Cytomegalovirus Shedding in Seropositive Pregnant Women From a High-Seroprevalence Population: The Brazilian Cytomegalovirus Hearing and Maternal Secondary Infection Study

Barbosa, Nayara Gonçalves; Yamamoto, Aparecida Yulie; Duarte, Geraldo; Aragon, Davi Casale; Fowler, Karen B.; Boppana, Suresh B.; Britt, William J.; Mussi-Pinhata, Marisa Márcia

doi:10.1093/cid/ciy166

Cited by 45 publications

(41 citation statements)

References 37 publications

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“…11 However, the proportion of CMV-seropositive women shedding virus in cervicovaginal secretions is relatively low (3% to 13%) in the third trimester of pregnancy. 11,12 In our study, 78% of VLBW infants and 48% of infants > 1,500 g with reported CMV infection were delivered by C-section. Postnatal CMV infection acquired via breastfeeding can cause disease in VLBW and premature (<32 weeks) infants because their immune system is relatively immature and most placental transfer of maternal antibodies occurs during the third trimester.…”

Section: Discussionmentioning

confidence: 67%

Cytomegalovirus Infection among Infants in Neonatal Intensive Care Units, California, 2005 to 2016

et al. 2019

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Aim The main purpose of this article is to assess trends in cytomegalovirus (CMV) infection reported among infants in California neonatal intensive care units (NICUs) during 2005 to 2016. Study Design The California Perinatal Quality Care Collaborative collects data on all very low birth weight (VLBW, birth weight ≤ 1,500 g) and acutely ill infants > 1,500 g, representing 92% of NICUs in California. We compared clinical characteristics and length of hospital stay among infants with and without reported CMV infection (CMV-positive viral culture or polymerase chain reaction). Results During 2005 to 2016, CMV infection was reported in 174 VLBW infants and 145 infants > 1,500 g, or 2.7 (range: 1.5–4.7) and 1.2 (range: 0.8–1.7) per 1,000 infants, respectively (no significant annual trend). Among infants > 1,500 g, 12 (8%) versus 4,928 (4%) of those reported with versus without CMV infection died (p < 0.05). The median hospital stay was significantly longer among infants reported with versus without CMV infection for both VLBW infants (98 vs. 46 days) and infants > 1,500 g (61 vs. 14 days) (p < 0.001). Conclusion Reports of CMV infection remained stable over a 12-year period. Although we were not able to assess whether infection was congenital or postnatal, CMV infection among infants > 1,500 g was associated with increased mortality.

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Section: Discussionmentioning

confidence: 67%

Cytomegalovirus Infection among Infants in Neonatal Intensive Care Units, California, 2005 to 2016

et al. 2019

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“…Interestingly, one of the studies carried out among Nigerians showed a trend towards increased risk of being CMV IgG positive with having more than one sexual partner [34], a trend similar to what has been observed in risk of HIV infection [53]. Per contra , Barbosa et al did not find any relationship between number of sexual partners and CMV viral shedding among Brazilian women [6].…”

Section: Factors Associated With Acquisition Of CMV In African Pregnamentioning

confidence: 64%

“…However, over 60% of the infants infected in utero with CMV are born to mothers with preconceptional immunity who have secondary infection in pregnancy, and more and more studies show severe sequelae in these infants. We therefore conclude that congenital CMV may be a significant problem even in children born to mothers with pre-pregnancy immunity [6][7][8][9][10]. Because cCMV prevalence (~3%) is higer in resource-limited settings where previous maternal infection is widespread, the majority of cCMV cases are a result of non-primary maternal infections compared with the developed world which has cCMV prevalence of ~0.3% [11][12].…”

