Herpes simplex virus type 2 infection in pregnancy: asymptomatic viral excretion at delivery and seroepidemiologic survey of two socioeconomically distinct populations in São Paulo, Brazil

Weinberg, Adriana; Canto, Cynthia L.M.; Pannuti, Claudio S.; Kwang, Wu N.; Garcia, Sidney A.L.; Zugaib, Marcelo

doi:10.1590/S0036-46651993000300011

Abstracts

The objective of the present study was to estimate the prevalence of herpes simplex virus type 2 (HSV 2) antibodies in child bearing women of 2 Brazilian populations with different socioeconomic status and to determine the risk of neonatal HSV exposure by means of maternal cultures at the onset of labor. The study was conducted at 2 hospitals: A, serving very low income patients and B, serving middle socioeconomic class. 173 participants from group A and 127 from B answered a questionnaire which showed that the patients had similar ages (27.7 and 26.8 years, respectively) but differed with regard to socioeconomic status, age at first intercourse (18.6 vs 20.6 years), number of sex partners (1.5 vs 1.2) and previous sexually transmitted diseases (15% vs. 1.5%). History of genital herpes was given by 11% of group A participants and by a similar number, 7%, of patients from group B. In addition, 200 serum samples from population A and 455 from B were tested by ELISA for and HSV antibodies and 92% and 86%, respectively, were found to be positive. Sixty seropositive samples from group A and 90 from B were further analyzed by Western blot, which showed the presence of type 2 specific antibodies in 46% and 36%, respectively, suggesting an overall HSV 2 prevalence of 42% in group A and 31% in B. Cervical specimens were obtained for culture from 299 asymptomatic patients of population A and 313 of B. HSV was isolated from one specimen in each group, indicating a 0.3% incidence of asymptomatic viral excretion in both populations. In conclusion, the prevalence of type 2 antibodies in childbearing women was very high, but it did not differ with the socioeconomic status. The risk of HSV perinatal transmission was also similar in the 2 study populations and it was comparable with the data from developed countries. Our findings do not indicate the need of special screening programs for asymptomatic HSV excretion in Brazilian pregnant women.

Herpes simplex; Genital herpes; Pregnancy; Neonatal herpes

O objetivo deste estudo constou em determinar a prevalência dos anticorpos anti virus herpes simplex (HSV) tipo 2 em mulheres em idade fértil, pertencendo a 2 populações socioeconomicamente distintas, e verificar o risco de exposição neonatal a HSV, por meio de isolamento de vírus no início do parto. O estudo foi realizado em 2 hospitais: A, servindo uma população de baixa renda; B, servindo a classe média. 173 participantes do grupo A e 127 do grupo B responderam um questionário que mostrou que os pacientes pertenciam à mesma faixa etária (27,7 e 26,8 anos, respectivamente) mas divergiam quanto ao estado socioeconômico, idade ao início da vida sexual (18,6 e 20,6, respectivamente), número de parceiros sexuais (1,5 comparado à 1,2) e doenças sexualmente transmitidas (15% e 1,5%, respectivamente). Uma história de herpes genital no passado foi obtida em números semelhantes nos dois grupos, 11% do grupo A e 7% do B. 200 soros do grupo A e 455 do B foram analisados por ELISA quanto à presença de anticorpos anti HSV, e 92% e 86%, respectivamente, foram positivos. 60 amostras soropositivas do grupo A e 90 do B foram analisados por Western blot, que mostrou anticorpos anti HSV 2 em 42% do grupo A e 31% do B. Material cervical foi obtido para isolamento de vírus de 299 parturientes assintomáticas do grupo A e 313 do B. Uma paciente em cada grupo teve isolamento positivo para HSV, indicando uma incidência de 0,3% de excreção vírica assintomática em ambos os grupos. Em conclusão, a prevalência de anticorpos anti HSV 2 em mulheres em idade fértil em São Paulo se mostrou muito elevada, mas não variou com o estado socioeconômico da população. O risco da transmissão perinatal do HSV foi semelhante nas duas populações e comparável aos números relatados em países desenvolvidos. Nossos achados não indicam a necessidade de programas especiais de detecção da excreção assintomática de HSV em gestantes do Brasil.

