Abstract
ObjectiveTo generate global and regional estimates for the prevalence and incidence of herpes simplex virus (HSV) type 1 and type 2 infection for 2016.MethodsTo obtain data, we undertook a systematic review to identify studies up to August 2018. Adjustments were made to account for HSV test sensitivity and specificity. For each World Health Organization (WHO) region, we applied a constant incidence model to pooled prevalence by age and sex to estimate the prevalence and incidence of HSV types 1 and 2 infections. For HSV type 1, we apportioned infection by anatomical site using pooled estimates of the proportions that were oral and genital.FindingsIn 2016, an estimated 491.5 million people (95% uncertainty interval, UI: 430.4 million–610.6 million) were living with HSV type 2 infection, equivalent to 13.2% of the world’s population aged 15–49 years. An estimated 3752.0 million people (95% UI: 3555.5 million–3854.6 million) had HSV type 1 infection at any site, equivalent to a global prevalence of 66.6% in 0–49-year-olds. Differing patterns were observed by age, sex and geographical region, with HSV type 2 prevalence being highest among women and in the WHO African Region.ConclusionAn estimated half a billion people had genital infection with HSV type 2 or type 1, and several billion had oral HSV type 1 infection. Millions of people may also be at higher risk of acquiring human immunodeficiency virus (HIV), particularly women in the WHO African Region who have the highest HSV type 2 prevalence and exposure to HIV.
Highlights
Herpes simplex virus (HSV) infections are widespread among humans globally[1, 2]
Estimates for oral HSV-1 infection were done for 0-49 year-olds, and estimates for genital HSV-1 and HSV-2 infection were done for 15-49 year-olds
When added together with studies identified previously that were still sufficiently recent, 474 HSV-2 prevalence data points (262 from newly-identified studies) and 223 HSV-1 prevalence data points (128 from newly-identified studies) were able to contribute to the estimates
Summary
Herpes simplex virus (HSV) infections are widespread among humans globally[1, 2]. They are lifelong, characterized by periodic reactivations at the infection site. Global and World Health Organization (WHO) regional estimates of HSV-2 infection prevalence and (derived) incidence among 15-49 year-olds have been produced by WHO twice before: for 2005 and for 2012(2, 16). The GBD study does not produce any estimates for HSV-1 infection, an increasingly important cause of genital infection. HSV-1 and HSV-2 infection estimates are important for understanding the total number of infections and their distribution across populations by geographical region, age, sex, HSV type, and infection site (oral vs genital). This information is needed for advocacy and resource planning. We present global and WHO regional estimates of HSV-2 and genital HSV-1 infection for 2016, incorporating newly-available data, and first estimates for oral HSV-1 infection
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