A Nurse Practitioner's Guide to the Management of Herpes Simplex Virus-1 in Children

Janel M. Drugge, MSM, RN, PNP; Patricia Jackson Allen, MS, RN, PNP, FAAN

Disclosures

Dermatology Nursing. 2008;20(6):455-466. 

In This Article

Prevention Strategies

Health care experts are still unsure exactly what causes recurrent outbreaks in individuals who have frequent secondary HSV-1 infections (Logan et al., 1998; Stock et al., 2001). HSV-1 tends to reactivate in each individual for varying reasons (Ensor, 2005). Therefore, it is important for each child and adolescent to recognize their individual triggers for HSV-1 outbreaks to help minimize and prevent recurring infections. Below are a few strategies clinicians can use to help prevent HSV-1 outbreaks for children and adolescents.

Physical and emotional stress reduction. Physical and emotional stress have been linked by some research studies as a possible trigger to recurrent HSV-1 infections (Augustin, 2001; Logan et al., 1998; Stock et al., 2001). Clinicians should encourage regular exercise; a balanced, nutritional diet; and sufficient amounts of rest and sleep. During times of emotional stress, relaxation techniques, such as imagery training, visualization, self-hypnosis, or meditation, can help lower stress levels (Gruzelier, 2002). Children and adolescents with recurrent HSV-1 infections should avoid physically demanding work if they feel a prodromal period of tingling and burning, signifying the beginning of an HSV-1 outbreak.

Weather. Recurrent outbreaks of HSV-1 have also been linked to extreme changes in the weather (Boon et al., 2000). During the winter season, children should avoid extreme frost, wind, or cold weather, and use a lip balm to prevent lips from cracking. In contrast, during summer months, children and adolescents should always wear sunscreen and use a lip balm with sun protection factor (SPF) of 15 or higher (Ichihashi et al., 2004).

Illness. The common cold, febrile illness, and immune deficiency have been linked in the scientific literature as triggers for HSV-1 infections (Dalkvist et al., 1995). Children and adolescents should be educated to properly rest and stay hydrated during times of illness or other infections to minimize the chance of HSV-1 outbreaks. Children should practice preventative measures to avoid the common cold, such as washing hands frequently with hot water and soap; limiting contact with people who have a cold when possible; avoiding touching eyes, nose, and mouth; and covering their nose and mouth when coughing or sneezing. These measures will help keep children, adolescents, and those around them healthy and illness-free.

Nutritional supplementation. Several studies involving adult participation have shown that various nutritional supplementations can help prevent the recurrence of HSV-1 infections (Baeten et al., 2004; Femiano et al., 2005; Tomblin & Lucas, 2001). HSV is dependent on the amino acid arginine for reproduction. Researchers have examined the use of lysine, an amino acid and active inhibitor of arginine, to decrease the severity and frequency of HSV-1 outbreaks (Tomblin & Lucas, 2001). A literature review on the efficacy of lysine in reducing the frequency, duration, and severity of HSV-1 outbreaks found six out of seven randomized, double-blind, placebo-controlled studies resulted in lysine effectively, decreasing the frequency of HSV-1 outbreaks. However, only two of the six clinical studies showed lysine decreasing the severity or duration of HSV-1 outbreaks (Tomblin & Lucas, 2001). Daily supplemental lysine at 3,000 mg/day may help decrease the frequency of HSV-1 outbreaks, but there have been no studies in children. Future studies need to examine the safety and efficacy of lysine supplementation in children before recommendations can be made for daily supplementation use.

Zinc has been shown in previous studies to boost the immune system by increasing the number of helper or effector T-cells (Bogden, 2004). Femiano and colleagues (2005) studied 20 people who had self-documented six or more episodes of HSV-1 outbreaks a year. Each participant took 22.5 mg of zinc sulphate twice daily for 4 months during the year they were studied. At the end of the trial period, HSV-1 lesions were reduced to less than four episodes during the year (average three episodes), and the duration of lesions was less than 7 days (average 5.7 days). More research is needed through larger scale clinical trials, as well as further studies examining the safety and efficacy of zinc supplementation in children and adolescents.

No nutritional supplementations are currently approved by the FDA for the use in children and adolescents for preventing or treating HSV-1 outbreaks. Further clinical randomized, double-blind, placebo-controlled studies are needed to prove if nutritional supplementation is safe and effective in children and adolescents for the prevention and management of HSV-1 recurrent outbreaks.

Prevention of transmission. HSV-1 is transmitted by close personal contact. Primary HSV-1 infections occur commonly in children between 1 and 3 years of age (Kimberlin, 2005). In a recent study, serology samples were taken from mothers and infants at 3, 5, 6, 12, 13, and 30 months of age, and analyzed for the presence of IgG antibodies to HSV (Tunback, Bergstrom, Claesson, Carlsson, & Lowhagen, 2007). Greater than half of primary HSV-1 infections were seen during the first 13 months of life (Tunback et al., 2007). This study suggests that a large portion of primary HSV-1 infections occur during infancy through parent-child or sibling-child transmission rather than during the school years. Therefore, parents, siblings, and friends should avoid kissing infants when active HSV-1 lesions are present (Kimberlin, 2005). Frequent and thorough hand washing should occur before any contact with the newborn. Breastfeeding should be avoided if HSV lesions are present on the mother's breast to avoid HSV transmission to the infant (Kimberlin, 2005).

Childcare facilities or school classrooms have increased rates of transmission of HSV-1 infections due to the close proximity of children and the sharing of utensils and beverages (Raborn & Grace, 1999). Parents of children with an acute infection worry about keeping their infected child home and away from other children, or when to safely return their child to daycare or school (Blevins, 2003). Children with severe HSV-1 infections should stay home from school or daycare facilities if excess drooling and secretions are present (American Academy of Pediatrics, 2006). Childcare workers can help prevent the spread of HSV-1 by discouraging sharing food, drinks, and utensils, as well as thoroughly washing toys between uses by different children. Frequent and thorough hand washing with soap and hot water by children and staff should also be encouraged.

Education. Nurse practitioners are in a prime position to educate children, adolescents, and their families on strategies to prevent HSV-1 outbreaks and to properly identify, manage, and treat HSV-1 infections. Figure 8 lists key educational points that should be taught to patients with outbreaks.

Figure 8.

Strategies to Prevent HSV-1 Infections

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