Nosocomial herpetic infections in a pediatric intensive care unit

A series of acute herpetic infections occurred among nurses and patients in a pediatric intensive care unit (PICU). Epidemiologic study revealed two separate time clusters of infections, one in early summer and another six weeks later. Restriction endonuclease analysis of DNA extracted from virus isolates showed that each time cluster was associated with a different genetic strain of herpes simplex virus (HSV) type 1 and provided evidence of cross infection between patients and nurses. Three nurses had herpetic whitlow; the husband of one had acute gingivostomatitis; a fourth nurse had acute pharyngitis. They had no previous history of HSV infection and sequential antibody testing of affected nurses showed 19S antibody in all initially positive serums, confirming primary infection. The data provide clear evidence that PICU personnel risk acquiring serious herpetic infections from patients and vice versa unless specific precautions are taken. Restriction endonuclease analysis of HSV DNA was useful in the epidemiologic study of the infections.