Trends in Herpes Simples Trends in Herpes Simples Virus Type 2 infection in the Virus Type 2 infection in the

United StatesUnited States ——Data from NHANESData from NHANES

Centers for Disease Control and Prevention Centers for Disease Control and Prevention (CDC) Emory University(CDC) Emory University

Atlanta, USA Atlanta, USA

NHANES NHANES ——A Unique Data SourceA Unique Data Source

NHANESNHANES——NNational ational HHealth ealth AAnd nd NNutrition utrition EExamination xamination SSurveyurvey

A series of nationally representative surveys A series of nationally representative surveys of non-institutionalized US population of non-institutionalized US population conducted by National Center for Health conducted by National Center for Health Statistics, CDCStatistics, CDC

Survey staff travel across the nation to Survey staff travel across the nation to conduct interviews and health examinations conduct interviews and health examinations

Statistical MethodsStatistical Methods

Age-adjustment Age-adjustment – US Census as the standard populationUS Census as the standard population

WeightsWeights– Accounting for oversampling and non-Accounting for oversampling and non-

responseresponse

SUDAAN software SUDAAN software – Accounting for multi-stage sampling designAccounting for multi-stage sampling design

Laboratory MethodsLaboratory Methods

HSV-2 serology (IgG antibodies)HSV-2 serology (IgG antibodies)

Type-specific immunodot assay Type-specific immunodot assay – Glycoprotein of gG2 as antigenGlycoprotein of gG2 as antigen

The same assay and the same laboratory were The same assay and the same laboratory were used over timeused over time

Tracking HSV-2 Trends Using Data Tracking HSV-2 Trends Using Data from NHANESfrom NHANES

NHANES II: 1976-80NHANES II: 1976-80

NHANES III: 1988-1994NHANES III: 1988-1994

NHANES 1999-2000NHANES 1999-2000

NHANES 2001-2002 (data to be released NHANES 2001-2002 (data to be released in May 2004)in May 2004)

NHANES 1976-2000NHANES 1976-2000

SurveysSurveys NHANES IINHANES II

(1976-80)(1976-80)

NHANES IIINHANES III

(1988-94) (1988-94)

NHANES NHANES

1999-’00 1999-’00

Examination Examination raterate

71%*71%* 76%76% 78%78%

Sample size Sample size 35973597 13,09413,094 35903590

Age rangeAge range >=12 yrs>=12 yrs >=12 yrs>=12 yrs 14-49 yrs14-49 yrs

*Response rate. Remaining sera for all non-whites and a random sample of 20-25% of the whites in each age group were tested.

Changes in HSV-2 Seroprevalence Changes in HSV-2 Seroprevalence between NHANES II and NHANES IIIbetween NHANES II and NHANES III

Overall, 30% increaseOverall, 30% increase

The relative increases similar in men (27%) The relative increases similar in men (27%) and women (32%)and women (32%)

Relative increases were largest in adolescents.. Relative increases were largest in adolescents..

Relative increase larger in whites (30%) than Relative increase larger in whites (30%) than blacks (9%)blacks (9%)

Changes in HSV-2 Seroprevalence Changes in HSV-2 Seroprevalence between NHANES II and NHANES IIIbetween NHANES II and NHANES III

0

10

20

30

40

50

14-19 20-29 30-39 40-49

Age Groups (Years)

HS

V-2

Sero

pre

vale

nce (

%)

NHANES II

NHANES III

Fleming DT et al. N Engl J Med 1997; 337: 1105-11.

Changes in HSV-2 Seroprevalence between Changes in HSV-2 Seroprevalence between NHANES III and NHANES’99-00NHANES III and NHANES’99-00

0

10

20

30

40

50

14-19 20-29 30-39 40-49

Age Groups (Years)

HS

V-2

Ser

op

reva

len

ce (

%)

NHANES III

NHANES '99-00

Changes in HSV-2 Seroprevalence between Changes in HSV-2 Seroprevalence between NHANES III and NHANES’99-00NHANES III and NHANES’99-00

VariablesVariables NHANES III NHANES III

(1988-1994) (1988-1994)

% (95% CI)% (95% CI)

NHANES NHANES

1999-2000 1999-2000

% (95% CI)% (95% CI)

PercentagePercentage

changechange

Total Total

Age (yrs)Age (yrs)

