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Epidemiology of herpes simplex virus type 2 in China: Systematic review, meta-analyses, and meta-regressions
  • +11
  • Chunfu Zheng,
  • Yehua Wang,
  • Xumeng Yan,
  • Wei Ai,
  • Rongyi Chen,
  • Yuanxi Jia,
  • Chengxin Fan,
  • Siyue Hu,
  • Yifan Dai,
  • Huachen Xue,
  • Feifei Li,
  • Jinbo Zhai,
  • Xuefeng Xia,
  • Weiming Tang
Chunfu Zheng
University of Calgary Department of Microbiology Immunology and Infectious Diseases

Corresponding Author:zheng.alan@hotmail.com

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Yehua Wang
The University of North Carolina at Chapel Hill UNC Project-China
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Xumeng Yan
The University of North Carolina at Chapel Hill UNC Project-China
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Wei Ai
Nanjing Medical University School of Public Health
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Rongyi Chen
Guangdong Provincial Dermatology Hospital
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Yuanxi Jia
Chinese Academy of Sciences Shenzhen Institutes of Advanced Technology
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Chengxin Fan
Nanjing Medical University School of Public Health
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Siyue Hu
The University of North Carolina at Chapel Hill UNC Project-China
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Yifan Dai
The University of North Carolina at Chapel Hill UNC Project-China
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Huachen Xue
The University of North Carolina at Chapel Hill UNC Project-China
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Feifei Li
The University of North Carolina at Chapel Hill UNC Project-China
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Jinbo Zhai
Inner Mongolia Minzu University
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Xuefeng Xia
GenePlus Technology Co Ltd
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Weiming Tang
The University of North Carolina at Chapel Hill UNC Project-China
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Abstract

Background: Herpes simplex virus type 2 (HSV-2) infection is prevalent and a significant public health problem. Understanding its epidemiology will help assess the current HSV-2 prevention efforts and inform future interventions in China. Methods: We followed Cochrane and PRISMA guidelines for a systematic review and included publications published in Chinese and English bibliographic systems until March 18 th, 2023. We synthesized seroprevalence, sero-incidence, and proportions of HSV-2 isolated in genital ulcer disease (GUD) and genital herpes data. We used random-effects models for meta-analyses and conducted meta-regression to assess the association between population characteristics and seroprevalence. Results: Overall, 21,849 articles were identified, and 457 publications (1,051,035 participants) were included. A total of 429 studies reported the overall seroprevalence rates (939 stratified measures), 5 reported seroincidence rates, 4 reported overall proportions of HSV-2 isolation in GUD (8 stratified proportions), and 24 reported overall proportions of HSV-2 isolation in genital herpes (59 stratified proportions). Pooled HSV-2 seroprevalence among overall populations was 14.9% (95% confidence interval (CI): 13.8-16.1%) and was 7.9% (95% CI: 6.9-8.8%) among the general population. Seroprevalence was highest among key populations (e.g., female sex workers and men who have sex with men) (32.1% (95% CI: 27.8-36.5%)). Among the general population, we found northeastern regions had a higher HSV-2 seroprevalence (12.4%, 95% CI: 7.8-17.9%). HSV-2 seroprevalence also increased with age. The pooled HSV-2 seroincidence rate was 4.3 per 100 person-years (95% CI: 1.0-7.6). Pooled HSV-2 seroprevalence among GUD and genital herpes were 45.2% (95% CI: 29.0-61.9%) and 52.8% (95% CI: 46.6-59.0%), respectively. We also found higher HSV-2 seroprevalence estimates in publications published in English bibliographic databases than those in Chinese databases (20.5% vs. 13.6%, risk ratio=1.10 (1.05-1.14)), indicating a potential existence of language bias in publication. Conclusion: Around 1 in 12 among the general population and 1 in 7 among all included populations were infected with HSV-2. The data revealed vulnerability to HSV-2 infection among higher-risk populations calling for expanding the intervention to prevent HSV-2 infection. It also revealed heterogeneities in synthesized HSV-2 prevalence results, suggesting the necessity to include Chinese bibliographic databases in conducting systematic reviews and meta-analyses of this topic.