Cytomegalovirus infection in day care centres: A systematic review and meta‐analysis of prevalence of infection in children

Abstract

Summary Maternofetal transmission of cytomegalovirus (CMV) is the most common infectious cause of congenital malformation in developed countries. Maternal infection often results from close contact with infected children, and this may occur in day care centres (DCCs). A systematic review of observational studies was conducted to examine the prevalence of CMV infection among children attending DCCs. Meta‐analysis using the random effect model was performed for studies including controls. Sources included PubMed, EMBASE (until August 2018), and references from identified publications. Inclusion criteria were studies reporting CMV infection prevalence among childcare children aged less than 7 years of age. Controls were children without childcare exposure. CMV infection was defined as viral excretion detected by culture, polymerase chain reaction, or CMV seropositivity. Twenty‐eight publications including 8347 participants met the eligibility criteria. The pooled prevalence of CMV infection among children in childcare from all studies was 32% (95% CI 23‐41). Within case‐controlled studies, prevalence among children attending DCCs was 34% (95% CI 25‐44), whereas prevalence among those without childcare exposure was 22% (95% CI 15‐30). Meta‐analysis showed a significant association between DCC attendance and CMV infection (odds ratio 2.69, 95% CI 1.68‐4.30; heterogeneity χ2/df = 8; I2 = 84%, P < 0.00001). Attendance at DCCs is significantly associated with increased risk of childhood CMV infection. Prevention strategies to reduce risk of CMV infection of pregnant women and children should involve review of DCC exposure and consideration of preventative hygiene strategies.

Examining the dynamics of Epstein-Barr virus shedding in the tonsils and the impact of HIV-1 coinfection on daily saliva viral loads

“…EBV infection is primarily transmitted via saliva and is nearly universal, acquired during early childhood in developing countries and before reaching young adulthood in developed countries [6][7][8]. During primary infection, EBV is thought first to infect oral epithelial cells overlying the lymphoid tissue known as Waldeyer's ring [9].…”

Fetal therapies for cytomegalovirus: What we tell prospective parents

“…Parents with a child 1 to 2 years of age in day care are at particularly high risk of encountering CMV infection. 12,13 A recent study from France found that 3% of women who were CMV negative in their first pregnancy, seroconverted in the periconceptual period or first trimester of their next pregnancy. 14 Many women of reproductive age (45% to 100%) have had CMV infection prior to pregnancy.…”

“…Infection in children in day care is common, and children may excrete infectious virus for long periods. Parents with a child 1 to 2 years of age in day care are at particularly high risk of encountering CMV infection 12,13 . A recent study from France found that 3% of women who were CMV negative in their first pregnancy, seroconverted in the periconceptual period or first trimester of their next pregnancy 14 .…”

“…Maternal hygiene measures reduce the risk of CMV infection in pregnancy, with young children in day care the major source of CMV transmission 13 . Ideally, hygiene measures should start pre‐conception and continue throughout the pregnancy.…”

Australian Paediatric Surveillance Unit Annual Report 2018

“…Human cytomegalovirus (CMV) is the leading non-genetic cause of congenital malformation in developed countries including Australia. 8,9 Infection may result in fetal and neonatal death or the development of serious clinical sequelae including sensorineural hearing loss and neurodevelopmental disability. We have recently shown that awareness in the medical and general community about congenital CMV is very low and in need of improvement.…”