Characterizing herpes simplex virus type 1 and type 2 seroprevalence declines and epidemiological association in the United States

Phase 1 randomized pharmacokinetic and safety study of a 90-day tenofovir vaginal ring in the United States

INTRODUCTION

Tenofovir-based oral pre-exposure prophylaxis is currently approved for HIV prevention; however, adherence in women has been low. A vaginal gel containing tenofovir (TFV) demonstrated partial protection to HIV but protection was not confirmed in additional studies. Vaginal rings offer user-controlled long-acting HIV prevention that could overcome adherence and protection challenges. TFV may also help prevent herpes simplex virus type 2 acquisition when delivered intravaginally. We evaluated the pharmacokinetics, safety, adherence and acceptability of a 90-day TFV ring.

METHODS

Between January and June 2019, Microbicide Trials Network (MTN)-038 enrolled 49 HIV-negative participants into a phase 1, randomized (2:1) trial comparing a 90-day ring containing 1.4 grams (g) TFV to a placebo ring. TFV concentrations were quantified in plasma, cervicovaginal fluid (CVF), rectal fluid and cervical tissue, and TFV-diphosphate (TFV-DP) in cervical tissue. Used rings were analysed for residual TFV. Safety was assessed by adverse events (AEs); acceptability and adherence by self-report.

RESULTS

Mean age was 29.5; 46 identified as cisgender-female and three gender non-conforming. There were no differences in the proportion of participants with grade ≥2 genitourinary AEs in the TFV versus placebo arms (p = 0.41); no grade ≥3 AEs were reported. Geometric mean TFV concentrations increased through day 34 in CVF/rectal fluid and day 59 in plasma, but declined across compartments by day 91. Geometric mean TFV-DP tissue concentrations exceeded the 1000 fmol/mg target through day 56, but fell to 456 fmol/mg at day 91. Among 32 rings returned at the end of the study, 13 had no or low (<0.1 g) residual TFV. Residual TFV did not differ by socio-demographics, sexual activity, Nugent Score or vaginal microbiota. Most participants reported being fully adherent to ring use: 85% and 81% in the TFV and placebo arms, respectively (p = 1.00). A majority of participants reported liking the ring (median 8 on a 10-point Likert scale) and reported a high likelihood of using the ring in the future, if effective (median 9).

CONCLUSIONS

The 90-day TFV ring was well-tolerated, acceptable and exceeded target cervical tissue concentrations through day 56, but declined thereafter. Additional studies are needed to characterize the higher release from TFV rings in some participants and the optimal duration of use.

Prior Herpes Simplex Virus Infection and the Risk of Herpes Zoster

BACKGROUND

The incidence of herpes zoster (HZ) has increased in the United States concurrent with decrease in herpes simplex virus (HSV) prevalence. We hypothesized that lack of HSV-elicited cross-reactive immunity to varicella-zoster virus (VZV) results in an increased risk of HZ. Using specimens from the placebo arm of the Shingles Prevention Study, we investigated whether persons who develop HZ are less likely to have prior HSV infection than persons who do not develop HZ, and whether HZ is less severe in persons with HSV than in HSV seronegative persons.

METHODS

We conducted a nested case-control (1:2) study comparing the seroprevalence of HSV-1 and HSV-2 in cases (persons with polymerase chain reaction-confirmed HZ) to age-, sex-, and health-matched controls (persons without HZ).

RESULTS

Sera from 639 study participants (213 cases and 426 controls) yielded definitive HSV antibody results and were analyzed. Overall, HSV seropositivity rate was 75%. HSV seronegativity was significantly higher in HZ cases than controls (30.5% vs 22.3%; P = .024), with a 55% higher risk of HZ in HSV seronegative than HSV seropositive participants. HSV seropositivity was associated with more severe HZ (P = .021).

CONCLUSIONS

Our study demonstrated that prior infection with HSV partly protects against HZ.

Donor-derived fulminant herpes simplex virus hepatitis after liver transplantation: Two cases and review of literature

BACKGROUND

Fulminant herpetic hepatitis due to herpes simplex virus (HSV), serotype 1 or 2, is a rare but often fatal complication after solid organ transplantation (SOT). HSV hepatitis in SOT recipients can occur either due to primary infection acquired post transplantation, viral reactivation in a seropositive patient, or as donor-derived infection. Cases of fatal hepatitis have been reported in the liver as well as in other SOT recipients. The fatal outcome is mostly due to delayed diagnosis and treatment, which is explained by the lack of clinical specificity of HSV hepatitis.

METHODS

We report two cases of fatal donor-derived HSV hepatitis in liver-transplanted recipients. We reviewed all published cases of donor-derived HSV infections after SOT with an evaluation of the presence of prophylaxis and outcome.

RESULTS

In both liver recipients, the retrospective determination of HSV serostatus was negative, and both cases occurred in the absence of cytomegalovirus or HSV prophylaxis. A review of the literature showed a significant series of cases of severe hepatitis, mostly fatal, as well as the absence of specific preventive therapy guidelines in cases of HSV serology mismatch.

CONCLUSIONS

The occurrence of two fatal donor-derived hepatitis made the Swiss Transplant Infectious Diseases working group modify its national recommendations regarding pretransplant serostatus determination and HSV prophylaxis after liver transplantation. Further studies are needed to assess this approach.

Epidemiology of herpes simplex virus type 1 in Canada: systematic review, meta-analyses, and meta-regressions

Background

The objective of this study was to characterize herpes simplex virus type 1 (HSV-1) epidemiology in Canada.

Methods

HSV-1 publications as recent as December 6, 2021 were systematically reviewed, synthesized, and reported following PRISMA guidelines. Meta-analyses and meta-regressions were conducted.

Results

HSV-1 measures were extracted from 22 studies and included 32 overall seroprevalence measures (79 stratified), 2 overall proportions of HSV-1 detection in clinically diagnosed genital ulcer disease (2 stratified), and 8 overall proportions of HSV-1 detection in laboratory-confirmed genital herpes (27 stratified). Pooled mean seroprevalence was 19.1% [95% confidence interval (CI): 12.6-26.4%] among healthy children and 51.4% (95% CI: 47.3-55.5%) among healthy adults. Pooled mean seroprevalence among healthy general populations increased with age, with the lowest being 35.7% (95% CI: 29.1-42.6%) among individuals <20 years of age, and the highest being 70.0% (95% CI: 54.8-83.2) among individuals ≥40 years. Seroprevalence increased by 1.02-fold (95% CI: 1.01-1.04) per year. Pooled mean proportion of HSV-1 detection in genital ulcer disease was 30.8% (95% CI: 12.6-52.8%). Pooled mean proportion of HSV-1 detection in genital herpes was 37.4% (95% CI: 29.5-45.6%) and was highest in women and in young persons. Proportion of HSV-1 detection in genital herpes increased by 1.04-fold (95% CI: 1.00-1.08) per year.

