The current state of vaccine development for ocular HSV-1 infection

Abstract

Herpes simplex virus type 1 continues to be the leading cause of infectious corneal blindness. Clinical trials for vaccines against genital HSV infection have been ongoing for more than three decades. Despite this, no approved vaccine exists, and no formal clinical trials have evaluated the impact of HSV vaccines on eye health. We review here the current state of development for an efficacious herpes simplex virus type 1 vaccine and call for involvement of ophthalmologists and vision researchers.

Keywords:

• cornea
• correlates of protection
• HSV-1
• immunopathology
• vaccine

Financial & competing interests disclosure

This review was financially supported by NIH R01 EY021238 awarded to DJJ Carr and by an unrestricted grant from Research to Prevent Blindness. DJ Royer is supported by National Eye Institute training grant T32EY023202. The content of this manuscript is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. The authors declare no financial conflict of interest with the materials or subject matter discussed in this review.

Key issues

• The utility and need for an efficacious vaccine to protect against ocular herpes simplex virus type 1 (HSV-1) infection is often overlooked.

• HSV-1 is the leading cause of infectious corneal blindness, yet no NIH-sanctioned clinical trial for HSV vaccines has evaluated the impact on eye health.

• Ophthalmologists and vision researchers have a unique role in the development and implementation of HSV-1 vaccines.

• Changing epidemiological trends due to delayed HSV-1 exposure have created an environment where a vaccine is both timely and needed to combat increasing incidence of clinical complications arising from primary HSV-1 infection during later ages.

• Success of vaccination against varicella zoster virus can inform our design of HSV vaccines.

• New evidence is challenging the static nature of the balance between lytic and latent HSV-1 infection and suggests that it is a dynamic process.

• The immune correlates of protection against HSV-1 infection, resolution and maintenance of latency may differ.

• Improvement in our immunologic understanding of future HSV vaccines can be achieved in animal models of ocular infection.