Changing perspectives of the effects of infectious diseases

There are a large number of infectious agents which damage or kill the developing fetus or child. In this report I have summarized the changing status of information available for just six of these diseases. For rubella there has been excellent success with the development of a vaccine for prevention of this disease. Unfortunately the vaccine is only used extensively in a few countries. Herpes simplex has become a particular problem because of the rapid increase in the frequency of genital herpes infections, the spontaneous recurrences of the lesions, and the difficulty in prevention or treating congenital infections. Cytomegalovirus infections are now known to occur in 1% of newborns, and some damage is produced in about 10% of these children. We have no methods for preventing or treating this infection. Varicella at term is also an important risk to the child but this can now be controlled by the use of VZIG. Varicella earlier in pregnancy may be teratogenic. Venezuelan equine encephalitis virus can cause severe brain damage to the fetus, and one of the vaccines for this infection was shown to be teratogenic in monkeys. Lastly, congenital toxoplasmosis has been known for many years to cause fetal damage and death. Further studies of serological detection of infection and treatment are needed. A number of other viral, bacterial, and parasitic diseases must also be considered as part of the total group of these preventable causes of physical and mental damage to the fetus and newborn.