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May 7, 2003

Cesarean Delivery and Risk of Herpes Simplex Virus Infection—Reply

Author Affiliations

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2003;289(17):2208-2209. doi:10.1001/jama.289.17.2208-a

To the Editor: Based on 18 cases of neonatal herpes, Dr Brown and colleagues1 argue that "development of a strategy to reduce this disease burden seems imperative." What, though, is the actual disease burden? The authors provided no clinical outcome details about the neonatal herpes cases they observed and did not acknowledge that theirs is among the highest incidence ever to be reported. Before broad neonatal herpes preventive efforts (eg, serologic screening) are instituted, the incidence and severity of neonatal herpes should be better defined and categorized on a populationwide basis. In California, during the 10-year period of 1985-1995, the incidence of neonatal herpes was stable at 1.1 per 10 000 births,2 a rate 3 times lower than that reported by Brown et al.1 It is difficult to imagine that screening and treatment for such an uncommon disease would ever be efficient or cost-effective.3

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