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The study by O'Riordan et al1 in this issue of Pediatrics focuses our attention on the special problem of herpes simplex virus (HSV) infections in premature infants. We recognize the deadly and complex nature of neonatal herpes, thanks to an exceptional body of work by Whitley, Arvin, Prober, Kimberlin, Nahmias, Corey, Brown, and other luminaries. Their research has established the role of mother-to-infant transmission in most cases.2 This body of work has clarified that most mothers of infected infants have no known history of genital herpes but may have a history of other sexually transmitted diseases and demonstrated that maternal immunity to HSV infection affords some type-specific immunity to the infant.3,4 They have shown the importance of cesarean delivery in reducing but not eliminating the risk of mother-to-infant transmission.5,6 These investigators developed the classification system that distinguishes between disease apparently limited to the portals of entry (the skin, eyes, and mouth) and more severe forms of encephalitis and disseminated infection.7 They have documented the …
Address correspondence to Lawrence R. Stanberry, MD, PhD, Department of Pediatrics and the Sealy Center for Vaccine Development, University of Texas Medical Branch, Galveston, 301 University Blvd, Galveston, TX 77555-0351. E-mail: l.stanberry{at}utmb.edu
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