). The Focus Technologies test yielded 97.7% (95% CI 86.5, 99.9) sensitivity and 94.5% (95% CI 83.9, 98.6) specificity. CONCLUSIONS: The performance of these HSV-2 type-specific serologic assays was adequate to support their use in high prevalence populations, such as STD clinic patients.     

Neonatal herpes should be a reportable disease

Neonatal herpes is a devastating disease, the most serious complication of genital herpes, one of the most common serious congenital or perinatal infections, and the most frequent complication of sexually transmitted infections among children. Nevertheless, neonatal herpes is not reportable to health authorities in most states. The potential for prevention has been enhanced by recent diagnostic and therapeutic advances, and the disease meets widely accepted criteria for reporting, including incidence rates that exceed those of comparable conditions, epidemiologic instability, disease severity, direct and indirect socioeconomic costs, concern by persons at risk, the potential for prevention by public health interventions, and the prospect that the resulting data would influence public health policy. The absence of national surveillance contributes to beliefs by healthcare providers and the public health community that genital and neonatal herpes are uncommon conditions that affect small segments of society, beliefs that directly interfere with prevention. Neonatal herpes should be a reportable condition.     

The public health imperative for a neonatal herpes simplex virus infection surveillance system

About 1 in 5 sexually active adults in the United States has serologic evidence of genital herpes caused by herpes simplex virus type-2. Neonatal herpes simplex virus infection is a serious consequence of genital herpes infection. Herpes infection in neonates causes significant morbidity and neurologic damage and generally has a case-fatality ratio untreated of 60%. It is estimated that 440 to 1,320 cases of neonatal herpes infections occur in the United States per year (11-33 cases occur per 100,000 live births). Given the challenges in surveillance for genital herpes due to the large number of asymptomatic infections and infrequent laboratory-based diagnosis, we recommend that to begin an effective national control program for herpes infections, a mandatory national surveillance system for neonatal herpes be implemented. Such a system would help assure appropriate therapy, help monitor trends and understand the burden of disease, identify risk determinants, and evaluate prevention efforts.     

The widespread use of skin lightening creams in Senegal: a persistent public health problem in West Africa

BACKGROUND: The use of skin lightening creams is common in the female population of some African countries. The long-term use of certain products for several months to years may cause cutaneous adverse effects. METHODS: From 1992 to 1993, we conducted an epidemiologic and clinical study in Dakar, Senegal. Women were questioned about the use of skin lightening creams and examined for potential adverse skin reactions. Six hundred and eighty-five Senegalese women participated in the study. RESULTS: Twenty-six per cent of women were using skin lightening creams at the time and 36% had used them at some time. The most common products used were hydroquinone and corticosteroids, but 25% of women had used products of unknown composition. Seventy-five per cent of women using such creams showed cutaneous adverse effects. Facial acne was the most common adverse effect. CONCLUSIONS: A major part of the female adult population of Senegal used skin lightening creams. The long-term use of these creams is responsible for a high rate of cutaneous adverse effects. This practice has also been reported in other countries from sub-Saharan Africa and suggests a widespread use in the African population.     

Bioterrorism: a renewed public health threat

In the aftermath of the terrorist attacks of September 11, the United States is coming to terms with new and urgently felt public health and safety concerns related to the threat of bioterrorism. The recent history and the legislative agenda emerging to prevent, monitor, and respond to bioterrorism in the United States are described.     

The potential role of suppressive therapy for sex partners in the prevention of neonatal herpes: a health economic analysis

BACKGROUND: The development of suppressive therapy and type specific tests for herpes infections allow for screening to reduce the risk of neonatal herpes. OBJECTIVES: To assess the potential effectiveness, cost effectiveness, and benefit of suppressive therapy among herpes simplex virus serodiscordant sex partners during pregnancy. METHODS: Decision and economic analyses are used to compare the incidence and costs of neonatal herpes in California (2000) for three interventions: (1) no management; (2) current guidelines (caesarean delivery for women with lesions); (3) screening for women at risk and use of suppressive treatment in sex partners. RESULTS: Screening and suppressive therapy are the most effective interventions, while current guidelines have limited effectiveness, but the latter provide the most cost effective results. CONCLUSIONS: While current guidelines are cost saving, they forgo a potential 82% decrease in neonatal herpes incidence that would be possible with screening and suppressive therapy if society were willing to pay the necessary US$363 000 per case prevented. To evaluate HSV screening and drug therapy completely, clinical trials and an economic assessment of infant mortality "value" to society are required.     

Genital herpes: an increasing problem?

Over the past 10 years there has been a pronounced increase in the number of cases of genital herpes seen in sexually transmitted disease (STD) clinics in the United Kingdom. The reporting system, however, does not differentiate between primary and recurrent infections, and consequently any increase in the number of patients reattending clinics with recurrent genital herpes would falsely inflate the statistics. A study of cases of herpes seen in the department of genitourinary medicine of this hospital in the two years 1972 and 1982 is presented. It showed that the proportion of patients attending with recurrent herpes had increased from 18% in 1972 to 31% in 1982. As a result of this, the 68% increase between 1972 and 1982 in the total number of cases of herpes seen in the clinic overestimates the real increase in the size of the problem, which is closer to 40%, based upon cases of primary herpes only. Modifications to the national recording system are necessary to overcome the problems highlighted by this study. These modifications could include classifying each case of genital herpes as primary, recurrent, or recurrent but not previously recorded, which would provide a more accurate picture of the size of the problem of genital herpes in the population.