Conclusions

HSV-1 epidemiology in Canada appears to be shifting toward less oral acquisition in childhood and more genital acquisition in adulthood, particularly among youth. Both HSV-1 seroprevalence and proportion of HSV-1 detection in genital herpes are increasing with time.

Genital Herpes Infection: Progress and Problems

Genital herpes (GH) is a sexually transmitted infection causing recurrent, self-limited genital, buttock, and thigh ulcerations. Symptoms range from unrecognized or mild to severe with frequent recurrences. Herpes simplex viruses (HSV) type-1 or type-2 cause GH. HSV establishes latency in sacral ganglia and causes lifelong infection. Viral reactivation leads to genital ulceration or asymptomatic shedding which may lead to transmission. HSV infection during pregnancy can cause fulminant hepatitis and neonatal transmission. Severe and atypical manifestations are seen in immunocompromised people. Guanosine analogs treat symptoms and prevent recurrences, shedding, and transmission. Novel preventive and therapeutic strategies are in development.

Epidemiology of herpes simplex virus type 2 in the Middle East and North Africa: Systematic review, meta-analyses, and meta-regressions

BACKGROUND

Herpes simplex virus type 2 (HSV-2) infection is a prevalent, sexually transmitted infection with poorly characterized prevalence in the Middle East and North Africa (MENA) region. This study characterized HSV-2 epidemiology in MENA.

METHODS

The systematic review was guided by the Cochrane Collaboration Handbook and findings were reported following PRISMA guidelines. Random-effects meta-analyses and meta-regressions were performed to estimate pooled mean outcome measures and to assess predictors of HSV-2 antibody prevalence (seroprevalence), trends in seroprevalence, and between-study heterogeneity.

FINDINGS

61 overall (133 stratified) HSV-2 seroprevalence measures and two overall (4 stratified) proportion measures of HSV-2 detection in laboratory-confirmed genital herpes were extracted from 37 relevant publications. Pooled mean seroprevalence was 5.1% (95% CI: 3.6-6.8%) among general populations, 13.3% (95% CI: 8.6-18.7%) among intermediate-risk populations, 20.6% (95% CI: 5.3-42.3%) among female sex workers, and 18.3% (95% CI: 3.9-39.4%) among male sex workers. Compared to Fertile Crescent countries, seroprevalence was 3.39-fold (95% CI: 1.86-6.20) and 3.90-fold (95% CI: 1.78-8.57) higher in Maghreb and Horn of Africa countries, respectively. Compared to studies published before 2010, seroprevalence was 1.73-fold (95% CI: 1.00-2.99) higher in studies published after 2015. Pooled mean proportion of HSV-2 detection in genital herpes was 73.8% (95% CI: 42.2-95.9%).

CONCLUSION

MENA has a lower HSV-2 seroprevalence than other world regions. Yet, 1 in 20 adults is chronically infected, despite conservative prevailing sexual norms. Seroprevalence may also be increasing, unlike other world regions. Findings support the need for expansion of surveillance and monitoring of HSV-2 infection in MENA. This article is protected by copyright. All rights reserved.

Epidemiology of herpes simplex virus type 1 and genital herpes in Australia and New Zealand: systematic review, meta-analyses and meta-regressions

Herpes simplex virus type 1 (HSV-1) infection is a lifelong infection that is acquired primarily orally and during childhood. We aimed to characterise HSV-1 epidemiology in Australia and New Zealand. HSV-1-related data as recent as 6 December 2021 were systematically reviewed, synthesised and reported, following PRISMA guidelines. Pooled mean seroprevalence and proportions of HSV-1 detection in genital ulcer disease (GUD) and in genital herpes were calculated using random-effects meta-analyses. Meta-regressions were also conducted. HSV-1 measures were retrieved from 21 eligible publications. Extracted HSV-1 measures included 13 overall seroprevalence measures (27 stratified) in Australia, four overall proportions of HSV-1 detection in clinically diagnosed GUD (four stratified) in Australia, and ten overall proportions of HSV-1 detection in laboratory-confirmed genital herpes (26 stratified) in Australia and New Zealand. Pooled mean seroprevalence among healthy adults in Australia was 84.8% (95% confidence interval (CI) 74.3-93.1%). Pooled mean seroprevalence was 70.2% (95% CI 47.4-88.7%) among individuals <35 years of age and 86.9% (95% CI 79.3-93.0%) among individuals ≥35 years. Seroprevalence increased by 1.05-fold (95% CI 1.01-1.10) per year. Pooled mean proportion of HSV-1 detection in GUD was 8.2% (95% CI 0.4-22.9%). Pooled mean proportion of HSV-1 detection in genital herpes was 30.5% (95% CI 23.3-38.3%), and was highest in young individuals. Proportion of HSV-1 detection in genital herpes increased by 1.04-fold (95% CI 1.00-1.08) per year. Included studies showed heterogeneity, but 30% of the heterogeneity in seroprevalence and 42% of the heterogeneity in proportion of HSV-1 detection in genital herpes were explained in terms of epidemiological factors. HSV-1 seroprevalence is higher in Australia than in other Western countries. HSV-1 epidemiology in Australia and New Zealand appears to be transitioning towards less oral acquisition in childhood, but more genital acquisition among youth.

Epidemiology of herpes simplex virus type 2 in Europe: systematic review, meta-analyses, and meta-regressions

Background

Herpes simplex virus type 2 (HSV-2) infection is a globally prevalent, life-long, sexually transmitted infection. This study characterized HSV-2 seroprevalence in Europe for various at-risk populations and proportions of HSV-2 detection in genital ulcer disease (GUD) and in genital herpes. Data on neonatal herpes and HSV-2's contribution to HIV transmission were also reviewed.

Methods

Cochrane and PRISMA guidelines were followed to systematically review, synthesize, and report HSV-2 related findings. The search was conducted in PubMed and Embase databases up to February 20, 2022. Any publication reporting data on the outcome measures was included. Meta-analyses and meta-regressions were conducted.

