A Population-Based Study of Primary Human Herpesvirus 6 Infection
Danielle M. Zerr, M.D., M.P.H., Amalia S. Meier, Ph.D., Stacy S. Selke, M.A., Lisa M. Frenkel, M.D., Meei-Li Huang, Ph.D., Anna Wald, M.D., M.P.H., Margaret P. Rhoads, B.A., Long Nguy, B.S., Rena Bornemann, M.D., Rhoda Ashley Morrow, Ph.D., and Lawrence Corey, M.D.
Background Serologic studies indicate that human herpesvirus6 (HHV-6) infects 90 percent of children by two years of age.Little is known about the acquisition, virologic course, andclinical manifestations of HHV-6 infection.
Methods We prospectively studied a cohort of 277 children frombirth through the first two years of life to define the patternof acquisition of HHV-6. The children's saliva was tested weeklyfor HHV-6 DNA with the use of the polymerase chain reaction.Parents maintained a daily log of signs and symptoms of illnessin their children.
Results Primary HHV-6 infection occurred in 130 children, withcumulative percentages of 40 percent by the age of 12 monthsand 77 percent by the age of 24 months. The peak age of acquisitionwas between 9 and 21 months. The acquisition of HHV-6 was associatedwith female sex (adjusted hazard ratio, 1.7; 95 percent confidenceinterval, 1.2 to 2.4) and having older siblings (adjusted hazardratio, 2.1; 95 percent confidence interval, 1.4 to 2.9). Among81 children with a well-defined time of acquisition of HHV-6,93 percent had symptoms, and 38 percent were seen by a physician.None had seizures. As compared with children who had other illnesses,those with primary HHV-6 infection were more likely to havefever (P=0.003), fussiness (P=0.02), diarrhea (P=0.03), rash(P=0.003), and roseola (P=0.002) and were more likely to visita physician (P=0.003).
Conclusions The acquisition of HHV-6 in infancy is usually symptomaticand often results in medical evaluation. Roseola occurs in aminority of patients, and febrile seizures are infrequentlyassociated with primary HHV-6 infection. Older siblings appearto serve as a source of HHV-6 transmission.
Source Information
From the Departments of Pediatrics (D.M.Z., L.M.F.), Laboratory Medicine (A.S.M., L.M.F., R.A.M., L.C.), Medicine (A.W.), and Epidemiology (A.W.), University of Washington; Children's Hospital (D.M.Z., L.M.F., M.P.R., R.B.); and the Programs in Biostatistics (A.S.M.) and Infectious Diseases (S.S.S., M.-L.H., L.N., L.C.), Fred Hutchinson Cancer Research Center — all in Seattle.
Address reprint requests to Dr. Zerr at Children's Hospital, 8G-1, 4800 Sand Point Way, NE, Seattle, WA 98105, or at zerr{at}u.washington.edu.
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