Confusion over Infant Herpes

More newborns have the disease, but fears are exaggerated

She has pretty blond hair, innocent blue eyes, and at the age of four is only the size of a two-year-old toddler. But for nearly a year, this child, who is mentally retarded and physically disabled, has been the subject of suspicion and fear in her home town of Emporia, Kans. When the child's mother tried to enroll her in a public school program for handicapped children, permission was denied. Last month, when she was finally admitted, several parents kept their children at home, and a number of teachers insisted on wearing surgical gloves. The reason for the ostracism: the child has been infected since birth with herpes, which is not only the source of her mental and physical disabilities but also causes the sores that break out on her scalp about every six weeks. In Sacramento County, Calif., a 3 1/2-year-old retarded boy with herpes suffered similar humiliations at his school. "A bus driver refused to have him on her bus, and several staff members requested transfers," reports Gerald Peterson, assistant superintendent for special schools and services. "It is an emotional issue."

Instances of herpes hysteria have become increasingly common as the disease affects growing numbers of the newborn. Campaigns to isolate these infected children are, however, misguided. According to pediatricians, the children pose no greater threat to their classmates than someone with a common cold sore. Moreover, the chances for transmission are slight since intimate contact with the infected area is required. "Kids are just as liable to become infected when kissed by their grandmother or aunt," says Lawrence Corey of Children's Orthopedic Hospital in Seattle.

Exaggerated fear of infected youngsters probably stems from confusion over the dangers that the herpes virus poses to small children. Herpes is most familiar as the cause of sores around the mouth and on the genitals. But in infants less than five weeks old, who lack the protection of a fully developed immune system, the infection can be disastrous, causing blindness, mental retardation, a range of neurological disorders and even death. The severe handicaps that afflict the Emporia and Sacramento children are typical results of herpes infection in the newborn. Their classmates, however, are safe from physical or mental damage because they have mature immune systems that are able to ward off infection.

According to one study published in the Journal of the American Medical Association, herpes in the newborn is up sharply. The survey, conducted in the Seattle area, showed that for every 100,000 births the incidence rose from 2.6 cases between 1966 and 1969 to 11.9 cases between 1979 and 1981. In 1982 the figure jumped to 17.2. In most cases, infants become infected during passage through the birth canal of a mother who has active genital herpes. In a few other instances, children have been exposed to the virus shortly after birth, perhaps through contact with cold sores. Treatment with antiviral agents that became available in the late 1970s has reduced the mortality rate of infected babies from 70% to 38%, but about half the survivors are seriously disabled.

Doctors agree that the best hope for preventing infection of newborns lies in more careful monitoring of pregnant women with a history of herpes. If active genital infection is detected before labor, a caesarean will generally protect the infant from contagion. For women who know they have been exposed to herpes but have no visible symptoms, a new 24-hour test for herpes should improve detection.

Unfortunately, a number of women who give birth to infected children are unaware that they have been exposed to the disease. In two out of 35 cases in the Seattle study, husbands had not told their wives about the infection. In such cases, only honesty can help prevent the tragic consequences to young victims.