SEROEPIDEMIOLOGY

Herpes simplex virus type 2 infection in pregnancy: asymptomatic viral excretion at delivery and seroepidemiologic survey of two socioeconomically distinct populations in São Paulo, Brazil

Infecções por herpes simplex tipo 2 durante a gestação: excreção assintomática do vírus durante o parto e estudo soroepidemiológico de duas populações socioeconomicamente distintas

Adriana Weinberg^I,II; Cynthia L.M. Canto^I; Claudio S. Pannuti^I; Wu N. Kwang^III; Sidney A.L. Garcia^IV,¹ (1 ) Supported in part by grant nº 408741/88 from CNPq ; Marcelo Zugaib^III

^IHC-LIM-52 Virology Laboratory of the Institute of Tropical Medicine, São Paulo

^IIDivision of Infectious Diseases of the Hospital das Clínicas of the University of São Paulo Medical School

^IIIDepartment of Obstetrics and Gynecology of the Hospital das Clínicas of the University of São Paulo Medical School

^IVDivision of Obstetrics of the Hospital do Servidor Público Estadual

^{Correspondence to} Correspondence to: A. Weinberg UCHSC Campus Box C 227 4200 E Ninth Ave, Denver CO 80262, U.S.A

SUMMARY

The objective of the present study was to estimate the prevalence of herpes simplex virus type 2 (HSV 2) antibodies in child bearing women of 2 Brazilian populations with different socioeconomic status and to determine the risk of neonatal HSV exposure by means of maternal cultures at the onset of labor. The study was conducted at 2 hospitals: A, serving very low income patients and B, serving middle socioeconomic class. 173 participants from group A and 127 from B answered a questionnaire which showed that the patients had similar ages (27.7 and 26.8 years, respectively) but differed with regard to socioeconomic status, age at first intercourse (18.6 vs 20.6 years), number of sex partners (1.5 vs 1.2) and previous sexually transmitted diseases (15% vs. 1.5%). History of genital herpes was given by 11% of group A participants and by a similar number, 7%, of patients from group B. In addition, 200 serum samples from population A and 455 from B were tested by ELISA for and HSV antibodies and 92% and 86%, respectively, were found to be positive. Sixty seropositive samples from group A and 90 from B were further analyzed by Western blot, which showed the presence of type 2 specific antibodies in 46% and 36%, respectively, suggesting an overall HSV 2 prevalence of 42% in group A and 31% in B. Cervical specimens were obtained for culture from 299 asymptomatic patients of population A and 313 of B. HSV was isolated from one specimen in each group, indicating a 0.3% incidence of asymptomatic viral excretion in both populations. In conclusion, the prevalence of type 2 antibodies in childbearing women was very high, but it did not differ with the socioeconomic status. The risk of HSV perinatal transmission was also similar in the 2 study populations and it was comparable with the data from developed countries. Our findings do not indicate the need of special screening programs for asymptomatic HSV excretion in Brazilian pregnant women.

Key words: Herpes simplex; Genital herpes; Pregnancy; Neonatal herpes.

RESUMO

O objetivo deste estudo constou em determinar a prevalência dos anticorpos anti virus herpes simplex (HSV) tipo 2 em mulheres em idade fértil, pertencendo a 2 populações socioeconomicamente distintas, e verificar o risco de exposição neonatal a HSV, por meio de isolamento de vírus no início do parto. O estudo foi realizado em 2 hospitais: A, servindo uma população de baixa renda; B, servindo a classe média. 173 participantes do grupo A e 127 do grupo B responderam um questionário que mostrou que os pacientes pertenciam à mesma faixa etária (27,7 e 26,8 anos, respectivamente) mas divergiam quanto ao estado socioeconômico, idade ao início da vida sexual (18,6 e 20,6, respectivamente), número de parceiros sexuais (1,5 comparado à 1,2) e doenças sexualmente transmitidas (15% e 1,5%, respectivamente). Uma história de herpes genital no passado foi obtida em números semelhantes nos dois grupos, 11% do grupo A e 7% do B. 200 soros do grupo A e 455 do B foram analisados por ELISA quanto à presença de anticorpos anti HSV, e 92% e 86%, respectivamente, foram positivos. 60 amostras soropositivas do grupo A e 90 do B foram analisados por Western blot, que mostrou anticorpos anti HSV 2 em 42% do grupo A e 31% do B. Material cervical foi obtido para isolamento de vírus de 299 parturientes assintomáticas do grupo A e 313 do B. Uma paciente em cada grupo teve isolamento positivo para HSV, indicando uma incidência de 0,3% de excreção vírica assintomática em ambos os grupos. Em conclusão, a prevalência de anticorpos anti HSV 2 em mulheres em idade fértil em São Paulo se mostrou muito elevada, mas não variou com o estado socioeconômico da população. O risco da transmissão perinatal do HSV foi semelhante nas duas populações e comparável aos números relatados em países desenvolvidos. Nossos achados não indicam a necessidade de programas especiais de detecção da excreção assintomática de HSV em gestantes do Brasil.

Full text available only in PDF format.

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ACKNOWLEDGEMENTS

We thank Ms. Lucy S. Vilas Boas for technical assistance and Ms. Jussara Morais for secretarial help.

