Management of neonatal central nervous system viral infections: Knowledge gaps and research priorities

Abstract

Congenital CMV, enteroviruses, human parechovirus and herpes simplex virus are all common causes of severe central nervous system (CNS) infection in neonates.The introduction of screening (i.e. newborn hearing screening programme), integration of molecular syndromic testing (i.e. multiplex polymerase chain reaction assays) and increase in sexually transmitted infections (i.e. anogenital herpes) have contributed to increases in each of these infections over the last decade. However, therapeutic options are highly limited in part due to the lack of epidemiological data informing trials. This review will describe our current understanding of the clinical burden and epidemiology of these severe neonatal CNS infections, outline the novel antiviral and vaccines in the pipeline and suggest future research studies which could help develop new therapeutics.

Neonatal herpes simplex virus infection: From the maternal infection to the child outcome

“…The problem of acyclovir resistance necessitates further research about novel antivirals such as brincidofovir/CMX001 (a nucleoside analogue), pritelivir, and amenamevir (both are viral helicase/primase inhibitors). 74 Brincidofovir is released into target cells, the lipid side chain is cleaved, releasing cidofovir to be further phosphorylated by intracellular kinases to cidofovir diphosphate. Cidofovir diphosphate has less renal toxicity than the parent molecule.…”

“…The problem of acyclovir resistance necessitates further research about novel antivirals such as brincidofovir/CMX001 (a nucleoside analogue), pritelivir, and amenamevir (both are viral helicase/primase inhibitors) 74 …”

“…Given the HSV resistance of suppressive medications, an investigation of existing vaccine candidates for vertical transmission is required, which will necessitate phase I studies in pregnant women 74 . The introduction of messenger RNA (mRNA) vaccines in the COVID pandemic, in particular, opens up a new path of vaccine research for the prevention of viral infections.…”

“…Given the HSV resistance of suppressive medications, an investigation of existing vaccine candidates for vertical transmission is required, which will necessitate phase I studies in pregnant women. 74 The introduction of messenger RNA (mRNA) vaccines in the COVID pandemic, in particular, opens up a new path of vaccine research for the prevention of viral infections. mRNA vaccine technology has the potential to boost vaccine production while also broadening the range of possible antigenic targets, which has been constrained by previous expression methods.…”