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Richardson BA, John-Stewart G, Atkinson C, Nduati R, Ásbjörnsdóttir K, Boeckh M, Overbaugh J, Emery V, Slyker JA. Vertical Cytomegalovirus Transmission From HIV-Infected Women Randomized to Formula-Feed or Breastfeed Their Infants. J Infect Dis 2015; 213:992-8. [PMID: 26518046 DOI: 10.1093/infdis/jiv515] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 10/19/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Cytomegalovirus (CMV) is associated with morbidity and mortality in human immunodeficiency virus (HIV)-exposed infants. We assessed the effect of and relative contribution of breastfeeding to CMV acquisition among infants delivered by HIV-infected mothers. METHODS Between 1993 and 1998 pregnant, HIV-infected women in Nairobi, Kenya, were randomly assigned to breastfeed or formula-feed their infants in an HIV transmission study. Women were allocated equally between treatment arms, and the study was not blinded. The primary endpoint of this nested study was time to infant CMV infection. RESULTS CMV infection was assessed in 138 breastfed and 134 formula-fed infants. Baseline characteristics were similar between arms. Breastfed infants acquired CMV earlier than formula-fed infants (median age of acquisition, 4.26 vs 9.87 months; P < .001) and had a higher 1-year probability of CMV infection (0.89 vs 0.69; P < .001). Breastfeeding was associated with a 1.6-fold increased risk of infant CMV acquisition independent of infant HIV status (multivariable hazard ratio, 1.61; 95% confidence interval, 1.20-2.16; P = .002). Approximately one third of CMV infections occurred during the peripartum period, with 40% acquired through breastfeeding and the remainder acquired through modes other than breast milk. CONCLUSIONS Preventing CMV acquisition may be a priority for HIV-exposed infants, but there is a narrow window of opportunity for intervention. Approaches that reduce maternal cervical and breast milk CMV reactivation may help delay infant infection.
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Affiliation(s)
- Barbra A Richardson
- Department of Biostatistics Department of Global Health Vaccine and Infectious Disease Division Public Health Sciences Division
| | - Grace John-Stewart
- Department of Global Health Department of Epidemiology Division of Allergy and Infectious Diseases, Department of Medicine Department of Pediatrics, University of Washington
| | - Claire Atkinson
- Institute for Immunity and Transplantation, University College, London
| | - Ruth Nduati
- Department of Pediatrics and Child health, School of Medicine, University of Nairobi, Kenya
| | | | - Michael Boeckh
- Division of Allergy and Infectious Diseases, Department of Medicine Vaccine and Infectious Disease Division Clinical Research Division
| | - Julie Overbaugh
- Human Biology Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Vincent Emery
- Department of Microbial and Cellular Sciences, University of Surrey, United Kingdom
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Anoh AE, Akoua-Koffi C, Couacy-Hymann E, Pauly M, Schubert G, Mossoun A, Weiss S, Leendertz SAJ, Jarvis MA, Leendertz FH, Ehlers B. Genetic identification of cytomegaloviruses in a rural population of Côte d'Ivoire. Virol J 2015; 12:155. [PMID: 26437859 PMCID: PMC4594925 DOI: 10.1186/s12985-015-0394-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 09/24/2015] [Indexed: 01/10/2023] Open
Abstract
Background Cytomegaloviruses (CMVs) are herpesviruses that infect many mammalian species, including humans. Infection generally passes undetected, but the virus can cause serious disease in individuals with impaired immune function. Human CMV (HCMV) is circulating with high seroprevalence (60–100 %) on all continents. However, little information is available on HCMV genoprevalence and genetic diversity in subsaharan Africa, especially in rural areas of West Africa that are at high risk of human-to-human HCMV transmission. In addition, there is a potential for zoonotic spillover of pathogens through bushmeat hunting and handling in these areas as shown for various retroviruses. Although HCMV and nonhuman CMVs are regarded as species-specific, potential human infection with CMVs of non-human primate (NHP) origin, shown to circulate in the local NHP population, has not been studied. Findings Analysis of 657 human oral swabs and fecal samples collected from 518 individuals living in 8 villages of Côte d’Ivoire with generic PCR for identification of human and NHP CMVs revealed shedding of HCMV in 2.5 % of the individuals. Determination of glycoprotein B sequences showed identity with strains Towne, AD169 and Toledo, respectively. NHP CMV sequences were not detected. Conclusions HCMV is actively circulating in a proportion of the rural Côte d’Ivoire human population with circulating strains being closely related to those previously identified in non-African countries. The lack of NHP CMVs in human populations in an environment conducive to cross-species infection supports zoonotic transmission of CMVs to humans being at most a rare event.
