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Original article
Herpes simplex virus type 2 cross-sectional seroprevalence and the estimated rate of neonatal infections among a cohort of rural Malawian female adolescents
  1. Christopher R Sudfeld1,
  2. Paul C Hewett2,
  3. Nadia N Abuelezam1,
  4. Satvika Chalasani3,
  5. Erica Soler-Hampejsek3,
  6. Christine A Kelly3,
  7. Barbara S Mensch3
  1. 1Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA
  2. 2Population Council, Lusaka, Zambia
  3. 3Population Council, New York, New York, USA
  1. Correspondence to Dr Christopher R Sudfeld, Department of Epidemiology, Harvard School of Public Health, 667 Huntington Ave, Building 1, Room 1102, Boston, MA 02115, USA; csudfeld{at} and Dr Barbara S Mensch, Population Council, One Dag Hammarskjold Plaza, 9th Floor, New York, NY 10017, USA;  bmensch{at}


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.

  • Adolescent
  • Epidemiology (Clinical)
  • Herpes Simplex (Clinical)
  • Neonates
  • Modeling

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