Section: Introductionmentioning

confidence: 99%

Epidemiology of Cytomegalovirus among pregnant women in Africa

Mhandire

Rowland‐Jones

Mhandire

et al. 2019

J Infect Dev Ctries

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Introduction: Vertical transmission of Cytomegalovirus (CMV), resulting in congenital CMV (cCMV) infection could have disabling and potentially fatal effects on the foetus or neonate. Although primary infection probably has a higher risk of leading to cCMV, in highly seropositive populations, a significant risk of vertical transmission is thought to be due to CMV reactivation and or reinfection during pregnancy. In this narrative review, we summarise the prevalence of CMV infection and associated risk factors among pregnant African women, in a setting where primary CMV infection usually occurs during infancy. Methodology: A systematic search of literature published between January 2000 and January 2019, retrieved on five bibliographic databases was performed. Search for relevant articles was performed using the following keywords: cytomegalovirus, CMV, infection, antenatal infections, pregnancy, pregnant women, gravidity, developing countries and Africa, with appropriate qualifiers such as OR, AND. Results: Systematic searching retrieved 11 relevant original research papers. Prevalence of anti-CMV IgG and IgM antibodies ranged from 60-100% and 0-15.5%, respectively. Prevalence of CMV DNA ranged from 0-29%, depending on the specimen used. However, there was no geographic trend for CMV seroprevalence or CMV DNA prevalence across the African continent. Overall, a substantial percentage of women of reproductive-age were CMV seronegative and at risk of primary infection. Associations of sociodemographic factors with CMV infection were inconsistent across all reviewed studies. Conclusions: The limited data and inconsistency of findings from the few studies carried out in Africa calls for prospective studies comparing prevalence and outcomes of cCMV in infants born to women with both primary and reactivated CMV in Africa.

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“…[15][16][17][18] A study from Brazil published in 2018 by Barbosa et al suggested that exposure to young children in the household also increased the risk for nonprimary congenital infection. 19 Younger age is associated with significantly higher viral loads in saliva and urine. Young children in daycare seem to be at particular risk for shedding the virus.…”

Section: Epidemiologymentioning

confidence: 99%

Congenital Cytomegalovirus Infection

Dietrich

Schieffelin

2019

TOJ

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Background: Congenital cytomegalovirus (cCMV) is the leading cause of nongenetic congenital hearing loss in much of the world and a leading cause of neurodevelopmental disabilities. Infected babies can be born to women who are seropositive and seronegative prior to pregnancy, and the incidence is approximately 0.6%-0.7% in the United States. Symptoms vary from mild to severe, and hearing loss can be delayed in onset and progressive. Methods: We reviewed the literature to summarize the epidemiology, clinical manifestations, diagnosis, treatment, and future directions of cCMV. Results: The best way to diagnose the infection is with polymerase chain reaction of urine or saliva within 3 weeks after birth, followed by a repeat confirmatory test if positive. Moderately to severely symptomatic neonates should be treated for 6 months with valganciclovir, and some practitioners also choose to treat infants who have isolated hearing loss only. Treatment is not recommended for asymptomatic infants. All infected infants should be screened for hearing loss and neurodevelopmental sequelae. Universal and targeted screening may be cost effective. Currently, no vaccine is commercially available, although multiple candidates are under study. Conclusion: Congenitally acquired cytomegalovirus is found in all communities around the world with a disease burden that is greater than many other well-known diseases. Advances are being made in prevention and treatment; however, improved awareness of the disease among clinicians and patients is needed.

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Cytomegalovirus Shedding in Seropositive Pregnant Women From a High-Seroprevalence Population: The Brazilian Cytomegalovirus Hearing and Maternal Secondary Infection Study

Abstract: CMV shedding is relatively frequent in seropositive pregnant women. The association between virus shedding and caring for young children as well as crowded living conditions may provide opportunities for increased exposures that could lead to CMV reinfections in seropositive women.

Cited by 45 publications

References 37 publications

Cytomegalovirus Infection among Infants in Neonatal Intensive Care Units, California, 2005 to 2016

Cytomegalovirus Infection among Infants in Neonatal Intensive Care Units, California, 2005 to 2016

Epidemiology of Cytomegalovirus among pregnant women in Africa

Congenital Cytomegalovirus Infection

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