From the Pediatrician: 10 Things You Didn’t Know About Viral Meningitis

We all love babies. So much so that it’s hard to resist the urge to smother them with cuddles and kisses in their first days of life. But resist, we must. After an Iowa couple’s devastating loss, we want to remind everyone – for the health of the baby – “look, but don’t touch,” at least not without a few precautions in place.

Last Monday, an 18-day-old baby girl was laid to rest after she contracted herpes virus, HSV-1, that later developed into viral meningitis. Doctors believe the baby may have caught the virus from a kiss by someone who was infected.

We sat down with Dr. Michelle Pastorello, MEDNAX-affiliated pediatric hospitalist and medical director of pediatrics and pediatric chair at HCA Healthcare’s Sunrise Children’s Hospital in Las Vegas, who was not involved in the care of this baby, to learn how something like this may have happened and what we can do to help prevent it from happening to others.

HCA Healthcare Today: What can you tell us about the virus that infected the baby?

Dr. Michelle Pastorello: There are two types of herpes simplex viruses (HSV) – types 1 and 2 – that infect humans.  And these viruses typically affect either the mouth or the genitals of the infected person.  More often, HSV-1 is found in oral infections, while HSV-2 is more frequent in genital infections.  However, either virus can cause oral or genital infections. It’s a virus that can infect nerves, lay dormant in the spinal cord and become reactivated throughout an individual’s life.

 HCA Healthcare Today: Can a baby contract this virus with something as simple as a kiss?

Dr. P: A baby can contract HSV by a kiss or any body fluids from a person who has HSV.  The MOST common way that a newborn will contract HSV is from the mother in the period shortly before (24-28 weeks) and after (1-4 weeks) birth. Many women may have asymptomatic genital HSV infection and subsequently, the infant can be exposed to the virus causing infection.

HSV is more problematic in people who have an impaired immune system.  Newborns have a diminished immune system and are therefore more susceptible to infection of any kind.

 HCA Healthcare Today: Does someone have to have the open cold sore to transmit the virus?

Dr. P: The virus can be transmitted from person to person even without active lesions.  It occurs by contact with infected body fluids even in the absence of obvious sores.

 HCA Healthcare Today: This tragedy made international headlines and has been reported as neonatal herpes, viral meningitis, HSV-1. Are those terms interchangeable? And which exactly caused the death of the baby?

Dr. P: I cannot make a determination of how this baby died.  However, these terms can all apply to an infant that has contracted herpes.

• Herpes is a virus and can cause viral meningitis or, more appropriately, meningoencephalitis, which is the HSV infection of both the brain tissue and the meninges – the three membranes that cover the brain and spinal cord.
• Neonatal herpes occurs in infants under 2 months old and can include meningoencephalitis, but can affect other parts of the body including eyes, mucous membranes and skin.
• Disseminated herpes (spread of infection throughout the body) is devastating and can infect all organ systems in the body. It is frequently fatal.

HCA Healthcare Today: How common is the HSV virus?

Dr. P.: HSV is very common. By 5 years old, approximately one-third of children will be infected with the HSV.  And this percentage increases with age, reaching as high as 90 percent in adults older than 70 years old.

HCA Healthcare Today: Does everyone with the HSV virus develop meningitis or meningoencephalitis?

Dr. P.: No, not everyone with the virus develops meningoencephalitis.  Outside of the neonatal period – the time period from birth to 1 month – HSV-1 can cause meningoencephalitis if it spreads from the mouth back into the brain through the nose.  This is not common but is often devastating.

HCA Healthcare Today: What type of symptoms can parents of newborns look for?

Dr. P.: In newborns, the symptoms can be subtle, but include fever or low temperature, poor feeding, lethargy or irritability.  In some cases, a raised, blistery rash, excessive eye discharge, sores in the mouth or nose or seizures.

HCA Healthcare Today: How is viral meningitis treated in babies?

Dr. P.: HSV infection is treated with a medication called acyclovir.  Not all forms of viral meningitis have a treatment, however.  Even with treatment, herpes can result in a very devastating disease.

HCA Healthcare Today: Is there a vaccination for HSV for babies?

Dr. P.: There is no vaccine for HSV, however, many of the current vaccines are protective for other forms of meningitis.

HCA Healthcare Today: How can parents protect their kids in the first few months of life?

Dr. P.: In order to protect newborns from any infection, parents should keep them away from high concentrations of people including planes, malls, or churches. People with known infectious illnesses should be kept away from infants as well.  Good hand washing before contact with the baby is also very important to prevent illnesses.  And any mother with known HSV infections should discuss this with her OB/GYN.

Dr. Michelle Pastorello belongs to a national physician group known as MEDNAX, and is the medical director of pediatrics and pediatric chair at Sunrise Children’s Hospital in Las Vegas, Nevada. Sunrise Children’s is a part of the HCA Healthcare Far West Division.