title: Seroprevalence, predictors and estimated incidence of maternal and neonatal Herpes Simplex Virus type 2 infection in semi-urban women in Kilifi, Kenya.
abstract: BACKGROUND
  Herpes Simplex Virus type 2 (HSV-2) has public health importance as a leading cause of genital ulcers, a co-factor in HIV-1 acquisition and transmission and as a cause of neonatal herpes infections. Little is known of its epidemiology and burden in Coastal Kenya.
  
  
  METHODS
  We screened plasma samples for HSV-2 infection from 826 women aged 15-34 years who participated in an HIV-1 survey in Kilifi in 2004. The sample comprised 563 women selected randomly from a demographic surveillance system (DSS) and 263 women who presented for voluntary counseling and testing (VCT). Predictors for HSV-2 seropositivity were determined using multivariate logistic regression. The incidence of HSV-2 infection and risk of neonatal herpes were estimated by a simple catalytic model fitted to age-seroprevalence data.
  
  
  RESULTS
  HSV-2 prevalence was 32% in the DSS recruits vs. 44% in the VCT recruits (P < 0.001), while, HIV-1 prevalence was 8% in the DSS recruits vs. 12% in the VCT recruits (P = 0.12). Independent risk factors for HSV-2 infection in all women were: older age (30-34 years; odds ratio (OR) 10.5, 95% confidence interval (CI): 5.2 - 21.0), recruitment from VCT (OR 1.5, 95% CI: 1.1 - 2.1), history of genital ulcers (OR 1.7, 95% CI: 1.2 - 2.3) and HIV infection (OR 2.7, 95% CI: 1.6-4.6). Education beyond primary (OR 0.7, 95% CI: 0.5 - 0.9) was inversely associated with HSV-2 infection. In the DSS sample, HSV-2 incidence was estimated at 4 cases (95% CI: 3.3 - 4.4) per 100 women per year, 17 cases (95% CI: 16-18) per 1,000 pregnancies per year and 33 neonatal cases (95% CI: 31-36) per 100,000 births per year.
  
  
  CONCLUSIONS
  HSV-2 transmission is rapid following the onset of sexual activity and likely to result in a significant burden of genital ulcer disease. Nevertheless, the burden of neonatal HSV-2 can be predicted to be low. Educating young women about HSV-2 infection may help in reducing its burden in this semi-urban population.
authors.affiliation: Centre for Geographic Medicine Research-Coast, Kenya Medical Research Institute, Kilifi, Kenya. jnyiro2005@yahoo.com
authors.forename: Joyce U
authors.initials: JU
authors.lastname: Nyiro
authors.forename: Eduard J
authors.initials: EJ
authors.lastname: Sanders
authors.forename: Caroline
authors.initials: C
authors.lastname: Ngetsa
authors.forename: Steve
authors.initials: S
authors.lastname: Wale
authors.forename: Ken
authors.initials: K
authors.lastname: Awuondo
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Bukusi
authors.forename: Matthew A
authors.initials: MA
authors.lastname: Price
authors.forename: Pauli N
authors.initials: PN
authors.lastname: Amornkul
authors.forename: D James
authors.initials: DJ
authors.lastname: Nokes
mesh_terms: D000293:Adolescent; D000328:Adult; D000914:Antibodies, Viral / Q000276:immunology; D005260:Female; D006561:Herpes Simplex / Q000453:epidemiology* / Q000276:immunology / Q000635:transmission* / Q000821:virology; D018258:Herpesvirus 2, Human / Q000276:immunology / Q000302:isolation & purification / Q000502:physiology*; D006801:Humans; D015994:Incidence; D007223:Infant; D018445:Infectious Disease Transmission, Vertical; D007630:Kenya / Q000453:epidemiology; D008297:Male; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology*; D016036:Seroepidemiologic Studies; D014504:Urban Health; D055815:Young Adult
chemical_list: D000914:Antibodies, Viral