Findings

211 relevant reports were identified, including 12 overall incidence measures, 294 overall (813 stratified by factors such as age and sex) seroprevalence measures, 13 overall (15 stratified by sex) proportions of HSV-2 detection in clinically diagnosed GUD, and 70 overall (183 stratified by factors such as age and sex) proportions of HSV-2 detection in laboratory-confirmed genital herpes. Pooled mean seroprevalence was 12.4% (95% CI: 11.5-13.3%) among general populations, 27.8% (95% CI: 17.5-39.4%) among men who have sex with men, 46.0% (95% CI: 40.1-51.8%) among people living with HIV and people in HIV discordant couples, and 63.2% (95% CI: 55.5-70.6%) among female sex workers. Most measures showed heterogeneity in HSV-2 seroprevalence. The pooled mean seroprevalence among general populations increased with age and was 0.65-fold (95% CI: 0.58-0.74) lower in men than women. Seroprevalence decreased by 1% per calendar year. Pooled mean proportions of HSV-2 detection in GUD and in genital herpes were 22.0% (95% CI: 15.3-29.6%) and 66.0% (95% CI: 62.9-69.1%), respectively. HSV-2 detection in genital herpes cases was 1.21-fold (95% CI: 1.10-1.32) higher in men compared to women and decreased by 1% per calendar year. Incidence of neonatal herpes indicated an increasing trend.

Interpretation

Although seroprevalence is declining, a significant proportion of Europe's population is infected with HSV-2. HSV-2 accounts for approximately one-fifth of GUD cases and two-thirds of genital herpes cases. Findings support the need to invest in HSV-2 vaccine development, and sexual and reproductive health services.

Funding

Qatar National Research Fund [NPRP 9-040-3-008] and pilot funding from the Biomedical Research Program at Weill Cornell Medicine in Qatar supported this study.

Worldwide Evolution of Vaccinable and Nonvaccinable Viral Skin Infections: Google Trends Analysis

BACKGROUND

Most common viral skin infections are not reportable conditions. Studying the population dynamics of these viral epidemics using traditional field methods is costly and time-consuming, especially over wide geographical areas.

OBJECTIVE

This study aimed to explore the evolution, seasonality, and distribution of vaccinable and nonvaccinable viral skin infections through an analysis of Google Trends.

METHODS

Worldwide search trends from January 2004 through May 2021 for viral skin infections were extracted from Google Trends, quantified, and analyzed.

RESULTS

Time series decomposition showed that the total search term volume for warts; zoster; roseola; measles; hand, foot, and mouth disease (HFMD); varicella; and rubella increased worldwide over the study period, whereas the interest for Pityriasis rosea and herpes simplex decreased. Internet searches for HFMD, varicella, and measles exhibited the highest seasonal patterns. The interest for measles and rubella was more pronounced in African countries, whereas the interest for HFMD and roseola was more pronounced in East Asia.

CONCLUSIONS

Harnessing data generated by web searches may increase the efficacy of traditional surveillance systems and strengthens the suspicion that the incidence of some vaccinable viral skin infections such as varicella, measles, and rubella may be globally increasing, whereas the incidence of common nonvaccinable skin infections remains stable.

HSV-1 0∆NLS vaccine elicits a robust B lymphocyte response and preserves vision without HSV-1 glycoprotein M or thymidine kinase recognition

Effective experimental prophylactic vaccines against viral pathogens such as herpes simplex virus type 1 (HSV-1) have been shown to protect the host through T and/or B lymphocyte-driven responses. Previously, we found a live-attenuated HSV-1 mutant, 0ΔNLS used as a prophylactic vaccine, provided significant protection against subsequent ocular HSV-1 challenge aligned with a robust neutralizing antibody response. Yet, how the virus mutant elicited the humoral immune response relative to parental virus was unknown. Herein, we present the characterization of B cell subsets in vaccinated mice at times after primary vaccination and following boost compared to the parental virus, termed GFP105. We found that 0∆NLS-vaccinated mice possessed more CD4⁺ follicular helper T (T_FH) cells, germinal B cells and class-switched B cells within the first 7 days post-vaccination. Moreover, 0∆NLS vaccination resulted in an increase in plasmablasts and plasma cells expressing amino-acid transporter CD98 along with an elevated titer of HSV-1-specific antibody compared to GFP105-vaccinated animals. Furthermore, O∆NLS-vaccine-induced CD4⁺ (T_FH) cells produced significantly more IL-21 compared to mice immunized with the parental HSV-1 strain. In contrast, there were no differences in the number of regulatory B cells comparing the two groups of immunized mice. In comparing sera recognition of HSV-1-encoded proteins, it was noted antiserum from GFP105-vaccinated mice immunoprecipitated HSV-1 thymidine kinase (TK) and glycoprotein M (gM) whereas sera from 0∆NLS-immunized mice did not even though both groups of vaccinated mice displayed similar neutralizing antibody titers to HSV-1 and were highly resistant to ocular HSV-1 challenge. Collectively, the results suggest (1) the live-attenuated HSV-1 mutant 0∆NLS elicits a robust B cell response that drives select B cell responses greater than the parental HSV-1 and (2) HSV-1 TK and gM are likely expendable components in efficacy of a humoral response to ocular HSV-1 infection.

The association between Herpes simplex virus type 2 and asthma: A cross-sectional study from National Health and Nutrition Examination Survey 1999–2016

Background

The association between Herpes simplex virus type 2 (HSV-2) infection, a common infectious disease that increases the incidence of multisystem diseases, and asthma was less well studied. The aim of this study was to investigate the association between HSV-2 infection and the prevalence of asthma.

Materials and methods

We used data from National Health and Nutrition Examination Survey (NHANES) 1999–2016 for analysis. The study population included was limited to those aged 20–45 years and contained complete information on HSV-2 infection and asthma. We calculated the prevalence of HSV-2, asthma, and HSV-2 combined with asthma separately. The association between HSV-2 infection and asthma was analyzed using multiple logistic regression. We also performed stratified analyses to reduce bias and to find sensitive cohorts.

Results

The prevalence of HSV-2 infection was decreasing with change in time period (P for trend < 0.01), but the prevalence of asthma was increasing (P for trend < 0.01). The prevalence of HSV-2 infection was higher in those with asthma than in non-asthma participants. A positive association was found between HSV-2 infection and asthma [odds ratio (OR) = 1.15, 95% CI: 1.04–1.27]. Subgroup analysis showed that this positive association was more pronounced in participants who were male, White, 30 years ≤ age ≤ 40 years, body mass index (BMI) ≤ 28 kg/m², 1.39 ≤ ratio of family income to poverty (PIR) < 3.49 and smokers.

Conclusion

There was a positive association between HSV-2 infection and asthma, and participants who were male, White race, 30 years ≤ age < 40 years, BMI ≥ 28 kg/m², 1.39 ≤ PIR < 3.49, and smokers should receive more attention.

Genital Herpes Simplex Virus-An Updated Review

The herpes virus was named by the Greek physician Hippocrates who called it herpes because the lesions appeared near each other and were vesicular. Alphaherpesvirinae, Betaherpesvirinae, and Gammaherpesvirinae are subfamilies of the human herpes virus family. The Alphaherpesvirinae subfamily includes the simplex viruses-HSV-1 and HSV-2-and varicellovirus-varicella zoster virus. There are more than 200 members of the Herpesviridae family capable of infecting different species, 8 of which are known to cause disease in humans. The simplex viruses can cause lifelong genital infections, and despite the prevalence of HSV-1 and HSV-2 infections in the United States decreasing in the past 20 years, infections with these viruses continue to contribute to significant clinical and psychological morbidities.

