Modern methods of treatment and prevention of herpesvirus infections in children

Herpesvirus infections remain an urgent problem in pediatrics due to their widespread prevalence and frequent relapses. Herpesviruses are able to persist and reproduce in cells of the immune system, which leads to their death or functional exhaustion, causing secondary immunological insufficiency, maintaining long-term persistence of the virus. The mechanisms leading to the latent state and reactivation of herpesvirus, as well as the factors controlling these processes on the part of the virus and the host organism, have not been fully studied. The authors analyze current literature data based on evidence-based medicine regarding herpesvirus infections, their effect on the immune system, and innovative methods of treatment and prevention. The insufficient effectiveness of traditional methods of treatment and prevention of herpesvirus infections leads to the need to consider the search for methods of immunocorrection. One of the drugs of choice for these infections is inosine pranobex, especially in children with a complicated premorbid background and in cases where a complex antiviral and immunomodulatory effect is required. Inosine pranobex has direct antiviral and immunostimulating effects, effectively relieves acute manifestations, and significantly reduces the frequency of relapses in herpesvirus infections. It is emphasized that the drug has a favorable safety profile, has a low risk of developing resistance, and can be used in children from 3 years of age. Combination therapy of inosine pranobex with antiviral drugs is more effective than monotherapy with antiviral drugs alone. Pharmacoeconomic analysis confirms the expediency of prescribing therapy using inosine pranobex. If there is no effect from the ongoing therapeutic and preventive measures for 3 months, an in-depth examination of the child in a polyclinic or hospital setting, and an individual selection of appropriate treatment are indicated.

1. Chang JY, Balch C, Oh HS. Toward the Eradication of Herpes Simplex Virus: Vaccination and Beyond. Viruses. 2024;16(9):1476. https://doi.org/https://doi.org/10.3390/v16091476.

2. Melnikova IM, Mizernitskiy YuL. Modern approaches to the prevention of frequent respiratory infections in childhood. Meditsinskiy Sovet. 2024;18(19):79–86. (In Russ.) https://doi.org/10.21518/ms2024-506.

3. Shul’zhenko AE, Zuikova IN, Shchubelko RV. Issues of treatment and prevention of recurrent inflammatory diseases of the upper respiratory tract: An immunologist’s view. A review. Terapevticheskii Arkhiv. 2024;96(11):1076–1082. (In Russ.) https://doi.org/10.26442/00403660.2024.11.203033.

4. Ruzhentsova TA, Garbuzov AA, Kanibolotskiy AA, Borisova OYu, Voropaeva EA, Shushakova E.K et al. Herpesvirus infections in the formation of acute and chronic pathology: rationale for timely therapy. Infekc. bolezni (Infectious Diseases). 2023;21(4):64–70. (In Russ.) https://doi.org/10.20953/1729-9225-2023-4-64-70/

5. Savenkova MS, Balakireva GM, Rumyantseva IG. Indications and experience in the use of inosine pranobex in pediatric practice. Pediatrics. Consilium Medicum. 2017;(4):52–55. (In Russ.) Available at: https://omnidoctor.ru/library/izdaniya-dlya-vrachey/pediatriya-consilium-medicum/ped2017/ped2017_4/pokazaniya-i-opyt-primeneniya-inozina-pranobeksav-pediatricheskoy-praktike.

6. Savenkova MS, Balakireva GM, Kuznetsova ES, Rumiantseva IG, Afanas’eva AA, Savenkova AM et al. Experience of treatment with groprinosin (inosine pranobex) for herpes virus infection in children with epilepsy and infantile cerebral palsy. Pediatrics. Consilium Medicum. 2019;(4):51–57. (In Russ.) https://doi.org/10.26442/26586630.2019.4.190750.

7. Savenkova MS, Sotnikov IA, Afanasieva AA, Afanasieva YaV, Dushkin RV. Importance of herpes viruses in children with post-COVID conditions. Russian Journal of Woman and Child Health. 2023;6(1):39–44. (In Russ.) https://doi.org/10.32364/2618-8430-2023-6-1-39-44.

8. Wang Y, Yan X, Ai W, Jia Y, Fan C, Hu S et al. Disparities in burden of herpes simplex virus type 2 in China: systematic review, meta-analyses, and metaregressions. Front Immunol. 2024;15:1369086. https://doi.org/10.3389/fimmu.2024.1369086.