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Affiliation(s)
- Augustin Etile Anoh
- Centre de Recherche pour le Développement, Université Alassane Ouattara de Bouake, 01 BP V18, Bouake, Côte d'Ivoire.
| | - Chantal Akoua-Koffi
- Centre de Recherche pour le Développement, Université Alassane Ouattara de Bouake, 01 BP V18, Bouake, Côte d'Ivoire.
| | | | - Maude Pauly
- Project group P3 "Epidemiology of Highly Pathogenic Microorganisms", Robert Koch Institute, Berlin, 13353, Germany. .,Division 12 "Measles, Mumps, Rubella and Viruses affecting immune-compromised patients", Robert Koch Institute, Berlin, 13353, Germany. .,Present address: Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, 4354, Luxembourg.
| | - Grit Schubert
- Project group P3 "Epidemiology of Highly Pathogenic Microorganisms", Robert Koch Institute, Berlin, 13353, Germany.
| | - Arsène Mossoun
- LANADA/Laboratoire Central de Pathologie Animale, Bingerville, 206, Côte d'Ivoire. .,UFR Biosciences, Université FHB, Abidjan-Cocody, Côte d'Ivoire, Abidjan, Côte d'Ivoire.
| | - Sabrina Weiss
- Project group P3 "Epidemiology of Highly Pathogenic Microorganisms", Robert Koch Institute, Berlin, 13353, Germany. .,Present address: European Public Health Microbiology (EUPHEM) training programme, European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden, and Public Health England (PHE), London, NW9 5EQ, UK.
| | - Siv Aina J Leendertz
- Project group P3 "Epidemiology of Highly Pathogenic Microorganisms", Robert Koch Institute, Berlin, 13353, Germany.
| | - Michael A Jarvis
- School of Biomedical and Healthcare Sciences, Plymouth University, Plymouth, United Kingdom.
| | - Fabian H Leendertz
- Project group P3 "Epidemiology of Highly Pathogenic Microorganisms", Robert Koch Institute, Berlin, 13353, Germany.
| | - Bernhard Ehlers
- Division 12 "Measles, Mumps, Rubella and Viruses affecting immune-compromised patients", Robert Koch Institute, Berlin, 13353, Germany.
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Human cytomegalovirus intrahost evolution-a new avenue for understanding and controlling herpesvirus infections. Curr Opin Virol 2014; 8:109-15. [PMID: 25154343 DOI: 10.1016/j.coviro.2014.08.001] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 07/31/2014] [Accepted: 08/02/2014] [Indexed: 01/31/2023]
Abstract
Human cytomegalovirus (HCMV) is exquisitely adapted to the human host, and much research has focused on its evolution over long timescales spanning millennia. Here, we review recent data exploring the evolution of the virus on much shorter timescales, on the order of days or months. We describe the intrahost genetic diversity of the virus isolated from humans, and how this diversity contributes to HCMV spatiotemporal evolution. We propose mechanisms to explain the high levels of intrahost diversity and discuss how this new information may shed light on HCMV infection and pathogenesis.