Tripartite-Motif 21 (TRIM21) Deficiency Results in a Modest Loss of Herpes Simplex Virus (HSV)-1 Surveillance in the Trigeminal Ganglia Following Cornea Infection

Tripartite-motif 21 (TRIM21) is thought to regulate the type I interferon (IFN) response to virus pathogens and serve as a cytosolic Fc receptor for immunoglobulin. Since herpes simplex virus (HSV)-1 is sensitive to type I IFN and neutralizing antibody, we investigated the role of TRIM21 in response to ocular HSV-1 infection in mice. In comparison to wild type (WT) mice, TRIM21 deficient (TRIM21 KO) mice were found to be no more susceptible to ocular HSV-1 infection than WT animals, in terms of infectious virus recovered in the cornea. Similar pathology, in terms of neovascularization, opacity, and loss of peripheral vision function, was observed in both WT and TRIM21 KO mice. However, TRIM21 KO mice did possess a significant increase in infectious virus recovered in the trigeminal ganglia, in comparison to the WT animals. The increased susceptibility was not due to changes in HSV-1-specific CD4+ or CD8+ T cell numbers or functional capabilities, or in changes in type I IFN or IFN-inducible gene expression. In summary, the absence of TRIM21 results in a modest, but significant, increase in HSV-1 titers recovered from the TG of TRIM21 KO mice during acute infection, by a mechanism yet to be determined.

Prevalence and correlates of Kaposi's sarcoma-associated herpesvirus and herpes simplex virus type 2 infections among adults: evidence from the NHANES III data

BACKGROUND

Kaposi's sarcoma-associated herpes virus (KSHV) prevalence and risk factors exhibit considerable variations across populations in different geographic regions. Determinants and the transmission routes of KSHV infection are uncertain. We seek to identify the possible risk factors and the transmission routes of KSHV infection in non-endemic areas.

METHODS

We collected annual cases and seroprevalence of KSHV and herpes simplex virus type 2 (HSV-2) from the NHANES III sampled individuals from the US general population (1988-1994). We included 13,179 and 10,720 individuals with available remaining serum samples of KSHV and HSV-2. Logistic regression was employed to explore potential risk factors for the seropositivity.

RESULTS

The seroprevalence was 2.05% for KSHV infection and 31.03% for HSV2 infection among this population. All risk factors of sexual behaviors included were strongly associated with HSV-2 positive, however, only MSM had an approximately fivefold increased risk of KSHV infection (OR = 4.71; 95%CI 1.61 11.30). Mexican Americans (2.51%) and older (chi-squaretrend =  - 6.71, P < 0.001) individuals had a higher risk of KSHV infection. After adjustment, individuals with higher level of education and economic status had lower KSHV infection.

CONCLUSIONS

In non-endemic areas, KSHV transmission may be related to sexual activity in men, especially in male homosexuals. Higher education level and economic status are protective factors for KSHV infection.

Epidemiology of herpes simplex virus type 2 in Asia: A systematic review, meta-analysis, and meta-regression

Background

Herpes simplex virus type 2 (HSV-2) infection is a prevalent sexually transmitted infection worldwide. This systematic review was conducted to characterize HSV-2 epidemiology in Asia, including the World Health Organization regions of Southeast Asia and the Western Pacific.

Methods

Cochrane and PRISMA guidelines were followed to systematically review and report findings. Pooled mean seroprevalence and proportions of HSV-2 isolated in genital ulcer disease (GUD) and in genital herpes were calculated using random-effects meta-analyses. Meta-regressions were also conducted. Quality assessment was performed.

Findings

HSV-2 measures extracted from 173 publications included 15 seroconversion rates, 11 seroincidence rates, 272 overall seroprevalence measures (678 stratified), 14 proportions of HSV-2 isolation in GUD (15 stratified), and 27 proportions of HSV-2 isolation in genital herpes (36 stratified). Pooled mean seroprevalence was 12.1% (95% confidence interval (CI): 11.0-13.2%) among general populations, 23.6% (95% CI: 20.9-26.3%) among men who have sex with men and transgender people, 46.0% (95% CI: 39.2-52.9%) among HIV-positive individuals and individuals in HIV-discordant couples, and 62.2% (95% CI: 58.9-65.6%) among female sex workers. Among general populations, pooled mean seroprevalence increased gradually from 4.7% (95% CI: 3.3-6.3%) in <20-year-old individuals to 26.6% (95% CI: 19.2-34.7%) in >60-year-old individuals. Compared to women and across all populations, men had 0.60-fold (95% CI: 54.0-67.0) lower seroprevalence, that is women had 70% higher seroprevalence. Seroprevalence declined by 0.98-fold (95% CI: 0.97-0.99) per year, that is a 2% decline per year in the last three decades. Pooled mean proportions of HSV-2 isolation in GUD and in genital herpes were 48.2% (95% CI: 34.9-61.6%) and 75.9% (95% CI: 68.3-82.8%), respectively.

Interpretation

Over 1 in 10 individuals is infected with HSV-2, but seroprevalence is declining. HSV-2 accounts for half of GUD cases and three-quarters of genital herpes cases. These findings support the need for an HSV-2 vaccine and universal access to sexual and reproductive health services.

Funding

This work was supported by the Qatar National Research Fund [NPRP 9-040-3-008] and by pilot funding from the Biomedical Research Program at Weill Cornell Medicine in Qatar.

Local Immune Control of Latent Herpes Simplex Virus Type 1 in Ganglia of Mice and Man

Herpes simplex virus type 1 (HSV-1) is a prevalent human pathogen. HSV-1 genomes persist in trigeminal ganglia neuronal nuclei as chromatinized episomes, while epithelial cells are typically killed by lytic infection. Fluctuations in anti-viral responses, broadly defined, may underlay periodic reactivations. The ganglionic immune response to HSV-1 infection includes cell-intrinsic responses in neurons, innate sensing by several cell types, and the infiltration and persistence of antigen-specific T-cells. The mechanisms specifying the contrasting fates of HSV-1 in neurons and epithelial cells may include differential genome silencing and chromatinization, dictated by variation in access of immune modulating viral tegument proteins to the cell body, and protection of neurons by autophagy. Innate responses have the capacity of recruiting additional immune cells and paracrine activity on parenchymal cells, for example via chemokines and type I interferons. In both mice and humans, HSV-1-specific CD8 and CD4 T-cells are recruited to ganglia, with mechanistic studies suggesting active roles in immune surveillance and control of reactivation. In this review we focus mainly on HSV-1 and the TG, comparing and contrasting where possible observational, interventional, and in vitro studies between humans and animal hosts.

