HSV-1 seroprevalence and viral detection in China: a systematic review and meta-analysis

Abstract

Herpes Simplex Virus Type 1 (HSV-1) is a prevalent viral infection that causes a range of clinical manifestations, including oral and genital lesions, as well as severe neurological complications. Although HSV-1 has been extensively studied worldwide, there is limited comprehensive data specific to China. This study aimed to provide a systematic review and meta-analysis of the epidemiology of HSV-1 in China. HSV-1 publications as recent as October 1, 2025 were systematically reviewed, synthesized, and reported following PRISMA guidelines. PubMed and Embase were searched from inception to October 1, 2025, without language or date restrictions, with supplementary reference-list screening. Eligible primary studies reported type-specific HSV-1 antibody positivity or direct HSV-1 detection in China and included at least 10 participants. Proportions were logit transformed and synthesized using REML random-effects models. Multilevel models nested estimates within publications and used publication-clustered robust inference. Subgroup, meta-regression, prediction-interval, influence, sensitivity, and small-study-effect analyses were performed. Thirty-eight publications contributed 65 estimates (59,347 observations; 16,700 positive results). The conventional all-estimate descriptive composite was 61.74% (95% CI 49.03–73.03%; 95% prediction interval 2.36–99.08%; I²=99.5%). In modality-specific multilevel analyses, antibody seroprevalence was 76.45% (95% CI 59.10–87.94%; prediction interval 14.74–98.39%), whereas molecular/tissue detection was 22.82% (95% CI 13.63–35.65%; prediction interval 1.09–88.82%). Molecular/tissue modality, children/adolescent populations, and larger sample size were independently associated with lower logit proportions. Egger’s test was borderline ( p = 0.0544), while Begg’s test suggested asymmetry ( p < 0.001). HSV-1 epidemiological estimates from China are highly heterogeneous and depend strongly on the biological outcome, population, and study design. Antibody seroprevalence and direct viral detection should be reported separately. Standardized, population-based, age-stratified surveillance with broader nationwide coverage is needed to characterize HSV-1 epidemiology in China more reliably.