9. Isakov DV, Isakov VA, Alekseeva EA. Immunomodulators for treatment and prevention of respiratory and herpesvirus infections. Clinical Pharmacology and Therapy. 2018;27(5):76–84. (In Russ.) https://doi.org/10.32756/0869-5490-2018-5-76-84.

10. Melnikova IM, Mizernitskiy YL. Methods of immune correction for recurrent respiratory infections in childhood. Meditsinskiy Sovet. 2015;(14):84–88. (In Russ.) https://doi.org/10.21518/2079-701X-2015-14-84-89.

11. Chudakova TK, Mikhaylova EV, Shvedova NM. Efficacy of antiviral treatment for acute respiratory viral infections in children. Clinical Practice in Pediatrics. 2015;10(1):58–63. (In Russ.) Available at: https://www.phdynasty.ru/katalog/zhurnaly/voprosy-prakticheskoypediatrii/2015/tom-10-nomer-1/24352.

12. Isakov VA, Isakov DV, Alekseeva EA. Current opportunities for therapy of respiratory infections. Clinical Pharmacology and Therapy. 2017;26(5):51–56. (In Russ.) Available at: https://clinpharm-journal.ru/articles/2017-5/sovremennye-vozmozhnosti-terapii-respiratornyh-infektsij.

13. Schalkwijk HH, Snoeck R, Andrei G. Acyclovir resistance in herpes simplex viruses: Prevalence and therapeutic alternatives. Biochem Pharmacol. 2022;206:115322. https://doi.org/10.1016/j.bcp.2022.115322.

14. Majewska A, Mlynarczyk-Bonikowska B. 40 Years after the Registration of Acyclovir: Do We Need New Anti-Herpetic Drugs? Int J Mol Sci. 2022;23(7):3431. https://doi.org/10.3390/ijms23073431.

15. Birkmann A, Saunders R. Overview on the management of herpes simplex virus infections: Current therapies and future directions. Antiviral Res. 2025;237:106152. https://doi.org/10.1016/j.antiviral.2025.106152.

16. Sirazitdinova VF, Dmitriev GA, Mannanov AM. Herpesvirus infection in children. Klinicheskaya Dermatologiya i Venerologiya. 2012;10(6):10–15. (In Russ.) Available at: https://www.mediasphera.ru/issues/klinicheskaya-dermatologiya-i-venerologiya/2012/6/031997-2849201262.

17. Saleh D, Yarrarapu SNS, Sharma S. Herpes Simplex Type 1. 2023 Aug 28. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025.

18. Ivanova ON. The study of immunity in children with herpetic infection. Modern Problems of Science and Education. 2018;(5). (In Russ.) Available at: https://science-education.ru/ru/article/view?id=27910.

19. Stern L, Emanuel Z, Traves R, Willis K, Purohit SK, Samer C et al. Herpes simplex virus type 1 impairs mucosal-associated invariant T cells. mBio. 2025;16(5):e0388724. https://doi.org/10.1128/mbio.03887-24.

20. Sliva J, Pantzartzi CN, Votava M. Inosine Pranobex: A Key Player in the Game Against a Wide Range of Viral Infections and Non-Infectious Diseases. Adv Ther. 2019;36(8):1878–1905. https://doi.org/10.1007/s12325-019-00995-6.

21. Zhu S, Viejo-Borbolla A. Pathogenesis and virulence of herpes simplex virus. Virulence. 2021;12(1):2670–2702. https://doi.org/10.1080/21505594.2021.1982373.

22. Nair PA, Patel BC. Herpes Zoster. 2023 Sep 4. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2025.

23. Kashuba EA, Antonova MV, Drozdova TG, Lyubimceva OA, Xanipova LV, Ogoshkova NV et al. Dynamic evaluation of the immune system response of children of different ages in Epstein-Barr viral infectious mononucleosis. Infectious Diseases: News, Opinions, Training. 2020;9(1):63–72. (In Russ.) https://doi.org/10.33029/2305-3496-2020-9-1-63-72.

24. Simovan’yan EN, Denisenko VB, Grigoryan AV. The Effectiveness of Complex Use of Inosine Pranobex and Recombinant Interferon-D2b by Chronic Epstein-Barr Virus Infection in Frequently Ill Children. Children Infections. 2015;(4):31–45. (In Russ.) https://doi.org/10.22627/2072-8107-2015-14-4-31-45.

25. Lagir GM, Stashkevich EV, Shcherbitskaia ZhM, Kudrin AP. Groprinosin in the treatment of infectious mononucleosis in children. Meditsinskie Novosti. 2009;(14):1–2. (In Russ.) Available at: https://www.mednovosti.by/Journal.aspx?id=230.

