Targeting virological core groups: a new paradigm for controlling herpes simplex virus type 2 epidemics.
BACKGROUND
Classic modeling of sexually transmitted diseases has focused on modeling behavioral heterogeneity and designing epidemic control strategies targeted at behavioral core groups.


METHODS
We analyzed a new mathematical model of herpes simplex virus type 2 (HSV-2) epidemics that includes virological core groups (i.e., groups of individuals with high rates of viral reactivation) and suggest a new paradigm for epidemic control. We used our model, in conjunction with virological data, to determine the potential role of virological core groups in contributing to transmission and the effect that daily antiviral therapy (DAT) could have on reducing transmission if virological core groups were targeted.


RESULTS
We estimated that a virological core group (11% of infected individuals) can cause a disproportionately large percentage (44%) of new infections and that a median of only 6.4 person-years of DAT would be necessary to prevent 1 HSV-2 infection. We determined that relatively few individuals would need to receive DAT to substantially reduce the incidence of HSV-2 infection.


CONCLUSIONS
Identifying and targeting individuals in the virological core group could be an effective and practical public health strategy for reducing transmission. Treating individuals who are high-frequency viral shedders should be evaluated as a strategy for reducing HSV-2 transmission.
Department of Biomathematics, David Geffen School of Medicine, University of California, Los Angeles (UCLA), Westwood, California 90024, USA. sblower@mednet.ucla.edu.
Sally
S
Blower
Anna
A
Wald
Hayley
H
Gershengorn
Fei
F
Wang
Larry
L
Corey
D000998:Antiviral Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D006558:Herpes Genitalis / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission* / Q000821:virology; D018258:Herpesvirus 2, Human / Q000187:drug effects* / Q000502:physiology; D006801:Humans; D008297:Male; D008433:Mathematics; D008954:Models, Biological; D009010:Monte Carlo Method; D014775:Virus Activation; D017201:Virus Shedding
D000998:Antiviral Agents