Meeting participants agreed on the urgent need for an HSV vaccine, BMS-354825 in vitro based on the large global burden of infection [3], the fact that HSV type 2 (HSV-2) fuels the HIV epidemic by increasing the risk of HIV acquisition and transmission [4], and the limited population impact of current HSV prevention measures [5]. Numerous seroprevalence studies provide a solid understanding of the substantial prevalence of HSV-2 infection globally, and the natural history of HSV infection has

been well delineated. However, data are more limited with respect to genital herpes caused by HSV-1, which cannot be distinguished serologically from oral infection. Several lines of basic and translational research have shown that both antibodies and innate immunity are important in preventing HSV infection, while T-cells are important in

controlling infection [5]. Selleck Epigenetic inhibitor Several candidate prophylactic HSV-2 vaccines have been evaluated in clinical trials involving more than 20,000 human volunteers and have been described by Johnston et al. in this issue [5]. Despite some promising early findings [6], in a large follow-up trial a recombinant glycoprotein subunit vaccine failed to prevent HSV-2 infection or disease [7]. These vaccines have been evaluated almost exclusively in high-income countries. The current HSV vaccine pipeline includes a variety of novel prophylactic vaccine platforms beyond glycoprotein targets that have shown efficacy in animal models, including replication-competent and replication-incompetent HSV-2 vaccines, as well as some therapeutic vaccines mafosfamide that are in early clinical development [5]. More immunological data are needed to understand differences in vaccine responses observed in previous vaccine trials – between HSV-discordant couples and the general population, between sexes, and according to HSV-1 serostatus – and also to understand the disparate clinical and virological manifestations of HSV-2 infection. Ideally, a series of immunological studies would be done using

specimens from people with well-defined HSV-2 severity and partnership status, including women from high- and low-income countries, involving assessment of mucosal T-cell and antibody responses, antibody avidity, and strategies to induce mucosal responses. Mucosal and systemic immune responses should be compared to look for systemic correlates of mucosal immunity. These studies may provide insight as to which antigens should be included in a potential vaccine and how antibody and T-cell immunity could be stimulated. Based on the experience from previous trials, vaccine development is feasible, although providing complete immunity against infection may be challenging, compared with reducing viral shedding or clinical disease.