Distinct populations of antigen-specific tissue-resident CD8+ T cells in human cervix mucosa

The ectocervix is part of the lower female reproductive tract (FRT), which is susceptible to sexually transmitted infections (STIs). Comprehensive knowledge of the phenotypes and T cell receptor (TCR) repertoire of tissue-resident memory T cells (TRMs) in the human FRT is lacking. We took single-cell RNA-Seq approaches to simultaneously define gene expression and TCR clonotypes of the human ectocervix. There were significantly more CD8+ than CD4+ T cells. Unsupervised clustering and trajectory analysis identified distinct populations of CD8+ T cells with IFNGhiGZMBloCD69hiCD103lo or IFNGloGZMBhiCD69medCD103hi phenotypes. Little overlap was seen between their TCR repertoires. Immunofluorescence staining showed that CD103+CD8+ TRMs were preferentially localized in the epithelium, whereas CD69+CD8+ TRMs were distributed evenly in the epithelium and stroma. Ex vivo assays indicated that up to 14% of cervical CD8+ TRM clonotypes were HSV-2 reactive in HSV-2-seropositive persons, reflecting physiologically relevant localization. Our studies identified subgroups of CD8+ TRMs in the human ectocervix that exhibited distinct expression of antiviral defense and tissue residency markers, anatomic locations, and TCR repertoires that target anatomically relevant viral antigens. Optimization of the location, number, and function of FRT TRMs is an important approach for improving host defenses to STIs.

Estimating HIV, HCV and HSV2 incidence from emergency department serosurvey

Background: Our understanding of pathogens and disease transmission has improved dramatically over the past 100 years, but coinfection, how different pathogens interact with each other, remains a challenge. Cross-sectional serological studies including multiple pathogens offer a crucial insight into this problem.  Methods: We use data from three cross-sectional serological surveys (in 2003, 2007 and 2013) in a Baltimore emergency department to predict the prevalence for HIV, hepatitis C virus (HCV) and herpes simplex virus, type 2 (HSV2), in a fourth survey (in 2016). We develop a mathematical model to make this prediction and to estimate the incidence of infection and coinfection in each age and ethnic group in each year. Results: Overall we find a much stronger age cohort effect than a time effect, so that, while incidence at a given age may decrease over time, individuals born at similar times experience a more constant force of infection over time. Conclusions: These results emphasise the importance of age-cohort counselling and early intervention while people are young. Our approach adds value to data such as these by providing age- and time-specific incidence estimates which could not be obtained any other way, and allows forecasting to enable future public health planning.

Herpes simplex virus type 1 in Europe: systematic review, meta-analyses and meta-regressions

Objective

To describe the epidemiology of herpes simplex virus type 1 (HSV-1) in Europe.

Methods

We systematically reviewed HSV-1 related publications, conducted various meta-analyses and meta-regressions, assessed pooled mean seroprevalence, and estimated pooled mean proportions of HSV-1 viral detection in clinically diagnosed genital ulcer disease (GUD) and in genital herpes.

Results

We extracted, from 142 relevant records, 179 overall (622 stratified) seroprevalence measures, 4 overall proportions of HSV-1 in GUD and 64 overall (162 stratified) proportions of HSV-1 in genital herpes. Pooled mean seroprevalence was 67.4% (95% CI 65.5% to 69.3%) with 32.5% (95% CI 29.4% to 35.7%) of children and 74.4% (95% CI 72.8% to 76.0%) of adults infected. Pooled seroprevalence increased steadily with age, being lowest in those aged <20 years (39.3%, 95% CI 35.9% to 42.7%) and highest in those aged >50 years (82.9%, 95% CI 78.8% to 86.6%). Pooled seroprevalence decreased yearly by 0.99-fold (95% CI 0.99 to 1.00). Pooled mean proportion of HSV-1 detection was 13.6% (95% CI 4.1% to 27.1%) in GUD, 34.1% (95% CI 31.7% to 36.5%) in genital herpes and 49.3% (95% CI 42.2% to 56.4%) in first episode genital herpes. Pooled proportion of HSV-1 detection in genital herpes increased yearly by 1.01-fold (95% CI 1.00 to 1.02), with higher detection in women (42.0%, 95% CI 37.4% to 46.7%) than men (24.1%, 95% CI 19.8% to 28.6%).

Conclusions

HSV-1 epidemiology is transitioning away from its historical pattern of oral acquisition in childhood. Every year, seroprevalence is declining by 1% and the proportion of HSV-1 in genital herpes is increasing by 1%. As many as two-thirds of children are reaching sexual debut unexposed, and at risk of HSV-1 genital acquisition in adulthood.

Epidemiology of herpes simplex virus type 2 in Latin America and the Caribbean: systematic review, meta-analyses and metaregressions

Objective

To characterise epidemiology of herpes simplex virus type 2 (HSV-2) in Latin America and the Caribbean.

Methods

HSV-2 reports were systematically reviewed and synthesised, and findings were reported following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Meta-analyses and metaregressions were conducted.

Finding

102 relevant reports were identified including 13 overall incidence measures, 163 overall (and 402 stratified) seroprevalence measures, and 7 and 10 proportions of virus detection in genital ulcer disease and in genital herpes, respectively. Pooled mean seroprevalence was 20.6% (95% CI 18.7% to 22.5%) in general populations, 33.3% (95% CI 26.0% to 41.0%) in intermediate-risk populations, 74.8% (95% CI 70.6% to 78.8%) in female sex workers, and 54.6% (95% CI 47.4% to 61.7%) in male sex workers, men who have sex with men and transgender people. In general populations, seroprevalence increased from 9.6% (95% CI 7.1% to 12.4%) in those aged <20 years to 17.9% (95% CI 13.6% to 22.5%) in those aged 20–30, 27.6% (95% CI 21.4% to 34.2%) in those aged 30–40 and 38.4% (95% CI 32.8% to 44.2%) in those aged >40. Compared with women, men had lower seroprevalence with an adjusted risk ratio (ARR) of 0.68 (95% CI 0.60 to 0.76). Seroprevalence declined by 2% per year over the last three decades (ARR of 0.98, 95% CI 0.97 to 0.99). Pooled mean proportions of HSV-2 detection in GUD and genital herpes were 41.4% (95% CI 18.9% to 67.0%) and 91.1% (95% CI 82.7% to 97.2%), respectively.

