Research Article: Herpes simplex virus type 1 epidemiology in Latin America and the Caribbean: Systematic review and meta-analytics

Date Published: April 22, 2019

Publisher: Public Library of Science

Author(s): Layan Sukik, Maryam Alyafei, Manale Harfouche, Laith J. Abu-Raddad, Remco PH Peters.


To investigate the epidemiology of herpes simplex virus type 1 (HSV-1) in Latin America and the Caribbean.

Systematic review and meta-analytics guided by the Cochrane Collaboration Handbook and reported following the PRISMA guidelines.

Thirty-three relevant reports were identified including 35 overall (and 95 stratified) seroprevalence measures, and five and nine proportions of virus isolation in genital ulcer disease (GUD) and in genital herpes, respectively. Pooled mean seroprevalence was 57.2% (95% CI: 49.7–64.6%) among children and 88.4% (95% CI: 85.2–91.2%) among adults. Pooled mean seroprevalence was lowest at 49.7% (95% CI: 42.8–56.6%) in those aged ≤10, followed by 77.8% (95% CI: 67.9–84.8%) in those aged 10–20, 82.8% (95% CI: 73.1–90.8%) in those aged 20–30, 92.5% (95% CI: 89.4–95.1%) in those aged 30–40, and 94.2% (95% CI: 92.7–95.5%) in those aged ≥40. Age was the strongest source of heterogeneity in seroprevalence, explaining 54% of variation. Evidence was found for seroprevalence decline over time. Pooled mean proportion of HSV-1 isolation was 0.9% (95% CI: 0.0–3.6%) in GUD and 10.9% (95% CI: 4.4–19.4%) in genital herpes.

HSV-1 is a widely prevalent infection in this region, but its epidemiology may be slowly transitioning, with still limited contribution for HSV-1 in genital herpes.

Partial Text

Infection with herpes simplex virus type 1 (HSV-1) is prevalent globally [1]. HSV-1 is responsible for a range of mild to serious morbidities [2, 3], with its typical clinical manifestation being orolabial herpes lesions [2, 4]. The infection, lifelong and mostly asymptomatic, is usually acquired orally and in childhood [3]. However, mounting evidence suggests an HSV-1 epidemiological transition in Europe and North America [4–7] and in Asia [8], associated with decreasing oral acquisition in childhood and increasing sexual acquisition (through oral sex) in adulthood [4–6]. In multiple Western countries, HSV-1 is already the primary cause of first episode genital herpes, surpassing the role of that of HSV-2 [4, 5, 7, 9–11]. An epidemiological transition is defined here as a significant change in the occurrence of the infection and/or its mode of transmission patterns.

The methodology of this study was adapted from that of a study investigating HSV-1 epidemiology in Asia [8].

The systematic review and meta-analytics reported here indicate that HSV-1 infection is widely prevalent in Latin America and the Caribbean, at a seroprevalence level that is higher than that of the global population at 67% [1]. Nearly 60% of children and 90% of adults are infected, a higher seroprevalence than that in Western Countries [31] and Asia [8], though lower than that in Africa [32] and the Middle East and North Africa (MENA) [33]. Seroprevalence increased steadily with age, but most HSV-1 acquisitions still occurred in childhood (Tables 2 and 3).

As in North America, Europe, and Asia [5, 7–11, 31, 35, 42], there is evidence for a possible transitioning HSV-1 epidemiology in Latin America and the Caribbean, though at a slower rate and with still limited contribution for HSV-1 in genital herpes and as a sexually transmitted infection. HSV-1 seroprevalence appears to be declining, with the younger cohorts experiencing lower infection risk than those experienced by the younger cohorts in earlier times. Yet, HSV-1 persists as a widely prevalent infection in this region, with 60% of children and 90% of adults being infected. These findings support the need for surveillance to monitor trends in seroprevalence and genital herpes etiology, and highlight the need for a vaccine to prevent infection and associated disease burden.