Recebido para publicação em 09/09/1992

Aceito para publicação em 15/10/1992

1. ARVIN, A.M.; HENSLEIGH, P.A.; PROBER, C.G.; AU, D.S.; YASUKAWA, L.L.; WITTEK, A.E.; PALUMBO, P.E.; PARYANI, S.G. & YEAGER, A.S. - Failure of anlepartum maternal cultures to predict the infant's risk of exposure to herpes simplex virus at delivery. New Engl. J. Med., 315: 796-800, 1986.
2. BERNSTEIN, D.I.; BRYSON, Y.J. & LOVETT, M.A. - Antibody response to type common and type-unique epitopes of herpes simplex virus polypeptides. J. mod. Virol., 15: 251-263, 1985.
3. BROWN, Z.; BERRY, S.; GRIFFIN, D.; BENEDETTI, J. & COREY, L. - Risk factors associated with the acquisition of neonatal HSV among infants exposed to mothers excreting HSV asymptomatical at the onset of labor. In: INTERSCIENCE CONFERENCE ON ANTIMICROBIAL AGENTS AND CHEMOTHERAPY, 28. Program and abstracts. 1988, p.261.
4. JOHNSON, R.E.; NAHMIAS, A.J.; MAGDER, L.S.; LEE, F.K.; BROOKS, C.A. & SNOWDEN, C.B. - A seroepidemiologic survey of the prevalence of herpes simplex virus type 2 infection in the United States. New Engl. J. Med., 321: 7-12, 1989.
5. LANGENBERG, A.; BENEDETTI, J.; JENKINS, J.; ASHLEY, R.; WINTER, C. & COREY, L. - Development of clinically recognizable genital lesions among women previously identified as having "asymptomatic" herpes simplex virus type 2 infection. Ann. intern. Med., 110: 882-887, 1989.
6. LEE, F.K.; COLEMAN, R.M.; PEREIRA, L.; BAILEY, P.D.; TATSUNO, M. & NAHMIAS, A.J. - Detection of herpes simplex virus type 2 specific antibody with glycoprotein G. J. clin. Microbiol., 22: 611-644, 1985.
7. PANNUTI, C.S.; VILAS-BOAS, L.S.; ANGELO, M.J.O.; CARVALHO, R.P.S. & SEGRE, C.M. - Congenital Cytomegalovirus infection. Occurence in two socioeconomically distinct populations of a developing country. Rev. Inst. Med. trop. S. Paulo, 27: 105-107, 1985.
8. PROBER, C.G.; HENSLEIGH, P.A.; BOUCHER, F.D.; YASUKAWA, L.L.; AU, D.S. & ARVIN, A.M. - Use of routine viral culture at delivery to identify neonates exposed to herpes simplex virus. New Engl. J. Med., 318: 887-891, 1988.
9. STAVRAKY, K.M.; RAWLS, W.E.; CHIAVETTA, J.; DONNER, A.P. & WANKLIN, J.M. - Sexual and socioeconomic factors affecting the risk of past infections with herpes simplex virus type 2. Amer. J. Epidem., 118: 109-121, 1983.
10. SULLIVAN-BOLYAI, J.; HULL, H.F.; WILSON, C. & COREY, L. - Neonatal herpes simplex virus infection in King County, Washington. Increasing incidence and epideiniologic correlates. J. Amer. med. Ass., 250: 3059-3062, 1983.
11. WEINBERG, A.; BASHAM, T.Y. & MERIGAN, T.C. - Regulation of the guinea pig immune functions by interleukin 2: critical role of natural killer activity in acute HSV 2 infection. J. Immunol., 147: 3312-3316, 1980.
12. WEINBERG, A. & MERIGAN, T.C. - Recombinant Interleukin-2 as an adjuvant for vaccine induced protection: immunization of guinea pigs with subunit HSV vaccines. J. Immunol., 140: 294-299, 1988.
13. WEINBERG, A.; VILAS BOAS, L.S.; FEHRER, O.; STRABELLI, T.M.V.; FINK, M.C.D.S.; DULLEY, F.L.; UIP, D.E.; BELLOTTI, G.; CHAMONE, D.A.F.; AMATO NETO, V. & PANNUTI, C.S. - Cytomegalovirus and oilier herpesviruses infections in heart and bone marrow transplant recipients. Rev. Inst. Med. trop. S. Paulo, 32: 338-342, 1990.
14. WHITLEY, R.J.; NAHMIAS, A.J.; SOONG, S.J.; GALASSO, G.G.; FLEMING, C.L. & ALFORD, C.A. - Vidarabine therapy of neonatal herpes simplex virus infection. Pediatrics, 73: 188-193, 1983.