14-1914-19

20-2920-29

30-3930-39

40-4940-49

21.3 (19.4, 23.3) 21.3 (19.4, 23.3)

5.8 (4.4, 7.5 )5.8 (4.4, 7.5 )

17.2 (14.9, 19.8)17.2 (14.9, 19.8)

27.8 (24.6, 31.4)27.8 (24.6, 31.4)

26.3 (23.0, 30.1)26.3 (23.0, 30.1)

17.6 (15.4, 20.0)17.6 (15.4, 20.0)

1.5 (0.9, 2.7)1.5 (0.9, 2.7)

8.9 (7.2, 11.1)8.9 (7.2, 11.1)

25.4 (21.6, 29.9)25.4 (21.6, 29.9)

26.4 (21.4, 32.5)26.4 (21.4, 32.5)

-17%†-17%†

-74%‡-74%‡

-48%‡-48%‡

-9%-9%

-0%-0%

CI, confidence interval. † p<0.05; ‡ p<0.001

Changes between NHANES III and Changes between NHANES III and NHANES’99-00NHANES’99-00 in in 14-29 year-olds14-29 year-olds

VariablesVariables NHANES III NHANES III (1988-1994) (1988-1994)

N = 4537N = 4537

% (95% CI)% (95% CI)

NHANES NHANES

1999-2000 1999-2000

N = 2232N = 2232

% (95% CI)% (95% CI)

PercentagePercentage

changechange

SexSex

Males Males

FemalesFemales

Race/ethnicityRace/ethnicity

NH whitesNH whites

NH blacksNH blacks

Mex AmericansMex Americans

9.8 (7.5, 12.9)9.8 (7.5, 12.9)

16.6 (14.9, 18.6)16.6 (14.9, 18.6)

11.1 (9.0, 13.9)11.1 (9.0, 13.9)

24.9 (21.9, 28.2)24.9 (21.9, 28.2)

11.7 (9.7, 14.1)11.7 (9.7, 14.1)

4.0 (2.7, 5.9)4.0 (2.7, 5.9)

8.5 (6.4, 11.2)8.5 (6.4, 11.2)

3.3 (1.9, 5.4) 3.3 (1.9, 5.4)

21.9 (16.8, 28.5) 21.9 (16.8, 28.5)

6.2 (3.6, 10.8) 6.2 (3.6, 10.8)

-59%‡-59%‡

-49%‡-49%‡

-70%†-70%†

-12%-12%

-47%†-47%†

CI, confidence interval. † p<0.05; ‡ p<0.001

HSV-2 Seroprevalence in NHANES HSV-2 Seroprevalence in NHANES By Age GroupBy Age Group

0

10

20

30

40

50

14-19 20-29 30-39 40-49

Age Groups (Years)

HS

V-2

Ser

op

reva

len

ce (

%)

NHANES II

NHANES III

NHANES '99-00

ConclusionsConclusions

From the NHANES, HSV-2 seroprevalence From the NHANES, HSV-2 seroprevalence increased and then decreased between increased and then decreased between 1976-20001976-2000

Largest changes occurred in adolescents Largest changes occurred in adolescents and in whitesand in whites– Cohort effectCohort effect

DiscussionDiscussion

No sexual behavior data in NHANES IINo sexual behavior data in NHANES II

Limited sexual behavior data in NHANES Limited sexual behavior data in NHANES III and NHANES ’99-00III and NHANES ’99-00– The number of lifetime sexual partnersThe number of lifetime sexual partners

– Changes in wordingsChanges in wordings

Teenage Pregnancy Rate Teenage Pregnancy Rate in the US, 1972-2000in the US, 1972-2000

80

90

100

110

120

1970 1975 1980 1985 1990 1995 2000

Year

Rate per 1,000 women aged 15-19

Discussion (cont)Discussion (cont)

Youth Risk Behavior Surveys (1991-2001)*Youth Risk Behavior Surveys (1991-2001)*

Ever had sexEver had sex

Had four or more partnersHad four or more partners

Used condomsUsed condoms

Decreased sexual activity accounted for about Decreased sexual activity accounted for about 25% of the decline in teenage pregnancy 25% of the decline in teenage pregnancy between 1988 and 1995between 1988 and 1995

*CDC. MMWR 2002; 51:856-859.