Assessing the Burden of Infant Deaths due to Herpes Simplex Virus, Human Immunodeficiency Virus, and Congenital Syphilis - United States, 1995-2017.

BACKGROUND Despite advances in diagnosis and treatment, neonatal infection with herpes simplex virus (HSV) has a high case fatality rate. The national burden of neonatal HSV, and associated deaths, is unknown because this condition is not nationally notifiable. We investigated trends in HSV-related infant deaths, compared to infant deaths from congenital syphilis (CS) and human immunodeficiency virus (HIV). METHODS Linked birth-death files for infant deaths during 1995-2017 were obtained from the National Center for Health Statistics. These files include infants who were born alive and died in the first 365 days of life and exclude stillbirths. We searched death certificates for disease codes indicating HSV, CS, or HIV, and calculated the frequency and rate of deaths for each infection, overall, by infant sex, and birthing parent age and race/ethnicity. RESULTS Nationally, 1,591 deaths related to the infections of interest were identified: 1,271 related to HSV (79.9%), 234 HIV (14.7%), and 86 CS (5.4%). HSV-related deaths increased significantly from 0.83/100,000 live-births (95% CI:0.57-1.17) in 1995 to 1.77 (95% CI:1.37-2.24) in 2017. In contrast, HIV-related deaths declined: 1.64/100,000 (95% CI:1.27-2.10) in 1995 to 0.00 in 2017. There was a median of 3 CS-related deaths/year, with elevated frequencies in 1995-1996 and 2017 (n=8). HSV-related death rates were elevated among infants born to birthing parents aged <20 years (4.17/100,000; 95% CI:3.75-4.59) and to Black parents (2.86/100,000; 95% CI:2.58-3.15). CONCLUSIONS Nationally, HSV-related infant deaths exceeded those caused by HIV and CS and appear to be increasing. Our findings underscore the need for an effective HSV vaccine, test technologies enabling rapid identification of infants exposed to HSV at delivery, and a focus on equity in prevention efforts.