在南非，单纯疱疹病毒 2 型（HSV-2）疫苗接种对 HSV-2、HIV 和生殖器溃疡疾病发病率的人群影响：一项数学建模研究。

The population impact of herpes simplex virus type 2 (HSV-2) vaccination on the incidence of HSV-2, HIV and genital ulcer disease in South Africa: a mathematical modelling study.

机构信息

Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.

出版信息

EBioMedicine. 2023 Apr;90:104530. doi: 10.1016/j.ebiom.2023.104530. Epub 2023 Mar 16.

BACKGROUND

Evidence suggests HSV-2 infection increases HIV acquisition risk and HIV/HSV-2 coinfection increases transmission risk of both infections. We analysed the potential impact of HSV-2 vaccination in South Africa, a high HIV/HSV-2 prevalence setting.

METHODS

We adapted a dynamic HIV transmission model for South Africa to incorporate HSV-2, including synergistic effects with HIV, to evaluate the impact of: (i) cohort vaccination of 9-year-olds with a prophylactic vaccine that reduces HSV-2 susceptibility; (ii) vaccination of symptomatically HSV-2-infected individuals with a therapeutic vaccine that reduces HSV shedding.

FINDINGS

An 80% efficacious prophylactic vaccine offering lifetime protection with 80% uptake could reduce HSV-2 and HIV incidence by 84.1% (95% Credibility Interval: 81.2-86.0) and 65.4% (56.5-71.6) after 40 years, respectively. This reduces to 57.4% (53.6-60.7) and 42.1% (34.1-48.1) if efficacy is 50%, 56.1% (53.4-58.3) and 41.5% (34.2-46.9) if uptake is 40%, and 29.4% (26.0-31.9) and 24.4% (19.0-28.7) if protection lasts 10 years. An 80% efficacious therapeutic vaccine offering lifetime protection with 40% coverage among symptomatic individuals could reduce HSV-2 and HIV incidence by 29.6% (21.8-40.9) and 26.4% (18.5-23.2) after 40 years, respectively. This reduces to 18.8% (13.7-26.4) and 16.9% (11.7-25.3) if efficacy is 50%, 9.7% (7.0-14.0) and 8.6% (5.8-13.4) if coverage is 20%, and 5.4% (3.8-8.0) and 5.5% (3.7-8.6) if protection lasts 2 years.

INTERPRETATION

Prophylactic and therapeutic vaccines offer promising approaches for reducing HSV-2 burden and could have important impact on HIV in South Africa and other high prevalence settings.

FUNDING

WHO, NIAID.

背景

有证据表明，单纯疱疹病毒 2 型（HSV-2）感染会增加人类免疫缺陷病毒（HIV）感染风险，HIV/HSV-2 合并感染会增加这两种感染的传播风险。我们分析了 HSV-2 疫苗接种在南非的潜在影响，南非是一个 HIV/HSV-2 高流行地区。

方法

我们改编了南非的一种动态 HIV 传播模型，纳入 HSV-2，包括与 HIV 的协同作用，以评估以下两种情况的影响：（i）对 9 岁儿童进行群体疫苗接种，接种一种预防疫苗，降低 HSV-2 的易感性；（ii）对有症状的 HSV-2 感染者进行疫苗接种，接种一种治疗性疫苗，减少 HSV 脱落。

发现

如果接种一种 80%有效、终生保护、接种率为 80%的预防性疫苗，可以使 HSV-2 和 HIV 的发病率分别降低 84.1%（95%可信度区间：81.2-86.0）和 65.4%（56.5-71.6），40 年后；如果疫苗有效率为 50%，接种率为 50%，则发病率分别降低至 57.4%（53.6-60.7）和 42.1%（34.1-48.1）；如果疫苗有效率为 50%，接种率为 40%，则发病率分别降低至 56.1%（53.4-58.3）和 41.5%（34.2-46.9）；如果疫苗保护期为 10 年，则发病率分别降低至 29.4%（26.0-31.9）和 24.4%（19.0-28.7）。如果接种一种 80%有效、终生保护、覆盖 40%有症状个体的治疗性疫苗，可以使 HSV-2 和 HIV 的发病率分别降低 29.6%（21.8-40.9）和 26.4%（18.5-23.2），40 年后；如果疫苗有效率为 50%，覆盖率为 20%，则发病率分别降低至 18.8%（13.7-26.4）和 16.9%（11.7-25.3）；如果疫苗有效率为 50%，覆盖率为 20%，则发病率分别降低至 9.7%（7.0-14.0）和 8.6%（5.8-13.4）；如果疫苗保护期为 2 年，则发病率分别降低至 5.4%（3.8-8.0）和 5.5%（3.7-8.6）。