Most parents teach their children to be generous and to share. Family members often show affection by sharing their drinks, utensils, or by kissing a child. But sometimes, these simple acts of caring can be dangerous, inadvertently causing a lifelong HSV-1 infection. This is because up to 70% of adults are infected with HSV-1 (oral herpes), many of whom are unaware they are infected and can transmit the virus to loved ones. An estimated 20-33% of children are infected with oral herpes by age five, and tragically most of these infections could have been prevented. Currently, there is no vaccine for HSV-1.

What is Herpes Simplex Virus – Type 1?

HSV-1 is the Herpes Simplex Virus - Type 1 and is responsible for cold sores, also known as fever blisters. Children with an initial infection with HSV-1 may exhibit blisters on the lips/mouth, inside the mouth and on gums. Other symptoms include fever, irritability, sore throat, an inability to eat or drink, and increased drooling in infants. However, some initial infections are unnoticeably mild. Regardless of the severity of the initial infection, painful blisters can recur throughout a child’s life.

How is HSV-1 transmitted?

HSV-1 is highly contagious and transmitted through contact with saliva, cold sores, and mucosal surfaces. Sharing utensils, cups, straws, kissing, or direct contact with objects such as toys contaminated with saliva can lead to infection.Sadly, parents, grandparents, and siblings are often the source of a child’s first infection. Loved ones may not realize they are infectious and unknowingly transmit the disease to an infant or child. Children may inadvertently infect a sibling through sharing contaminated objects or through direct skin-to-skin contact. Furthermore, HSV-1 infections are most contagious when a person has symptoms but can still be transmitted when a person does not have symptoms. Newborns and infants are at particularly high risk of serious complications due to infection, including death.

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Recurrence and lifelong infection

Children who have recurrent flare-ups on their face (mouth/nose/chin/etc.) may deal with painful sores and sometimes psychosocial issues, including emotional distress. Some children infected with HSV-1 may not have recurrent cold sores after the initial infection, but the virus remains in their body for a lifetime and can produce cold sores in the future when the virus is reactivated by stress or other triggers.

How to keep you and your loved ones safe

• Avoid direct contact with sores or saliva.
• Avoid kissing newborns and children on or near the mouth, nose, eyes, or other susceptible membranes.
• If someone wants to hold your infant, have them wash their hands first. 
• People with a cold sore or who have had one recently should not hold your infant.
• Do not share objects that might be contaminated with saliva including utensils, cups, towels, or toys.
• If someone in the household has an active infection, they should avoid touching the sore which can spread the virus to objects or to other parts of their body (fingers, eyes). 
• Sanitize objects such as toys that might be shared and put into the mouth by another child. 
• Wash hands frequently.
• If your children participate in sports involving skin-skin contact (like martial arts or wrestling), be sure the mats are sanitized frequently. Children should not engage in skin-to-skin contact sports with someone with a visibly active infection.

Parents should inform their children and family members about ways to prevent HSV-1 infection. By taking these steps, parents reduce the risk of a child contracting oral herpes and other diseases spread through saliva such as mononucleosis, strep throat, and hand foot and mouth disease.

Children can help be their own advocates for staying healthy, but infants rely on us for protection. If you have questions about preventing, diagnosing, or treating HSV-1, you can connect with a board-certified pediatrician through Blueberry Pediatrics.

Blueberry offers on-demand virtual healthcare through text, phone, or video, 24/7. The best part? An entire year of Blueberry membership costs less than the typical copay of a single urgent care visit, and one membership covers all children in your household - it's like having a doctor's office in your home! Sign up here.

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‍Shelby Bohl, PhD, MPH, CPH is a Senior Public Health & Clinical Research Consultant. This article is excerpted from Bohl, S. (2021, March 15). Communicable Disease Prevention in Infants and Children: A Guide for New Parents [Presentation].

Sources

1. American Academy of Pediatrics (2017). Cold Sores in Children: About the Herpes Simplex Virus. Horsager-Boehrer, R. & Kahn, J. (2017). How to protect your baby from Herpes Infection.
2. Bohl, S. (2021, March 15). Communicable Disease Prevention in Infants and Children: A Guide for New Parents [Presentation].
3. CDC. (2018). McQuillan, Kruszon-Moran, G.D. Flagg, E., Ph.D., M.S., & Paulose-Ram, R. Prevalence of Herpes Simplex Virus Type 1 and Type 2 in Persons Aged 14–49:United States, 2015–2016.
4. Chayavichitsilp P., Buckwalter J.V, Krakowski, A.C. & Friedlander, S.F. (2009, April). Pediatrics in Review, 30 (4) 119-130; DOI
5. Horsager-Boehrer, R. & Kahn, J. (2017). Your Pregnancy Matters: How to protect your baby from herpes infection.
6. World Health Organization. (2020, May 1). Herpes Simplex Virus.