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Cannon MJ, Hyde TB, Schmid DS. Review of cytomegalovirus shedding in bodily fluids and relevance to congenital cytomegalovirus infection. Rev Med Virol 2011; 21:240-55. [PMID: 21674676 DOI: 10.1002/rmv.695] [Citation(s) in RCA: 228] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2011] [Revised: 04/01/2011] [Accepted: 04/05/2011] [Indexed: 12/12/2022]
Abstract
Congenital cytomegalovirus (CMV) infections are a leading cause of sensorineural hearing loss (SNHL) and neurological impairment. Congenital transmission of CMV can occur with maternal primary infection, reactivation, or reinfection during pregnancy. We reviewed studies of CMV shedding in bodily fluids (defined as CMV detected by culture or CMV DNA detected by polymerase chain reaction). Following diagnosis at birth, children with congenital CMV infection exhibited the highest prevalences of CMV shedding (median = 80%, number of sample population prevalences [N] = 6) and duration of shedding, with a steep decline by age five. Healthy children attending day care shed more frequently (median = 23%, N = 24) than healthy children not attending day care (median = 12%, N = 11). Peak shedding prevalences in children occurred at 1-2 years of age, confirming that young children are the key transmission risk for pregnant women. CMV shedding among children was more prevalent in urine specimens than in oral secretions (median prevalence difference = 11.5%, N = 12). Adults with risk factors such as STD clinic attendance had higher shedding prevalences (median = 22%, N = 20) than adults without risk factors (median = 7%, N = 44). In adults with risk factors, CMV was shed more frequently in urine; in adults without risk factors genital shedding was most common. The prevalence of CMV shedding in nine sample populations of pregnant women increased with advancing gestation. In seven sample populations of children with congenital CMV infection, higher viral load at birth was consistently associated with an elevated risk of SNHL. Higher CMV viral load at birth also consistently correlated with the presence of symptoms of congenital CMV at birth. Published 2011. This article is a US Government work and is in the public domain in the USA.
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Affiliation(s)
- Michael J Cannon
- National Center on Birth Defects and Developmental Disabilities, Atlanta, GA, USA.
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Bates M, Monze M, Bima H, Kapambwe M, Kasolo F, Gompels U. High human cytomegalovirus loads and diverse linked variable genotypes in both HIV-1 infected and exposed, but uninfected, children in Africa. Virology 2008; 382:28-36. [DOI: 10.1016/j.virol.2008.09.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2008] [Revised: 08/09/2008] [Accepted: 09/03/2008] [Indexed: 01/08/2023]
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Bradley AJ, Kovács IJ, Gatherer D, Dargan DJ, Alkharsah KR, Chan PKS, Carman WF, Dedicoat M, Emery VC, Geddes CC, Gerna G, Ben-Ismaeil B, Kaye S, McGregor A, Moss PA, Pusztai R, Rawlinson WD, Scott GM, Wilkinson GWG, Schulz TF, Davison AJ. Genotypic analysis of two hypervariable human cytomegalovirus genes. J Med Virol 2008; 80:1615-23. [PMID: 18649324 PMCID: PMC2658010 DOI: 10.1002/jmv.21241] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Most human cytomegalovirus (HCMV) genes are highly conserved in sequence among strains, but some exhibit a substantial degree of variation. Two of these genes are UL146, which encodes a CXC chemokine, and UL139, which is predicted to encode a membrane glycoprotein. The sequences of these genes were determined from a collection of 184 HCMV samples obtained from Africa, Australia, Asia, Europe, and North America. UL146 is hypervariable throughout, whereas variation in UL139 is concentrated in a sequence encoding a potentially highly glycosylated region. The UL146 sequences fell into 14 genotypes, as did all previously reported sequences. The UL139 sequences grouped into 8 genotypes, and all previously reported sequences fell into a subset of these. There were minor differences among continents in genotypic frequencies for UL146 and UL139, but no clear geographical separation, and identical nucleotide sequences were represented among communities distant from each other. The frequent detection of multiple genotypes indicated that mixed infections are common. For both genes, the degree of divergence was sufficient to preclude reliable sequence alignments between genotypes in the most variable regions, and the mode of evolution involved in generating the genotypes could not be discerned. Within genotypes, constraint appears to have been the predominant mode, and positive selection was detected marginally at best. No evidence was found for linkage disequilibrium. The emerging scenario is that the HCMV genotypes developed in early human populations (or even earlier), becoming established via founder or bottleneck effects, and have spread, recombined and mixed worldwide in more recent times.
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Affiliation(s)
- Amanda J Bradley
- MRC Virology Unit, Institute of Virology, University of Glasgow, Glasgow, United Kingdom
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Seo SY, Park SJ, Hwang JY, Hahn SH, Kim SY, Kim HH, Lee W. The alteration of the positive rate of cytomegalovirus IgG antibody among preschool period children. KOREAN JOURNAL OF PEDIATRICS 2006. [DOI: 10.3345/kjp.2006.49.1.51] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Se-Young Seo
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sang-Jun Park
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ja-Young Hwang
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seong-Hoon Hahn
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - So-Young Kim
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyun-Hee Kim
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Wonbae Lee
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
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