Conclusions

One in five adults is HSV-2 infected, a higher level than other world regions, but seroprevalence is declining. Despite this decline, HSV-2 persists as the aetiological cause of nearly half of GUD cases and almost all of genital herpes cases.

Herpes Simplex Virus 1 Infection of Neuronal and Non-Neuronal Cells Elicits Specific Innate Immune Responses and Immune Evasion Mechanisms

Alphaherpesviruses (α-HV) are a large family of double-stranded DNA viruses which cause many human and animal diseases. There are three human α-HVs: Herpes Simplex Viruses (HSV-1 and HSV-2) and Varicella Zoster Virus (VZV). All α-HV have evolved multiple strategies to suppress or exploit host cell innate immune signaling pathways to aid in their infections. All α-HVs initially infect epithelial cells (primary site of infection), and later spread to infect innervating sensory neurons. As with all herpesviruses, α-HVs have both a lytic (productive) and latent (dormant) stage of infection. During the lytic stage, the virus rapidly replicates in epithelial cells before it is cleared by the immune system. In contrast, latent infection in host neurons is a life-long infection. Upon infection of mucosal epithelial cells, herpesviruses immediately employ a variety of cellular mechanisms to evade host detection during active replication. Next, infectious viral progeny bud from infected cells and fuse to neuronal axonal terminals. Here, the nucleocapsid is transported via sensory neuron axons to the ganglion cell body, where latency is established until viral reactivation. This review will primarily focus on how HSV-1 induces various innate immune responses, including host cell recognition of viral constituents by pattern-recognition receptors (PRRs), induction of IFN-mediated immune responses involving toll-like receptor (TLR) signaling pathways, and cyclic GMP-AMP synthase stimulator of interferon genes (cGAS-STING). This review focuses on these pathways along with other mechanisms including autophagy and the complement system. We will summarize and discuss recent evidence which has revealed how HSV-1 is able to manipulate and evade host antiviral innate immune responses both in neuronal (sensory neurons of the trigeminal ganglia) and non-neuronal (epithelial) cells. Understanding the innate immune response mechanisms triggered by HSV-1 infection, and the mechanisms of innate immune evasion, will impact the development of future therapeutic treatments.

Analytic Characterization of the Herpes Simplex Virus Type 2 Epidemic in the United States, 1950-2050

Background

We analytically characterized the past, present, and future levels and trends of the national herpes simplex virus type 2 (HSV-2) epidemic in the United States.

Methods

A population-level mathematical model was constructed to describe HSV-2 transmission dynamics and was fitted to the data series of the National Health and Nutrition Examination Survey.

Results

Over 1950–2050, antibody prevalence (seroprevalence) increased rapidly from 1960, peaking at 19.9% in 1983 in those aged 15–49 years, before reversing course to decline to 13.2% by 2020 and 8.5% by 2050. Incidence rate peaked in 1971 at 11.9 per 1000 person-years, before declining by 59% by 2020 and 70% by 2050. Annual number of new infections peaked at 1 033 000 in 1978, before declining to 667 000 by 2020 and 600 000 by 2050. Women were disproportionately affected, averaging 75% higher seroprevalence, 95% higher incidence rate, and 71% higher annual number of infections. In 2020, 78% of infections were acquired by those 15–34 years of age.

Conclusions

The epidemic has undergone a major transition over a century, with the greatest impact in those 15–34 years of age. In addition to 47 million prevalent infections in 2020, high incidence will persist over the next 3 decades, adding >600 000 new infections every year.

A review of current guidelines and research on the management of sexually transmitted infections in adolescents and young adults

Adolescents and young adults are at high risk for sexually transmitted infections (STIs). Providers have the responsibility to accurately manage these infections to prevent medical complications and the spread of STIs. This article will review the epidemiology, screening recommendations, diagnostic tests, and treatment guidelines for STIs most commonly encountered in this population: Chlamydia trachomatis, Neisseria gonorrhoeae, Herpes simplex virus, and Trichomonas vaginalis, as well as the sexually associated infection bacterial vaginosis. This review will discuss ongoing research that explores ways to improve the management of STIs in adolescents and young adults.

Seroprevalence and characterisation of herpes simplex virus from human immunodeficiency virus in samples collected from two provinces in South Africa: a retrospective study

Background: Herpes simplex virus (HSV) is a widely distributed human pathogen that is known for its ulcerative lesions at the infection site. HSV can cause persistent infection in the host that is often followed by a period of latency within the neurons. Considering the high rate of HIV infection in South Africa, it is important to assess the seroprevalence of HSV with a focus to determine the epidemiological association between HSV-DNA and HIV-1 in the population. Methods: A total of 44 sera samples were screened for HSV and HIV-1 using the highly sensitive enzyme-linked immunosorbent assay (ELISA). The ELISA positive samples were characterized using polymerase chain reaction (PCR) to confirm the positivity of both viruses and to further differentiate HSV into HSV-1 and -2. Thereafter, the samples were analysed for relatedness using phylogenetic analysis. Results: Of the 44 samples, 36 (81.8%) were positive for HIV-1, while 35 (79.5%) were positive for HSV when screened with ELISA kits. The PCR results, with the use of type specific primers, showed that 4/35 (11.4%) samples were specific for HSV-1 while 30/35 (85.7%) were specific for HSV-2. Statistical analysis performed using the chi-squared goodness-of-fit test showed that there is a significant relationship between HSV-2 and HIV-1 transmission. Conclusions: The prevalence of HSV in the population is high with an increased HSV-2 infection in women. Our study shows that some of the HSV-2 isolates are not related to the clinical isolate SD90e from South Africa, suggesting diversity in HSV-2 viral transmission.

Seroprevalence and characterisation of herpes simplex virus from human immunodeficiency virus in samples collected from two provinces in South Africa: a retrospective study

Background: Herpes simplex virus (HSV) is a widely distributed human pathogen that is known for its ulcerative lesions at the infection site. HSV can cause persistent infection in the host that is often followed by a period of latency within the neurons. Considering the high rate of HIV infection in South Africa, it is important to assess the seroprevalence of HSV with a focus to determine the epidemiological association between HSV-DNA and HIV-1 in the population. Methods: A total of 44 sera samples were screened for HSV and HIV-1 using the highly sensitive enzyme-linked immunosorbent assay (ELISA). The ELISA positive samples were characterized using polymerase chain reaction (PCR) to confirm the positivity of both viruses and to further differentiate HSV into HSV-1 and -2. Thereafter, the samples were analysed for relatedness using phylogenetic analysis. Results: Of the 44 samples, 36 (81.8%) were positive for HIV-1, while 35 (79.5%) were positive for HSV when screened with ELISA kits. The PCR results, with the use of type specific primers, showed that 4/35 (11.4%) samples were specific for HSV-1 while 30/35 (85.7%) were specific for HSV-2. Statistical analysis performed using the chi-squared goodness-of-fit test showed that there is a significant relationship between HSV-2 and HIV-1 transmission. Conclusions: There is a significant positive association between HSV-2 and HIV-1 in the study population. Our study shows that some of the HSV-2 isolates are not related to the clinical isolate SD90e from South Africa, suggesting diversity in HSV-2 viral transmission.

