Pepose Jay S, Keadle Tammie L, Morrison Lynda A
Pepose Vision Institute, 16216 Baxter Road, Ste. 205, Chesterfield, MO 63107, USA.
Am J Ophthalmol. 2006 Mar;141(3):547-557. doi: 10.1016/j.ajo.2005.10.008.
To review the changing epidemiology of herpes simplex virus infection, emerging patterns of herpetic ocular disease, and the challenges and promise of herpes simplex virus vaccine therapy.
Perspective.
Literature review.
An epidemic increase in genital herpes simplex type 2 infection is reflected in a 30% increase in HSV-2 antibodies in the United States since 1976. Approximately one in four people in the United States over age 30 is infected with HSV-2. Primary acquisition of herpes simplex type 1 is becoming progressively delayed in many industrialized countries, in contrast to developing nations where the virus is acquired early in life and is ubiquitous. Changes in sexual behavior among young adults have been associated with a recent increase in genital HSV-1 infection, resulting from oral-genital rather than genital-genital contact. Clinical trials of HSV vaccines using selected herpes simplex virus type 2 proteins mixed in adjuvant have shown limited efficacy in seronegative women, but not in men.
The recent epidemic of genital herpes simplex type 2 infection is likely to result in an increase in neonatal ocular herpes and in delayed cases of acute retinal necrosis syndrome. The increase in genital HSV-1 may lead to industry production of vaccines that contain components of both HSV-1 and HSV-2 targeted toward limiting genital disease and transmission. As newer herpes simplex vaccines become available, ophthalmologists must be vigilant that a boost in immunity against HSV does not have a paradoxical effect in exacerbating break-through cases that develop immune-mediated herpes simplex stromal keratitis.
回顾单纯疱疹病毒感染不断变化的流行病学、疱疹性眼病的新出现模式以及单纯疱疹病毒疫苗治疗的挑战与前景。
观点阐述。
文献综述。
自1976年以来，美国2型单纯疱疹病毒生殖器感染的流行率上升，表现为HSV-2抗体增加30%。美国30岁以上人群中约四分之一感染了HSV-2。在许多工业化国家，1型单纯疱疹病毒的初次感染时间逐渐推迟，而在发展中国家，该病毒在儿童早期即已感染且普遍存在。年轻人性行为的变化与近期生殖器HSV-1感染的增加有关，这是由口交而非生殖器性交接触引起的。使用佐剂中混合的选定2型单纯疱疹病毒蛋白进行的HSV疫苗临床试验在血清阴性女性中显示出有限的疗效，但在男性中则不然。
近期2型单纯疱疹病毒生殖器感染的流行可能导致新生儿眼部疱疹增加以及急性视网膜坏死综合征的延迟病例增加。生殖器HSV-1感染的增加可能会促使疫苗行业生产同时包含HSV-1和HSV-2成分的疫苗，旨在限制生殖器疾病和传播。随着新型单纯疱疹病毒疫苗的出现，眼科医生必须保持警惕，防止针对HSV的免疫力增强在加重发生免疫介导的单纯疱疹性基质性角膜炎的突破性病例方面产生矛盾效应。