Correspondence to:

A. Weinberg

UCHSC

Campus Box C 227

4200 E Ninth Ave, Denver

CO 80262, U.S.A

(1

) Supported in part by grant nº 408741/88 from CNPq

Publication Dates

Publication in this collection
20 July 2006
Date of issue
June 1993

History

Accepted
15 Oct 1992
Received
09 Sept 1992

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. ARVIN, A.M.; HENSLEIGH, P.A.; PROBER, C.G.; AU, D.S.; YASUKAWA, L.L.; WITTEK, A.E.; PALUMBO, P.E.; PARYANI, S.G. & YEAGER, A.S. - Failure of anlepartum maternal cultures to predict the infant's risk of exposure to herpes simplex virus at delivery. New Engl. J. Med., 315: 796-800, 1986.

[2] 2. BERNSTEIN, D.I.; BRYSON, Y.J. & LOVETT, M.A. - Antibody response to type common and type-unique epitopes of herpes simplex virus polypeptides. J. mod. Virol., 15: 251-263, 1985.

[3] 3. BROWN, Z.; BERRY, S.; GRIFFIN, D.; BENEDETTI, J. & COREY, L. - Risk factors associated with the acquisition of neonatal HSV among infants exposed to mothers excreting HSV asymptomatical at the onset of labor. In: INTERSCIENCE CONFERENCE ON ANTIMICROBIAL AGENTS AND CHEMOTHERAPY, 28. Program and abstracts. 1988, p.261.

[4] 4. JOHNSON, R.E.; NAHMIAS, A.J.; MAGDER, L.S.; LEE, F.K.; BROOKS, C.A. & SNOWDEN, C.B. - A seroepidemiologic survey of the prevalence of herpes simplex virus type 2 infection in the United States. New Engl. J. Med., 321: 7-12, 1989.

[5] 5. LANGENBERG, A.; BENEDETTI, J.; JENKINS, J.; ASHLEY, R.; WINTER, C. & COREY, L. - Development of clinically recognizable genital lesions among women previously identified as having "asymptomatic" herpes simplex virus type 2 infection. Ann. intern. Med., 110: 882-887, 1989.

[6] 6. LEE, F.K.; COLEMAN, R.M.; PEREIRA, L.; BAILEY, P.D.; TATSUNO, M. & NAHMIAS, A.J. - Detection of herpes simplex virus type 2 specific antibody with glycoprotein G. J. clin. Microbiol., 22: 611-644, 1985.

[7] 7. PANNUTI, C.S.; VILAS-BOAS, L.S.; ANGELO, M.J.O.; CARVALHO, R.P.S. & SEGRE, C.M. - Congenital Cytomegalovirus infection. Occurence in two socioeconomically distinct populations of a developing country. Rev. Inst. Med. trop. S. Paulo, 27: 105-107, 1985.

[8] 8. PROBER, C.G.; HENSLEIGH, P.A.; BOUCHER, F.D.; YASUKAWA, L.L.; AU, D.S. & ARVIN, A.M. - Use of routine viral culture at delivery to identify neonates exposed to herpes simplex virus. New Engl. J. Med., 318: 887-891, 1988.

[9] 9. STAVRAKY, K.M.; RAWLS, W.E.; CHIAVETTA, J.; DONNER, A.P. & WANKLIN, J.M. - Sexual and socioeconomic factors affecting the risk of past infections with herpes simplex virus type 2. Amer. J. Epidem., 118: 109-121, 1983.

[10] 10. SULLIVAN-BOLYAI, J.; HULL, H.F.; WILSON, C. & COREY, L. - Neonatal herpes simplex virus infection in King County, Washington. Increasing incidence and epideiniologic correlates. J. Amer. med. Ass., 250: 3059-3062, 1983.

[11] 11. WEINBERG, A.; BASHAM, T.Y. & MERIGAN, T.C. - Regulation of the guinea pig immune functions by interleukin 2: critical role of natural killer activity in acute HSV 2 infection. J. Immunol., 147: 3312-3316, 1980.

[12] 12. WEINBERG, A. & MERIGAN, T.C. - Recombinant Interleukin-2 as an adjuvant for vaccine induced protection: immunization of guinea pigs with subunit HSV vaccines. J. Immunol., 140: 294-299, 1988.

[13] 13. WEINBERG, A.; VILAS BOAS, L.S.; FEHRER, O.; STRABELLI, T.M.V.; FINK, M.C.D.S.; DULLEY, F.L.; UIP, D.E.; BELLOTTI, G.; CHAMONE, D.A.F.; AMATO NETO, V. & PANNUTI, C.S. - Cytomegalovirus and oilier herpesviruses infections in heart and bone marrow transplant recipients. Rev. Inst. Med. trop. S. Paulo, 32: 338-342, 1990.

[14] 14. WHITLEY, R.J.; NAHMIAS, A.J.; SOONG, S.J.; GALASSO, G.G.; FLEMING, C.L. & ALFORD, C.A. - Vidarabine therapy of neonatal herpes simplex virus infection. Pediatrics, 73: 188-193, 1983.