Cytomegalovirus, Epstein-Barr virus and varicella zoster virus infection in the first two years of life: a cohort study in Bradford, UK

Abstract

BackgroundCytomegalovirus (CMV), Epstein Barr virus (EBV) and varicella-zoster virus (VZV) are common herpesviruses frequently acquired in childhood, which establish persistent, latent infection and are likely to impact the developing immune system. Little is known about the epidemiology of CMV and EBV infections in contemporary UK paediatric populations, particularly whether age at infection differs by ethnic group.MethodsChildren enrolled in the Born in Bradford Allergy and Infection Study had a blood sample taken and a questionnaire completed at 12 and 24 months of age. Ordered logistic regression quantified associations between ethnicity and other risk factors and age at CMV/EBV/VZV infection (<12 months, 12–24 months, uninfected at 24 months).ResultsPakistani children (n = 472) were more likely to be infected with CMV and EBV at a younger age than White British children (n = 391) (CMV: adjusted odds ratio (OR) 2.53, 95% confidence interval (CI) 1.47–4.33; EBV: adjusted OR 2.16, 95% CI 1.43–3.26). Conversely, Pakistani children had lower odds of being VZV infected in the second year than White British children (adjusted OR 0.57, 95% CI 0.33–0.97). There was a strong association between increasing birth order and later CMV infection in Pakistani children.ConclusionsWe report large differences in CMV and EBV incidence in the first 2 years between Pakistani and White British children born in Bradford, which cannot be explained by differences in risk factors for infection. Our data will inform the optimum schedule for future CMV and EBV vaccination programmes.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-017-2319-7) contains supplementary material, which is available to authorized users.

Age at cytomegalovirus, Epstein Barr virus and varicella zoster virus infection and risk of atopy: The Born in Bradford cohort, UK

“…EBV infection tends to be acquired later than CMV; in this cohort, most of the CMV infections occurred in the first year, usually through contact with the mother, whereas most EBV infections occurred in the second year via contact with siblings and other children. 26 The 18% prevalence of atopy in our study is generally consistent with results from other European birth cohorts 19,46 and UK studies. 47,48 Some of these measured allergen-specific IgE (sIgE) in serum rather than SPT, and the children included ranged from age 2 to 7 years with all primary school-aged children included in one study.…”

“…The findings for age at CMV infection were compared between the univariable and multiple logistic regression analyses, and no evidence of multicollinearity was found, so the multiple regression analysis was accepted as the final model. Birth order and duration of breastfeeding were included in the CMV model a priori as these are strongly associated with age at CMV infection and associated with atopy in other studies . Effect modification by sex and ethnic group was investigated …”

“…28 Of the 2559 children enrolled in ALL IN, serum samples were tested for CMV-IgG, EBV-IgG and VZV-IgG for 1000 children to establish age at infection; infected by 12 months; infected between 12 and 24 months; or uninfected at 24 months. 26 Samples with concentration values of ≥6.0 AU/mL were considered as positive for CMV-IgG, and VCA IgG concentrations of ≥20 U/mL were considered as positive for EBV-IgG. For VZV, samples containing 160 mIU/mL were considered positive, those between 140 and 160 were equivocal and those less than 140 mIU/mL were deemed negative.…”

Clinical characteristics and treatment courses for cytomegalovirus-associated thrombocytopenia in immunocompetent children after neonatal period

“…After the neonatal period, the incidence of CMV infection varies according to race, economic status, and environmental factors. One study showed that one-third of Pakistani children had CMV infection by the age of 12 months, compared to only 9% of white British children [ 25 ]. In another study, most preschool children (>90%) in South America, East Asia, and India were CMV seropositive, in contrast, seroepidemiologic surveys in Great Britain and in USA have found that less than 20% of children of similar age were seropositive [ 26 ].…”

Molecular Biology and Epidemiology of Neurotropic Viruses

“…The mode of transmission varies from direct contact to nosocomial and transplacental transmission from mother to fetus, resulting in congenital cytomegalovirus with an estimated incidence in developed countries that ranges from 0.6% to 0.7% of all live births. The risk factors for transmission include low socioeconomic status, sexual activity, overcrowding, and increasing birth order [ 47 - 49 ].…”