Epidemiology of Cytomegalovirus among pregnant women in Africa

Abstract

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.

Prevalence of hepatitis B surface antigen and serological markers of other endemic infections in HIV-infected children, adolescents and pregnant women in Sierra Leone: A cross-sectional study

“…In contrast, the seroprevalence of HCV, HTLV 1/2 and syphilis was low, suggesting low endemicity. These findings are in concordance with our earlier seroprevalence study among HIV-infected adults in Sierra Leone, as well as other studies from the wider Africa region (Patterson et al, 2019;Rao et al, 2015;Gessain and Cassar, 2012;Murphy et al, 2015;Mhandire et al, 2019;Hussen and Tadesse, 2019). As hepatitis A is primarily transmitted through the oral-fecal route, improved water and food safety practices and immunization are effective in combating the infection.…”

Seroprevalence of CMV IgG and IgM in Korean women of childbearing age

“…In the present study, overall CMV IgM seropositivity was 2.4%, with the highest seroprevalence of 11.6% in women aged 15‐ <20 years. This high seropositivity rate was comparable to those in previous studies including those of young pregnant women in India (overall 13.63% and 16.4% in the 15‐ to 25‐year age group) 9 and Africa (ranged from 0% to 15.5% through systematic review of the literature) 10 . A previous study performed in the United States using NHANES III 1998–1994 reported overall 5.3% CMV IgM prevalence in 12‐ to 19‐year‐old women 11 .…”

“…This high seropositivity rate was comparable to those in previous studies including those of young pregnant women in India (overall 13.63% and 16.4% in the 15-to 25-year age group) 9 and Africa (ranged from 0% to 15.5% through systematic review of the literature). 10 A previous study performed in the United States using NHANES III 1998-1994 reported overall 5.3% CMV IgM prevalence in 12-to 19-year-old women. 11 Overall CMV IgM seroprevalence in the present study (2.4%) was comparable to that of other studies performed in Korea, Norway and the United States.…”

Seroprevalence and associated factors of maternal cytomegalovirus in Southern Ethiopia

“…(6) Seropositivity of CMV IgG in our study was in line with a review done in Africa, with ranges from 60% to 100%. (9) Seropositivity rates of 77.3% for IgG and 8.1% for IgM in Kenya,(7) 93% for IgG and 11.1% for IgM in Nigeria,(13) 94% for IgG and 8.5% for IgM in Tanzania(14) were comparable to our finding.…”

“…In Africa the highest prevalence of CMV IgG was estimated ranging from 72 – 97.5% (7, 8) and of CMV IgM antibodies ranging from 0-15.5%. (9) However, for several reasons CMV infection among pregnant women in Africa have been overlooked. (10) One of the main reasons for +inattention is the perception that being infected in early childhood endures immunity for subsequent infection, so maternal reactivation or reinfection during pregnancy is unlikely to cause severe congenital infection.…”