Herpes simplex virus type 2 cross-sectional seroprevalence and the estimated rate of neonatal infections among a cohort of rural Malawian female adolescents

Sex Transm Infect. 2013 Nov;89(7):561-7. doi: 10.1136/sextrans-2012-050869. Epub 2013 Jun 21.

Abstract

Objective: To assess herpes simplex virus type 2 (HSV-2) seroprevalence among rural Malawian adolescent women and estimate the number of neonatal herpes infections among infants of these adolescents.

Methods: A longitudinal cohort study of adolescents (14-16 years at entry) residing in rural Malawi was initiated in 2007 with annual observation. HSV-2 testing was introduced in 2010. In this study, we (1) determined, using cross-sectional analysis, risk factors for positive serostatus, (2) adjusted for non-response bias with imputation methods and (3) estimated the incidence of neonatal herpes infection using mathematical models.

Results: A total of 1195 female adolescents (age 17-20 years) were interviewed in 2010, with an observed HSV-2 seroprevalence of 15.2% among the 955 women tested. From a multivariate analysis, risk factors for HSV-2 seropositivity include older age (p=0.037), moving from the baseline village (p=0.020) and report of sexual activity with increasing number of partners (p<0.021). Adjusting for non-response bias, the estimated HSV-2 seroprevalence among the total female cohort (composed of all women interviewed in 2007) was 18.0% (95% CI 16.0% to 20.2%). HSV-2 seropositivity was estimated to be 25.6% (95% CI 19.6% to 32.5%) for women who refused to provide a blood sample. The estimated number of neonatal herpes infections among the total female cohort was 71.8 (95% CI 57.3 to 86.3) per 100 000 live births.

Conclusions: The risk of HSV-2 seroconversion is high during adolescence, when childbearing is beginning, among rural Malawian women. Research on interventions to reduce horizontal and vertical HSV-2 transmission during adolescence in resource-limited settings is needed.

Keywords: Adolescent; Epidemiology (Clinical); Herpes Simplex (Clinical); Modeling; Neonates.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Antibodies, Viral / blood*
  • Cohort Studies
  • Female
  • Herpes Genitalis / epidemiology*
  • Herpes Genitalis / transmission*
  • Herpesvirus 2, Human / immunology*
  • Humans
  • Incidence
  • Infant, Newborn
  • Infectious Disease Transmission, Vertical*
  • Longitudinal Studies
  • Malawi / epidemiology
  • Male
  • Models, Theoretical
  • Pregnancy
  • Rural Population
  • Seroepidemiologic Studies
  • Young Adult

Substances

  • Antibodies, Viral