Seroepidemiology of herpes simplex virus type 1 in Yanji, Jilin, China

Prevalence and clinical markers of herpes simplex virus infection in oral lesions of bullous pemphigoid

Background

The manifestations of bullous pemphigoid (BP) and herpes simplex virus (HSV) infection are similar in oral mucosa, and the laboratory detection of HSV has some limitations, making it difficult to identify the HSV infection in oral lesions of BP. In addition, the treatments for BP and HSV infection have contradictory aspects. Thus, it is important to identify the HSV infection in BP patients in time.

Objective

To identify the prevalence and clinical markers of HSV infection in oral lesions of BP.

Methods

This prospective cross-sectional descriptive analytical study was conducted on 42 BP patients with oral lesions. A total of 32 BP patients without oral lesions and 41 healthy individuals were enrolled as control groups. Polymerase chain reaction was used to detect HSV. Clinical and laboratory characteristics of patients with HSV infection were compared with those without infection.

Results

A total of 19 (45.2%) BP patients with oral lesions, none (0.0%) BP patients without oral lesions, and four (9.8%) healthy individuals were positive for HSV on oral mucosa. Among BP patients with oral lesions, the inconsistent activity between oral and skin lesions (p=0.001), absence of blister/blood blister in oral lesions (p=0.020), and pain for oral lesions (p=0.014) were more often seen in HSV-positive than HSV-negative BP patients; the dosage of glucocorticoid (p=0.023) and the accumulated glucocorticoid dosage in the last 2 weeks (2-week AGC dosage) (p=0.018) were higher in HSV-positive BP patients. Combining the above five variables as test variable, the AUC was 0.898 (p<0.001) with HSV infection as state variable in ROC analysis. The absence of blister/blood blister in oral lesions (p=0.030) and pain for oral lesions (p=0.038) were found to be independent predictors of HSV infection in multivariable analysis. A total of 14 (73.7%) HSV-positive BP patients were treated with 2-week famciclovir and the oral mucosa BPDAI scores significantly decreased (p<0.001).

Conclusion

HSV infection is common in BP oral lesions. The inconsistent activity between oral and skin lesions, absence of blister in oral lesions, pain for oral lesions, higher currently used glucocorticoid dosage, and higher 2-week AGC dosage in BP patients should alert physicians to HSV infection in oral lesions and treat them with 2-week famciclovir in time.

The Epidemiology of Herpes Simplex Virus Type 1 in Asia: Systematic Review, Meta-analyses, and Meta-regressions

Background

Herpes simplex virus type 1 (HSV-1) epidemiology in Asia was characterized by assessing seroprevalence levels and extent to which HSV-1 is isolated from clinically diagnosed genital ulcer disease (GUD) and genital herpes.

Methods

HSV-1 reports in Asia were systematically reviewed and synthesized, following PRISMA guidelines. Random-effects meta-analyses estimated pooled mean seroprevalence and proportion of HSV-1 detection in GUD and genital herpes. Random-effects meta-regressions identified predictors of seroprevalence and sources of between-study heterogeneity.

Results

Forty-nine relevant publications were identified. Fifty-four overall seroprevalence measures (182 stratified measures), and 8 and 24 proportions of HSV-1 detection in GUD and in genital herpes, respectively, were extracted. The pooled mean seroprevalence was 50.0% (n = 26; 95% confidence interval [CI], 41.3%–58.7%) for children and 76.5% (n = 151; 73.3%–79.6%) for adults. By age group, the pooled mean was lowest at 55.5% (n = 37; 95% CI, 47.5%–63.4%) in individuals aged <20 years, followed by 67.9% (n = 48; 62.4%–73.3%) in those aged 20–39 and 87.5% (n = 44; 83.4%–91.1%) in those aged ≥40 years. In meta-regression, age was the major predictor of seroprevalence. The mean proportion of HSV-1 detection was 5.6% (n = 8; 95% CI, 0.8%–13.6%) in GUD and 18.8% (n = 24; 12.0%–26.7%) in genital herpes.

Conclusions

HSV-1 epidemiology is transitioning in Asia. HSV-1 is probably playing a significant role as a sexually transmitted infection, explaining one-fifth of genital herpes cases. There is a need for expanded seroprevalence monitoring and GUD/genital herpes etiological surveillance.

Epidemiology of herpes simplex virus in children by detection of specific antibodies in saliva

OBJECTIVES

To facilitate the study of the prevalence of herpes simplex virus (HSV) infection and its determinants in children, we developed a noninvasive saliva test.

METHODS

A capture enzyme-linked immunosorbent assay (ELISA) for the detection of IgG to HSV in saliva was developed, validated against a commercial serum ELISA in 110 children and 187 adults and used in a cross-sectional population-based study including 2,048 children ages 1 to 17 years, recruited in day-care centers and schools of Geneva, Switzerland. Demographic and socioeconomic determinants of HSV prevalence were studied.

RESULTS

The sensitivity and specificity of the saliva assay were 94.1 and 95.5%, respectively, compared with the commercial serum ELISA. Participation in the cross-sectional study was 86.6%. The overall prevalence of anti-HSV IgG was 23.91%. It increased with age up to 7 years, reaching a plateau at 35% without evidence for day-care or school transmission. The main determinants of prevalence were region of national origin and parents' professional category.

CONCLUSIONS

This new saliva-based assay proved its feasibility in the first population-based study of HSV prevalence in children that uses saliva, confirmed its validity by identifying determinants of prevalence consistent with previous reports and yielded new information, such as the lack of influence of day-care attendance, in the population studied.

Production of herpes simplex virus fluorescein labelled typing reagents

29 herpes simplex virus monoclonal antibodies (MAbs) were produced and shown by indirect immunofluorescence assay (IIFA) to be HSV type specific or HSV cross reactive. Two HSV-1 and two HSV-2 specific MAbs were selected as HSV typing reagents on the basis of their specificity and the fluorescence pattern produced. When directly conjugated to fluorescein both reagents detected and correctly identified HSV isolates previously typed by restriction endonuclease analysis (REA). No cross reactions were observed with a panel of human viral pathogens. Assessment of these reagents in parallel with the Syva Microtrak Culture Identification/Typing Test indicated 100% concordance for the detection and typing of 80 clinical isolates.