26. Suxanov DS, Timofeev EV, Alekseeva YuS, Tret`yakov SN, Korshunova AL. Herpetic infections in humans: modern approaches to etiopathogenetic therapy. Lechaschi Vrach. 2025;(6):74–81. (In Russ.) https://doi.org/10.51793/OS.2025.28.6.011.

27. Mizernitskiy YuL, Melnikova IM. Modern therapy of acute respiratory viral infections and influenza in children: how to resist polypharmacy? Pediatrics. Consilium Medicum. 2018;(3):69–73. (In Russ.) https://doi.org/10.26442/2413-8460_2018.3.69-73.

28. Mynbaev OA, Eliseeva MYu, Masikhi KN, Manukhin IB, Tsarev VN. Groprinosin is beneficial immune stimulating agent in immunocompromised patient. Trudnyi Patsient. 2009;(8-9):5–12. (In Russ.) Available at: https://web.archive.org/web/20130522015620/http://www.t-pacient.ru/archive/tp8-9-09/tp8-9-09_601.html.

29. Melekhina EV, Preobrazhenskaya DV, Music AD, Soldatova IM, Gorelov AV. Recurrent respiratory diseases and active herpesvirus infections in children: problems and solutions. breast cancer. RMJ. Medical Review. 2023;7(11): 704–712. (In Russ.) https://doi.org/10.32364/2587-6821-2023-7-11-2.

30. Lee H, Davoudi J, Vistoso A, Khalifeh M, Sedghizadeh P. Reactivated herpetic gingivostomatitis with secondary herpesassociated erythema multiforme and oral candidiasis post-COVID infection: A case report. Clin Case Rep. 2023;11:e7175. https://doi.org/10.1002/ccr3.7175.

31. Yan M, Xiao LY, Gosau M, Friedrich RE, Smeets R, Fu LL et al. The causal association between COVID-19 and herpes simplex virus: a Mendelian randomization study. Front Immunol. 2023;14:1281292. https://doi.org/10.3389/fimmu.2023.1281292.

32. Veretennikova MA. Current treatment of herpes with using different pharmaceutical forms. Fundamental Research. 2014;(8-7):1630–1634. (In Russ.) Available at: https://fundamental-research.ru/ru/article/view?id=35266.

33. Sharma D, Sharma S, Akojwar N, Dondulkar A, Yenorkar N, Pandita D et al. An Insight into Current Treatment Strategies, Their Limitations, and Ongoing Developments in Vaccine Technologies against Herpes Simplex Infections. Vaccines. 2023;11(2):206. https://doi.org/10.3390/vaccines11020206.

34. Gordon P, Brown ER. The antiviral activity of Isoprinosine. Can J Microbiol. 1972;18:1463–1470. https://doi.org/10.1139/m72-224.

35. Lasek W, Janyst M, Wolny R, Zapała Ł, Bocian K, Drela N. Immunomodulatory effects of inosine pranobex on cytokine production by human lymphocytes. Acta Pharm. 2015;65(2):171–180. https://doi.org/10.1515/acph2015-0015.

36. Serhiyenko EN. Application Groprinosin in pediatric practice: a review of the literature. Meditsinskie Novosti. 2016;(9):37–40. (In Russ.) Available at: https://elibrary.ru/wmgubd.

37. Maiorov RV, Getmanov SD, Malysheva EA. Comparative analysis of the efficacy of antiviral drugs to treat Epstein-Barr virus in frequently ill school-aged children. Postgraduate Doctor. 2016;2(1):140–145. (In Russ.) Available at: https://vrach-aspirant.ru/articles/pediatrics/16057.

38. Panasenko LM, Krasnova E, Karceva TV, Nefedova ZhV, Izvekova IYa. Epstein – Barr viral infection in children: clinical characteristic, modern aspects of diagnostics, differentiated approach to treatment. Lechaschi Vrach. 2019;(4):24–28. (In Russ.) https://doi.org/10.26295/OS.2019.42.15.006.

39. Chudakova TK. Inosine pranobex in therapy of acute respiratory viral infections in children. Pediatrics. Consilium Medicum. 2017;(2):24–27. (In Russ.) Available at: https://cyberleninka.ru/article/n/inozin-pranobeksv-terapii-ostryh-respiratornyh-virusnyh-infektsiy-u-detey/viewer.

