title: Herpes simplex virus type 2 cross-sectional seroprevalence and the estimated rate of neonatal infections among a cohort of rural Malawian female adolescents.
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.
authors.affiliation: Department of Epidemiology, Harvard School of Public Health, , Boston, Massachusetts, USA.
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Sudfeld
authors.forename: Paul C
authors.initials: PC
authors.lastname: Hewett
authors.forename: Nadia N
authors.initials: NN
authors.lastname: Abuelezam
authors.forename: Satvika
authors.initials: S
authors.lastname: Chalasani
authors.forename: Erica
authors.initials: E
authors.lastname: Soler-Hampejsek
authors.forename: Christine A
authors.initials: CA
authors.lastname: Kelly
authors.forename: Barbara S
authors.initials: BS
authors.lastname: Mensch
mesh_terms: D000293:Adolescent; D000914:Antibodies, Viral / Q000097:blood*; D015331:Cohort Studies; D005260:Female; D006558:Herpes Genitalis / Q000453:epidemiology* / Q000635:transmission*; D018258:Herpesvirus 2, Human / Q000276:immunology*; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical; D008137:Longitudinal Studies; D008295:Malawi / Q000453:epidemiology; D008297:Male; D008962:Models, Theoretical; D011247:Pregnancy; D012424:Rural Population; D016036:Seroepidemiologic Studies; D055815:Young Adult
chemical_list: D000914:Antibodies, Viral
keywords: Adolescent; Epidemiology (Clinical); Herpes Simplex (Clinical); Modeling; Neonates