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Herpes simplex virus type 1 in Europe: systematic review, meta-analyses and meta-regressions
  1. Wajiha Yousuf1,
  2. Hania Ibrahim1,
  3. Manale Harfouche1,
  4. Farah Abu Hijleh2,
  5. Laith Abu-Raddad1,3
  1. 1 Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation - Education City, Doha, Qatar
  2. 2 Department of Public Health, College of Health Sciences, Academic Quality Affairs Office, Qatar University, Doha, Ad Dawhah, Qatar
  3. 3 Department of Healthcare Policy and Research, Weill Cornell Medicine, Cornell University, Ithaca, New York, USA
  1. Correspondence to Dr Laith Abu-Raddad; lja2002{at}qatar-med.cornell.edu

Abstract

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.

  • herpes
  • genital ulcer disease
  • seroprevalence
  • prevalence
  • meta-analysis
  • meta-regression
  • europe
  • region
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

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Footnotes

  • Handling editor Alberto L Garcia-Basteiro

  • WY, HI and MH contributed equally.

  • Contributors WY, HI, and MH conducted the systematic search, data extraction, data analysis and wrote the first draft of the paper. FAH conducted the double extraction. LA-R conceived the study and led the data analysis and interpretation of the results. All authors contributed to drafting and revision of the article, and read and approved the final manuscript.

  • Funding This work was supported by the Qatar National Research Fund (NPRP 9-040-3-008), and through pilot funding by the Biomedical Research Program at Weill Cornell Medicine, Qatar.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information. All data are fully available without restriction.

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