Herpes B

Question 1

Herpes B structure & classification

Answer 1

Family: Herpesviridae
Genus: Simplexvirus

Enveloped dsDNA

Baltimore: I

Reservoir: exclusively macaques - latent infection & genital lesions with oral and genital secretions

Question 2

Epidemiology of Herpes B

Answer 2

India, Indonesia, Nepal
Puerto Rico, Caribbean
Florida

Question 3

Herpes B incubation

Answer 3

2 days to 5 weeks

Question 4

Herpes B clinical syndrome

Answer 4

1. Vesicular lesion at site of injury/bite
2. IFI
3. Encephalitis

Question 5

Herpes B mortality

Answer 5

80% if no antivirals
Antivirals PEP - 0 cases after exposure

Question 6

Herpes B diagnostics

Answer 6

No testing in the UK - previously offered at VRD Colindale
National B virus Resource Centre in Atlanta offers PCR, serology (4 fold titre increase) and viral cultures

Question 7

PEP in Herpes B

Answer 7

CDC guidelines -
Indicated if exposure < 5 days ago

Aciclovir/Valaciclovir - 800mg 5 times a day/1g TDS for 14 days

Question 8

Herpes B treatment

Answer 8

1. Immediate treatment: IV aciclovir 15mg/kg TDS if no PNS/CNS involvement

IV ganciclovir in PNS/CNS involvement

Duration: 2-3 weeks or until symptoms resolve.

2. Oral step down: Then oral aciclovir/valaciclovir at PEP doses for 1 year - expert opinion as it can establish latency.
3. Suppression: Then lifelong suppression with low doses Valaciclovir 500 BD/aciclovir 400 BD.