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Clinical and Developmental Immunology
Volume 2013 (2013), Article ID 369172, 16 pages
Review Article

The Immunologic Basis for Severe Neonatal Herpes Disease and Potential Strategies for Therapeutic Intervention

1Department of Pediatrics, Division of Infectious Diseases, University of Washington and Seattle Children’s Hospital, Seattle, WA 98105, USA
2Department of Pediatrics, Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA

Received 4 January 2013; Accepted 6 March 2013

Academic Editor: Tobias R. Kollmann

Copyright © 2013 Soren Gantt and William J. Muller. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Herpes simplex viruses types 1 and 2 (HSV-1 and HSV-2) infect a large proportion of the world’s population. Infection is life-long and can cause periodic mucocutaneous symptoms, but it only rarely causes life-threatening disease among immunocompetent children and adults. However, when HSV infection occurs during the neonatal period, viral replication is poorly controlled and a large proportion of infants die or develop disability even with optimal antiviral therapy. Increasingly, specific differences are being elucidated between the immune system of newborns and those of older children and adults, which predispose to severe infections and reflect the transition from fetal to postnatal life. Studies in healthy individuals of different ages, individuals with primary or acquired immunodeficiencies, and animal models have contributed to our understanding of the mechanisms that control HSV infection and how these may be impaired during the neonatal period. This paper outlines our current understanding of innate and adaptive immunity to HSV infection, immunologic differences in early infancy that may account for the manifestations of neonatal HSV infection, and the potential of interventions to augment neonatal immune protection against HSV disease.