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.

Other Information

Published in: Journal of Infection
License: http://creativecommons.org/licenses/by-nc-nd/4.0/
See article on publisher's website: https://dx.doi.org/10.1016/j.jinf.2019.07.012