Epidemiology of herpes simplex virus type 2 in Latin America and the Caribbean: systematic review, meta-analyses and metaregressions

Abstract

ObjectiveTo characterise epidemiology of herpes simplex virus type 2 (HSV-2) in Latin America and the Caribbean.MethodsHSV-2 reports were systematically reviewed and synthesised, and findings were reported following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Meta-analyses and metaregressions were conducted.Finding102 relevant reports were identified including 13 overall incidence measures, 163 overall (and 402 stratified) seroprevalence measures, and 7 and 10 proportions of virus detection in genital ulcer disease and in genital herpes, respectively. Pooled mean seroprevalence was 20.6% (95% CI 18.7% to 22.5%) in general populations, 33.3% (95% CI 26.0% to 41.0%) in intermediate-risk populations, 74.8% (95% CI 70.6% to 78.8%) in female sex workers, and 54.6% (95% CI 47.4% to 61.7%) in male sex workers, men who have sex with men and transgender people. In general populations, seroprevalence increased from 9.6% (95% CI 7.1% to 12.4%) in those aged <20 years to 17.9% (95% CI 13.6% to 22.5%) in those aged 20–30, 27.6% (95% CI 21.4% to 34.2%) in those aged 30–40 and 38.4% (95% CI 32.8% to 44.2%) in those aged >40. Compared with women, men had lower seroprevalence with an adjusted risk ratio (ARR) of 0.68 (95% CI 0.60 to 0.76). Seroprevalence declined by 2% per year over the last three decades (ARR of 0.98, 95% CI 0.97 to 0.99). Pooled mean proportions of HSV-2 detection in GUD and genital herpes were 41.4% (95% CI 18.9% to 67.0%) and 91.1% (95% CI 82.7% to 97.2%), respectively.ConclusionsOne in five adults is HSV-2 infected, a higher level than other world regions, but seroprevalence is declining. Despite this decline, HSV-2 persists as the aetiological cause of nearly half of GUD cases and almost all of genital herpes cases.

Epidemiology of Herpes Simplex Virus Type 2 in Canada, Australia, and New Zealand: Systematic Review, Meta-Analyses, and Meta-Regressions

“…This study provided a thorough, systematic investigation of HSV-2 epidemiology in Australia, Canada, and New Zealand. The HSV-2 seroprevalence in the general population was estimated at 10% in Canada and 15% in the sister nations of Australia and New Zealand, levels that are similar to those found at present in the United States 42s–45s and in Asia, 20 but lower than the seroprevalence in Africa at 37% 21 and in Latin America and the Caribbean (LAC) at 21% 22 . While HSV-2 seroprevalence in Canada at 10% is similar to that in the United States, estimated most recently at 12%, 42s the estimate for Canada is based on seroprevalence studies conducted over the last two decades, including times in which seroprevalence in the United States was higher and approached 20%.…”

“…Unlike as in Africa, 21 Asia, 20 LAC, 22 and the United States, 42s–45s there was no evidence for declining HSV-2 seroprevalence in these countries. It is not known whether this lack of decline compared with other world regions could be a consequence of recent migration into these countries from countries with higher seroprevalence than in these countries.…”

“…59s Herpes simplex virus type 2 seems to play a minor role in GUD, at only 17% (Table 4 ), lower than that found in Africa at 51%, 21 Asia at 48%, 20 and LAC at 41%. 22 However, only 5 GUD studies were identified in these countries; thus, they may not be representative of the true contribution of HSV-2 to GUD in these countries.…”

“…The HSV-2 seroprevalence in the general population was estimated at 10% in Canada and 15% in the sister nations of Australia and New Zealand, levels that are similar to those found at present in the United States 42s–45s and in Asia, 20 but lower than the seroprevalence in Africa at 37% 21 and in Latin America and the Caribbean (LAC) at 21%. 22 While HSV-2 seroprevalence in Canada at 10% is similar to that in the United States, estimated most recently at 12%, 42s the estimate for Canada is based on seroprevalence studies conducted over the last two decades, including times in which seroprevalence in the United States was higher and approached 20%. 42s–45s It appears thus that HSV-2 seroprevalence in Canada has been lower than that in the United States, perhaps because Canada was less affected by the cohort effect of high incidence between 1960 and mid-1980s that was described recently for the United States.…”

“…These findings support the existence of generic patterns in the global epidemiology of HSV-2 infection. Just as in Africa, 21 Asia, 20 and LAC, 22 seroprevalence increased steadily with age and varied immensely by population sexual-risk classification (Table 3 ). Age and risk group alone explained over half of the seroprevalence variation across studies (Table 3 ).…”