SIOUX CITY | A little over a week after Owen Putzier was born, mysterious blisters began forming on his forehead.
Riley Coleman, of Mapleton, Iowa, said her son seemed to be sleeping quite a bit, but wasn't running a fever.
Coleman and Owen's dad, David Putzier, took him to the doctor for a checkup on July 14. A day later, Owen's blisters had worsened, and he was admitted to UnityPoint Health-St. Luke's pediatric unit.
"When he was awake, he was a happy baby," Coleman said. "He would eat his full bottles. There was never any other symptoms other than the blisters."
While Putzier and Coleman were waiting for the results of Owen's skin swabs, blood draws and spinal tap, they heard about Mariana Reese Sifrit, an infant who developed viral meningitis after likely being kissed by someone with herpes simplex virus 1 (HSV-1), the virus that causes cold sores.
Mariana, whose story received national media coverage, died from the infection at the University of Iowa Children's Hospital in Iowa City on July 18. She was just 18 days old.
"After we saw that, we were kind of in a panic, because we had to wait all weekend to get the results back from Mayo," Coleman recalled.
A sample of Owen's spinal fluid revealed he did in fact have HSV-1, which came as a shock to Coleman. She said Owen's doctors remained in constant contact with an infection team in Omaha, Nebraska, as they treated his condition with intravenous antiviral medication.
"When the doctor had said it was a herpes virus, the first thing you think of is the other kind. I never knew that cold sores were a herpes," Coleman said.
An estimated 3.7 billion people under age 50 worldwide have HSV-1, which typically produces sores around the mouth and lips, according to the World Health Organization (WHO). Another 417 million people ages 15-49 have HSV-2, a sexually transmitted infection that causes lesions in the genital area. Most show no symptoms.
Kristi Klein, a neonatologist at St. Luke's, said HSV infection in newborn babies can be dangerous because their immune systems haven't fully developed. Signs of the virus include low grade fever, poor feeding, irritability, listlessness and a skin rash in the form of pimples or blisters. In rare instances, HSV can develop into meningitis, an inflammation of the protective membranes that cover the brain and spinal cord.
Klein said HSV-1 commonly spreads through saliva, skin-to-skin contact or by touching an object handled by an infected person.
"If someone has a cold sore, what we would recommend is they're not kissing the baby, they're not having the baby anywhere near the lesion. That applies to anyone with a cold sore, not just mom or dad," Klein said. "They also shouldn't be putting things in their mouth that the baby may then put in their mouth -- like cleaning off a pacifier."
An infant can also be exposed to HSV in the genital tract during delivery, but the WHO says neonatal herpes is rare, occurring in an estimated 10 out of every 100,000 births globally.
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To prevent the spread of HSV-2 at birth, Klein said obstetric providers require women who have active genital lesions to give birth via C-section rather than deliver vaginally to keep the baby from coming into contact with the virus in the birth canal. She urges women with a history of genital herpes to talk to their doctor beforehand.
Klein said health care staff at St. Luke's see cases of HSV in newborn babies from time to time, but she said serious complications that arise from a case of influenza or respiratory syncytial virus (RSV) are more common.
RSV causes moderate to severe cold-like symptoms in children and babies that can progress to a severe lung infection, lead to serious breathing problems and ultimately result in hospitalization.
"Usually an adult isn't going to know if they have RSV," Klein said. "Anybody that has fever, cough, runny nose -- unless it's a mom or dad, who obviously cannot leave their child alone -- those visitors shouldn't be coming into the home if you have a newborn."
Klein said parents and anyone else caring for a newborn should be up-to-date on their immunizations. When the baby comes home, especially in the winter months, she recommends that the parents keep a bottle of hand sanitizer in every room in the house.
"Hands are the place where you're going to transfer germs," she said. "If you are holding the baby and you set the baby down, you should wash your hands before you come back to pick the baby up again."
For the first four weeks after birth, Klein said parents should be wary about whom they let into their homes and where they take their babies. Shopping malls, grocery stores and even churches, she said, should be avoided, if possible, to prevent the baby from coming into contact with someone who's ill.
"Make sure you're saying, 'If you're sick. Please don't visit until you don't have any symptoms anymore,'" she said.
Coleman said family did visit Owen while he was hospitalized in St. Luke's neonatal intensive care unit after his birth on July 3. During labor, which Coleman described as "a little rough," the umbilical cord tore. Owen, who weighed 8 pounds, 2 1/2 ounces at birth, remained in the NICU until July 7.
From the time Owen returned home to the time he was admitted to St. Luke's pediatric unit, Coleman said not many friends and family members visited their home. How exactly Owen contracted HSV-1, she said, still remains unknown.
"Unless it's the mom or dad, don't be kissing up on the baby, because we're not sure still how Owen got it," Coleman warned. "There's plenty of time when they're older."
After a 21-day hospital-stay, Owen has fully recovered from HSV-1 and Coleman is grateful for the care the medical staff at St. Luke's provided her son. She said Owen is sleeping through the night and has gained quite a bit of weight since the illness.
"He's doing great. I guess we never really knew what his normal babyself was because he was sick," she said.