40. Beran J, Špajdel M, Slíva J. Inosine Pranobex Deserves Attention as a Potential Immunomodulator to Achieve Early Alteration of the COVID-19 Disease Course. Viruses. 2021;13(11):2246. https://doi.org/10.3390/v13112246.

41. Kowalska A. Comparative study of inosine pranobex and famciclovir in herpes simplex keratitis. Clin Ophthalmol. 2020;14:2341–2348. https://doi.org/10.2147/opth.s267891.

42. Sichinava IV. Isoprinosine in the combination treatment of acute respiratory viral infections in pediatric practice. RMJ. 2015;(22):1314–1316. (In Russ.) Available at: https://www.rmj.ru/articles/pediatriya/Primenenie_Izoprinozina_v_kompleksnom_lecheniiostryh_respiratornyh_virusnyh_infekciyv_pediatricheskoy_praktike.

43. Петрова ТИ, Андреева НП, Леженина СВ, Шутова ЕО, Андреева ЛВ. Возможности иммунотропной терапии часто болеющего ребенка в практике врача педиатра. В: Ксембаев СС (ред.) Здоровье человека в XXI веке: материалы 8-й Российской научно-практической конференции с международным участием, Казань, 31 марта – 1 апреля 2016 г. Казань: Бриг; 2016. С. 480–483.

44. Babachenko IV. Effectiveness of inosine pranobex in the treatment and prevention of infectious diseases (system review). Jurnal Infektologii. 2023;15(4):42–53. (In Russ.) https://doi.org/10.22625/2072-6732-2023-15-4-42-53.

45. Chernenkov YuV, Kurmacheva NA, Lobanov ME, Gumenyuk OI, Panshina EV, Gasanova SK et al. Clinical efficacy of inosine pranobex in children with acute respiratory viral infections of the upper respiratory tract. Russian Journal of Woman and Child Health. 2025;8(2):142–148. (In Russ.) https://doi.org/10.32364/2618-8430-2025-8-2-8.

46. Akulich NF, Krivenko NA, Khnykov AM, Semyonov VM, Dmitrachenko TI. Experience in the treatment of socially significant viral infections with Groprinosin. Meditsinskie Novosti. 2009;(6):51–53. (In Russ.) Available at: https://web.archive.org/web/20210512205139/ https://www.mednovosti.by/Journal.aspx?id=220.

47. Markova TP. Isoprinosine Use For the prophylaxis of recurrent respiratory infections in frequently Ill children. Farmateka. 2009;(5):49–52. (In Russ.) Available at: https://pharmateca.ru/ru/archive/article/7459.

48. Majewska A, Lasek W, Janyst M, Młynarczyk G. In vitro infibition of HHV-1 replication by inosine pranobex and interferon-α. Acta Pol Pharm. 2016;73(3):637–644. Available at: https://pubmed.ncbi.nlm.nih.gov/27476281.

49. Latysheva TV, Pavlova KS. Comparative study of inosine pranobex and standard treatment in patients with frequent and prolonged respiratory viral infections. Clinical Pharmacology and Therapy. 2016;26(4):36–40. (In Russ.) Available at: https://clinpharm-journal.ru/files/articles/sravnitelnaya-otsenka-effektivnosti-groprinosinai-obshheprinyatoj-terapii-u-patsientov-chasto-i-dlitelno-boleyushhihrespiratornymi-virusnymi-zabolevaniyami.pdf.

50. Nazarova NM, Attoeva DI, Dovletkhanova ER, Prilepskaya VN. Genital viral infections in clinical practice: effectiveness of complex treatment. Meditsinskiy Sovet. 2019;(13):166–171. (In Russ.) https://doi.org/10.21518/2079-701X2019-13-166-171.

51. Germanenko IG. Chickenpox: new approaches to treating “old” children's infections. Meditsinskie Novosti. 2009;(2):15–17. (In Russ.) Available at: https://www.mednovosti.by/Journal.aspx?id=215.

52. Sinha D, Yaugel-Novoa M, Waeckel L, Paul S, Longet S. Unmasking the potential of secretory IgA and its pivotal role in protection from respiratory viruses. Antiviral Res. 2024;223:105823. https://doi.org/10.1016/j.antiviral.2024.105823.

53. Kundu N, Kumar A, Corona C, Chen Y, Seth S, Karuppagounder SS, Ratan RR. A STING agonist preconditions against ischaemic stroke via an adaptive antiviral Type 1 interferon response. Brain Commun. 2022;4(3):fcac133. https://doi.org/10.1093/braincomms/fcac133.