A study in BMC Global and Public Health in July 2024 explores the economic consequences of herpes simplex virus (HSV)-2 and –1 infections in adults and adolescents. The researchers highlight a significant economic burden, most of which is borne by the Americas and Western Pacific regions combined. They conclude that prevention interventions could avert both economic and disease burdens, and demand “crucial” efforts to accelerate HSV vaccine development.
The burden of HSV
The authors state that, in 2016, around 13.2% of the world’s population between the ages of 15 and 49 years were living with HSV-2, while 67% of the world’s population aged 0-49 years were infected with HSV-1. HSV-2 causes genital herpes and can “almost triple” the risk of sexually acquired HIV infection. HSV-1 is “mainly” transmitted by oral-oral contact to cause oral herpes but can also cause genital herpes. Both genital HSV-1 and HSV-2 can cause neonatal infection with a high fatality rate.
“Concerns about HSV infection include not only its far-reaching health effects but also its impact on quality of life.”
Although there are interventions such as antiviral drugs, they do not cure or prevent transmission on a population level.
“The development of a safe and efficacious vaccine for HSV is an important goal to reduce HSV infection and avert health and economic burden.”
To support the public health value assessment of HSV vaccine development, the authors highlight the need for an assessment of the economic burden of HSV. However, there is a “poor understanding” of the global economic impact, so they sought to estimate the global economic burden of genital herpes caused by HSV-2 and HSV-1 infections in adults, pregnant women, neonatal herpes, and HIV infection attributable to HSV-2 over the six WHO regions in 2016.
The study
The team used a societal perspective that incorporated costs related to direct medical care, transportation, and productivity loss in the main analysis and a healthcare perspective that included only direct medical costs in the sensitivity analysis. The disease burden was taken from published global disease burden studies in 2016 and disaggregated for 194 countries.
The estimated economic burden of genital HSV infection and its consequences in 2016 was 2016 international dollars (I$) 35.3 billion. Of this, I$31.2 billion (88%) was associated with HSV-2 and I$4.0 billion with HSV-1. It is also presented by WHO region:
- I$3.6 billion in the African region
- I$8.6 billion in the Americas region
- I$1.9 billion in the Eastern Mediterranean region
- I$5.0 billion in the Europe region
- I$3.9 billion in South-East Asia region
- I$12.2 billion in the Western Pacific region
The proportion of economic burden due to HSV infections differed by country income level, with high- and upper-middle-income countries contributing to “more than three quarters” of the global HSV burden in 2016 (I$27.0 billion). Direct medical costs were responsible for most of the total costs associated with HSV infection: I$22.0 billion. This was followed by indirect costs (I$12.3 billion) and direct nonmedical costs (I$1.0 billion).
The economic burden was greatest for HSV-2 genital ulcer disease (GUD) at I$30.8 billion, compared to HSV-1 GUD at I$4.0 billion. This is “not surprising” to the researchers, as the global burden of HSV-2 GUD is “much higher”. However, they note that the “magnitude of economic burden did not necessarily correspond to the size of disease burden”. For example, although the number of people with HSV GUD was highest in the African region (59 million), the number of people estimated to be seeking and receiving care was “relatively smaller” than other regions.
Vaccine development
“The results highlight the importance of a concerted effort in accelerating the development of HSV vaccines.”
If these vaccines could reduce the number of genital HSV infections in the population or reduce the frequency or severity of HSV GUD outbreaks, the “substantial economic costs could be averted”. Further benefits could include a reduction of HIV incidence, as people with HSV-2 infection are “more vulnerable to contracting HIV infection”.
“Our global economic burden estimates for HSV in 2016 provide compelling evidence on the importance of investing in development of HSV prevention and control interventions. Such interventions have the potential not only to improve outcomes of affected populations worldwide but also to avert a large economic burden attributable to HSV.”
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