Seroprevalence and characterisation of herpes simplex virus from human immunodeficiency virus in samples collected from two provinces in South Africa: a retrospective study

Background: Herpes simplex virus (HSV) is a widely distributed human pathogen that is known for its ulcerative lesions at the infection site. HSV can cause persistent infection in the host that is often followed by a period of latency within the neurons. Considering the high rate of HIV infection in South Africa, it is important to assess the seroprevalence of HSV with a focus to determine the epidemiological association between HSV-DNA and HIV-1 in the population. Methods: A total of 44 sera samples were screened for HSV and HIV-1 using the highly sensitive enzyme-linked immunosorbent assay (ELISA). The ELISA positive samples were characterized using polymerase chain reaction (PCR) to confirm the positivity of both viruses and to further differentiate HSV into HSV-1 and -2. Thereafter, the samples were analysed for relatedness using phylogenetic analysis. Results: Of the 44 samples, 36 (81.8%) were positive for HIV-1, while 35 (79.5%) were positive for HSV when screened with ELISA kits. The PCR results, with the use of type specific primers, showed that 4/35 (11.4%) samples were specific for HSV-1 while 30/35 (85.7%) were specific for HSV-2. Statistical analysis performed using the chi-squared goodness-of-fit test showed that there is a significant relationship between HSV-2 and HIV-1 transmission. Conclusions:There is a significant relationship between HSV-2 and HIV-1 in the study population. Our study shows that some of the HSV-2 isolates are not related to the clinical isolate SD90e from South Africa, suggesting diversity in HSV-2 viral transmission.

Testing for Sexually Transmitted Diseases in US Public Health Laboratories, 2016

BACKGROUND

Laboratory testing practices are an important part of sexually transmitted disease (STD) diagnosis and control. The goal of this article is to describe the volume and types of STD tests performed in public health laboratories (PHLs) in the United States in 2016.

METHODS

A total of 105 state and local PHLs who were members of the Association of Public Health Laboratories were invited to participate in a survey between May and August 2017. This web-based survey included questions on types of tests offered for different types of STDs, the number of tests offered in 2016, and number of samples that tested positive for each STD.

RESULTS

Eighty-one (77.1%) of 105 member PHLs responded. Overall in 2016, 2,242,728 Chlamydia trachomatis tests, 2,298,596 Neisseria gonorrhoeae (GC) tests, 1,235,037 Treponema pallidum (syphilis) tests, 177,571 Trichomonas vaginalis tests, 37,101 herpes simplex virus tests, and 8707 human papillomavirus tests were performed in 2016 in surveyed laboratories. Sixty-seven (82.7%) of PHLs offered C. trachomatis and GC nucleic acid amplification testing. Ninety percent of laboratories performed syphilis testing, 42% performed T. vaginalis testing, and 28.4% performed herpes simplex virus type-specific nucleic acid amplification testing. Few laboratories tested for human papillomavirus.

CONCLUSIONS

This survey collected important information on PHL STD laboratory testing practices. Capacity for important reference laboratory testing, such as GC culture and antimicrobial susceptibility, are needed to support STD programs. Public health laboratories play a key role in STD screening, surveillance, and prevention by offering test methods that are not available at commercial laboratories. Funding constraints affect the resources available for STD screening and surveillance, and thus, it is important to continue to monitor testing practices and the capacity of PHLs to test for STDs.

Herpes Simplex Virus 1 (HSV-1) 0ΔNLS Live-Attenuated Vaccine Protects against Ocular HSV-1 Infection in the Absence of Neutralizing Antibody in HSV-1 gB T Cell Receptor-Specific Transgenic Mice

The contribution of T cell and antibody responses following vaccination in resistance to herpes simplex virus 1 (HSV-1) infection continues to be rigorously investigated. In the present article, we explore the contribution of CD8+ T cells specific for the major antigenic epitope for HSV-1 glycoprotein B (gB498-505, gB) in C57BL/6 mice using a transgenic mouse (gBT-I.1) model vaccinated with HSV-1 0ΔNLS. gBT-I.1-vaccinated mice did not generate a robust neutralization antibody titer in comparison to the HSV-1 0ΔNLS-vaccinated wild-type C57BL/6 counterpart. Nevertheless, the vaccinated gBT-I.1 mice were resistant to ocular challenge with HSV-1 compared to vehicle-vaccinated animals based on survival and reduced corneal neovascularization but displayed similar levels of corneal opacity. Whereas there was no difference in the virus titer recovered from the cornea comparing vaccinated mice, HSV-1 0ΔNLS-vaccinated animals possessed significantly less infectious virus during acute infection in the trigeminal ganglia (TG) and brain stem compared to the control-vaccinated group. These results correlated with a significant increase in gB-elicited interferon-γ (IFN-γ), granzyme B, and CD107a and a reduction in lymphocyte activation gene 3 (LAG-3), programmed cell death 1 (PD-1), and T cell immunoglobulin and mucin domain-containing protein 3 (TIM-3) expressed by TG infiltrating gB-specific CD8+ T cells from the HSV-1 0ΔNLS-vaccinated group. Antibody depletion of CD8+ T cells in HSV-1 0ΔNLS-vaccinated mice rendered animals highly susceptible to virus-mediated mortality similar to control-vaccinated mice. Collectively, the HSV-1 0ΔNLS vaccine is effective against ocular HSV-1 challenge, reducing ocular neovascularization and suppressing peripheral nerve virus replication in the near absence of neutralizing antibody in this unique mouse model.IMPORTANCE The role of CD8+ T cells in antiviral efficacy using a live-attenuated virus as the vaccine is complicated by the humoral immune response. In the case of the herpes simplex virus 1 (HSV-1) 0ΔNLS vaccine, the correlate of protection has been defined to be primarily antibody driven. The current study shows that in the near absence of anti-HSV-1 antibody, vaccinated mice are protected from subsequent challenge with wild-type HSV-1 as measured by survival. The efficacy is lost following depletion of CD8+ T cells. Whereas increased survival and reduction in virus replication were observed in vaccinated mice challenged with HSV-1, cornea pathology was mixed with a reduction in neovascularization but no change in opacity. Collectively, the study suggests CD8+ T cells significantly contribute to the host adaptive immune response to HSV-1 challenge following vaccination with an attenuated virus, but multiple factors are involved in cornea pathology in response to ocular virus challenge.

