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

Manale Harfouche, Farah M Abu-Hijleh, Charlotte James, Katharine J Looker, Laith J Abu-Raddad

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Abstract

Background
Herpes simplex virus type 2 (HSV-2) infection is a prevalent, sexually transmitted infection with a sizable disease burden that is highest in sub-Saharan Africa. This study aimed to characterize HSV-2 epidemiology in this region.

Methods
Cochrane and PRISMA guidelines were followed to systematically review, synthesize, and report HSV-2 related findings up to August 23, 2020. Meta-analyses and meta-regressions were conducted.

Findings
From 218 relevant publications, 451 overall outcome measures and 869 stratified measures were extracted. Pooled incidence rates ranged between 2.4–19.4 per 100 person-years across populations. Pooled seroprevalence was lowest at 37.3% (95% confidence interval (CI): 34.9–39.7%) in general populations and high in female sex workers and HIV-positive individuals at 62.5% (95% CI: 54.8–70.0%) and 71.3% (95% CI: 66.5–75.9%), respectively. In general populations, pooled seroprevalence increased steadily with age. Compared to women, men had a lower seroprevalence with an adjusted risk ratio (ARR) of 0.61 (95% CI: 0.56–0.67). Seroprevalence has decreased in recent decades with an ARR of 0.98 (95% CI: 0.97–0.99) per year. Seroprevalence was highest in Eastern and Southern Africa. Pooled HSV-2 proportion in genital ulcer disease was 50.7% (95% CI: 44.7–56.8%) and in genital herpes it was 97.3% (95% CI: 84.4–100%).

Interpretation
Seroprevalence is declining by 2% per year, but a third of the population is infected. Age and geography play profound roles in HSV-2 epidemiology. Temporal declines and geographic distribution of HSV-2 seroprevalence mirror that of HIV prevalence, suggesting sexual risk behavior has been declining for three decades. HSV-2 is the etiological cause of half of genital ulcer disease and nearly all genital herpes cases with limited role for HSV-1.

Funding
This work was supported by pilot funding from the Biomedical Research Program at Weill Cornell Medicine in Qatar and by the Qatar National Research Fund [NPRP 9–040–3–008].
Original languageEnglish
Article number100876
Number of pages12
JournalEClinicalMedicine
Volume35
DOIs
Publication statusPublished - 7 May 2021

Bibliographical note

Funding Information:
MH, FAH, CJ, and LJA declare no competing interests. KL is currently funded by the World Health Organization and by GlaxoSmithKline (GSK) for a gonorrhea vaccine modeling project.

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

Funding Information:
MH and FAH conducted the systematic search, data extraction, and data analysis. MH wrote the first draft of the paper. CJ and KJL contributed to the systematic search, data extraction, and interpretation of the results. LJA conceived the study and led the data extraction and analysis and interpretation of the results. All authors contributed to drafting and revising the manuscript. This work was supported by pilot funding from the Biomedical Research Program at Weill Cornell Medicine in Qatar and by the Qatar National Research Fund [NPRP 9?040?3?008]. All relevant data are presented in the manuscript and its sypplementary material. The authors gratefully acknowledge Professor Emeritus Rhoda Ashley Morrow from the University of Washington, for her support in assessing the quality of study diagnostic methods. The authors are also grateful to Ms. Adona Canlas for administrative support. The authors are grateful for pilot funding by the Biomedical Research Program and infrastructure support provided by the Biostatistics, Epidemiology, and the Biomathematics Research Core at Weill Cornell Medicine-Qatar. This publication was also made possible by NPRP grant number 9?040?3?008 from the Qatar National Research Fund (a member of Qatar Foundation). The findings achieved herein are solely the responsibility of the authors. KL thanks the National Institute for Health Research, Health Protection Research Unit in Evaluation of Interventions at the University of Bristol, in partnership with Public Health England, for research support. The authors alone are responsible for the views expressed in this article and they do not necessarily represent the views, decisions or policies of the institutions with which they are affiliated, the NHS, the NIHR, the Department of Health and Social Care or Public Health England.

Funding Information:
The authors gratefully acknowledge Professor Emeritus Rhoda Ashley Morrow from the University of Washington, for her support in assessing the quality of study diagnostic methods. The authors are also grateful to Ms. Adona Canlas for administrative support. The authors are grateful for pilot funding by the Biomedical Research Program and infrastructure support provided by the Biostatistics, Epidemiology, and the Biomathematics Research Core at Weill Cornell Medicine-Qatar. This publication was also made possible by NPRP grant number 9–040–3–008 from the Qatar National Research Fund (a member of Qatar Foundation). The findings achieved herein are solely the responsibility of the authors. KL thanks the National Institute for Health Research, Health Protection Research Unit in Evaluation of Interventions at the University of Bristol, in partnership with Public Health England, for research support. The authors alone are responsible for the views expressed in this article and they do not necessarily represent the views, decisions or policies of the institutions with which they are affiliated, the NHS, the NIHR, the Department of Health and Social Care or Public Health England.

Publisher Copyright:
© 2021 The Author(s)

Keywords

  • seroprevalence
  • genital ulcer disease
  • genital herpes
  • synthesis
  • region

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