Herpes simplex virus type 1 epidemiology in the Middle East and North Africa: systematic review, meta-analyses, and meta-regressions

Chaabane, Sonia; Harfouche, Manale; Chemaitelly, Hiam; Schwarzer, Guido; Abu‐Raddad, Laith J.

doi:10.1038/s41598-018-37833-8

Cited by 45 publications

(77 citation statements)

References 51 publications

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“…Moreover, no variation in seroprevalence by country, or by country's income level, was found in Africa ( Tables 1 and 3 ). This stands in contrast to observed variations in other regions, 15,41 that are consistent with an association between HSV-1 infection and lower socio-economic status. 39,42 Though seroprevalence is declining in developed countries, 7-13 , 39,40 such as the U.S.A 40,43 and Japan, 15,44 with the improvements in living and hygiene conditions, 40 such trend is not seen in Africa ( Table 3 ).…”

Section: Discussionsupporting

confidence: 53%

“…Remarkably, it explained also nearly 80% of seroprevalence variation-hardly any other factor was needed to explain this variation. This is to be contrasted with Asia, 15 MENA, 41 and Latin America and the Caribbean 16 where age explained only 34% 48%, and 54% of seroprevalence variation, respectively. This further affirms the universality and homogeneity of the infection in Africait is just a question of cumulative person-time of exposure before nearly every person acquires the infection.…”

Section: Discussionmentioning

confidence: 76%

“…1 HSV-1 seroprevalence is also well documented in different Western countries, with levels of only about 50%. 7-13 , 39,40 Though HSV-1 seroprevalence was found to be high in Asia, the Middle East and North Africa (MENA), and Latin America and the Caribbean in three recent systematic reviews, 15,16,41 it was not as high as that in Africa, particularly among younger adults. Moreover, no variation in seroprevalence by country, or by country's income level, was found in Africa ( Tables 1 and 3 ).…”

Section: Discussionmentioning

confidence: 99%

“…Notably, 51.2% of the studies used Western blot, the gold standard for HSV-1 serological diagnosis, 36 in contrast to other regions where seroprevalence is most often assessed using ELISA. 15,41 This is probably explained by the wellfunded and high-quality international studies that were conducted in Africa to investigate HSV-1 infection, as part of the expansion of HIV research in this continent.…”

Section: Discussionmentioning

confidence: 99%

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

Harfouche

Chemaitelly

Abu‐Raddad

2019

Journal of Infection

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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.

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Section: Discussionsupporting

confidence: 53%

Section: Discussionmentioning

confidence: 76%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

Harfouche

Chemaitelly

Abu‐Raddad

2019

Journal of Infection

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“…1 2 The historical pattern of HSV-1 epidemiology appears to be changing, at least in a few regions. [4][5][6][7][8][9][10][11][12] Studies show a decrease in early acquisition of HSV-1, a decline in seroprevalence among youths and an increase in genital herpes cases BMJ Global Health caused by HSV-1. 4 5 11 13-17 The disease burden of this infection, alongside its evolving epidemiology, has drawn the attention of the World Health Organization (WHO) and global partners, who are leading an international multisectorial effort focused on understanding the epidemiology of the virus and developing a HSV vaccine.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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ObjectiveTo describe the epidemiology of herpes simplex virus type 1 (HSV-1) in Europe.MethodsWe 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.ResultsWe 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%).ConclusionsHSV-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.

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

Harfouche

Alareeki

Osman

et al. 2023

Journal of Medical Virology

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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. HSV-2 reports were systematically reviewed as guided by the Cochrane Collaboration Handbook and findings were reported following PRISMA guidelines. Random-effects meta-analyses and metaregressions 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. In total, sixty-one overall (133 stratified) HSV-2 seroprevalence measures and two overall (four 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% confidence interval [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%). In 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.

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Herpes simplex virus type 1 epidemiology in the Middle East and North Africa: systematic review, meta-analyses, and meta-regressions

Cited by 45 publications

References 51 publications

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

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

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

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

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