Distinguishing Features of High- and Low-Dose Vaccine against Ocular HSV-1 Infection Correlates with Recognition of Specific HSV-1-Encoded Proteins

The protective efficacy of a live-attenuated HSV type 1 (HSV-1) vaccine, HSV-1 0∆ nuclear location signal (NLS), was evaluated in mice prophylactically in response to ocular HSV-1 challenge. Mice vaccinated with the HSV-1 0∆NLS were found to be more resistant to subsequent ocular virus challenge in terms of viral shedding, spread, the inflammatory response, and ocular pathology in a dose-dependent fashion. Specifically, a strong neutralizing Ab profile associated with low virus titers recovered from the cornea and trigeminal ganglia was observed in vaccinated mice in a dose-dependent fashion with doses ranging from 1 × 10³ to 1 × 10⁵ PFU HSV-1 0∆NLS. This correlation also existed in terms of viral latency in the trigeminal ganglia, corneal neovascularization, and leukocyte infiltration and expression of inflammatory cytokines and chemokines in infected tissue with the higher doses (1 × 10⁴-1 × 10⁵ PFU) of the HSV-1 0∆NLS-vaccinated mice, displaying reduced viral latency, ocular pathology, or inflammation in comparison with the lowest dose (1 × 10³ PFU) or vehicle vaccine employed. Fifteen HSV-1-encoded proteins were uniquely recognized by antisera from high-dose (1 × 10⁵ PFU)-vaccinated mice in comparison with low-dose (1 × 10³ PFU)- or vehicle-vaccinated animals. Passive immunization using high-dose-vaccinated, but not low-dose-vaccinated, mouse sera showed significant efficacy against ocular pathology in HSV-1-challenged animals. In summary, we have identified the minimal protective dose of HSV-1 0∆NLS vaccine in mice to prevent HSV-mediated disease and identified candidate proteins that may be useful in the development of a noninfectious prophylactic vaccine against the insidious HSV-1 pathogen.

Epidemiological Impact of Novel Preventive and Therapeutic HSV-2 Vaccination in the United States: Mathematical Modeling Analyses

This study aims to inform herpes simplex virus type 2 (HSV-2) vaccine development, licensure, and implementation by delineating the population-level impact of vaccination. Mathematical models were constructed to describe the transmission dynamics in presence of prophylactic or therapeutic vaccines assuming 50% efficacy, with application to the United States. Catch-up prophylactic vaccination will reduce, by 2050, annual number of new infections by 58%, incidence rate by 60%, seroprevalence by 21%, and avert yearly as much as 350,000 infections. Number of vaccinations needed to avert one infection was only 50 by 2050, 34 by prioritizing those aged 15-19 years, 4 by prioritizing the highest sexual risk group, 43 by prioritizing women, and 47 by prioritizing men. Therapeutic vaccination of infected adults with symptomatic disease will reduce, by 2050, annual number of new infections by 12%, incidence rate by 13%, seroprevalence by 4%, and avert yearly as much as 76,000 infections. Number of vaccinations needed to avert one infection was eight by 2050, two by prioritizing those aged 15-19 years, three by prioritizing the highest sexual risk group, seven by prioritizing men, and ten by prioritizing women. HSV-2 vaccination offers an impactful and cost-effective intervention to prevent genital herpes medical and psychosexual disease burden.

Seroprevalence of Toxoplasma, Rubella, CMV and HSV infection at a teaching hospital: A 7 year study from North India

Objectives:

The present study was aimed to find seroprevalence in different age group population to explore the burden of TORCH (toxoplasma, rubella virus, cytomegalovirus [(CMV] and herpes simplex virus [HSV]) infection in the North Indian Population.

Materials and Methods:

It is a retrospective study carried out in the Microbiology Department, Institute of Medical Science, Banaras Hindu University (IMS, BHU), a tertiary care centre of North India. The blood samples of the suspected population of either sex or age group from different departments were analysed over a period of 7 years. The samples were tested for TORCH infections by the IgM ELISA kit following the manufactures instruction.

Results:

Out of total 4044 samples, 1353 (33.46%) cases were seropositive with maximum cases from the obstetrics and gynaecology department 39.46%. The highest seropositivity of TORCH (43.15%) was in the age group 15–25 years followed by 36.33% in the age group 25–35 years. This study revealed an overall male and female ratio of the total positive cases as 0.12 while it was 2.2 for pediatric cases (0–15 years). The overall seroprevalence was contributed as toxoplasma 1.38%, rubella 1.14%, CMV 13.63% and herpes 17.43%. The overall seropositivity (IgM) contributed as toxoplasma gondii with 4%, rubella with 3%, cytomegalovirus with 41% and herpes simplex virus with 52%. The coinfection of HSV with CMV was most abundant with 246 cases.

Conclusions:

The seropositivity of toxoplasma and rubella were comparatively more in infants while CMV and herpes were more prevalent in adults. Though, the incidence of TORCH has reduced over the past few years. Furthermore, knowing the epidemiology is an important aspect to develop strategies and appropriate implementation for the prevention of infection.

Herpes simplex virus type 1 epidemiology in Africa: Systematic review, meta-analyses, and meta-regressions

OBJECTIVE

To assess herpes simplex virus type 1 (HSV-1) epidemiology in Africa.

METHODS

This systematic review was conducted per the Cochrane Collaboration guidelines. Findings were reported following the PRISMA guidelines. Research questions were addressed using random-effects meta-analyses and meta-regressions.

RESULTS

Forty-three overall (and 69 stratified) HSV-1 seroprevalence measures, and 18 and eight proportions of HSV-1 viral detection in genital ulcer disease (GUD) and in genital herpes, respectively, were extracted from 37 reports. Pooled mean seroprevalence was 67.1% (95% confidence interval (CI): 54.7-78.5%) in children, and 96.2% (95% CI: 95.0-97.3%) in adults. Across age groups, pooled mean was 44.4% (95% CI: 29.9-59.3%) in ≤5 years-old, 85.6% (95% CI: 81.0-89.6%) in 6-15 years-old, 93.3% (95% CI: 89.2-96.6%) in 16-25 years-old, and 93.8% (95% CI: 84.6-99.4%) in >25 years-old. Age explained 78.8% of seroprevalence variation. Pooled mean proportion of HSV-1 detection was 0.4% (95% CI: 0.0-1.5%) in GUD, and 1.2% (95% CI: 0.0-4.0%) in genital herpes.

CONCLUSIONS

HSV-1 is universally prevalent in Africa, at higher levels than other regions, with no evidence for declines in seroprevalence in recent decades. Nearly every person acquires the infection in childhood through oral-to-oral transmission, before sexual debut. Sexual oral-to-genital and genital-to-genital transmission appear very limited.