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TROMBETTA CLAUDIAMARIA, VIVIANI SIMONETTA, MONTOMOLI EMANUELE, MARCHI SERENA. Seroprevalence of antibodies to cytomegalovirus in pregnant women in the Apulia region (Italy). JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2021; 62:E372-E376. [PMID: 34604575 PMCID: PMC8451340 DOI: 10.15167/2421-4248/jpmh2021.62.2.1800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 04/14/2021] [Indexed: 11/23/2022]
Abstract
Introduction Cytomegalovirus is ubiquitous and easily transmitted by contact. Following the first infection, the virus becomes latent and periodic reactivation could occur due to immunosuppression. If the infection is acquired in pregnancy, especially in the first trimester, the foetal consequences could be serious. The present study was conducted to assess the serological profile of pregnant women with respect to cytomegalovirus in Apulia from 2016 to 2019. Methods Serum samples were tested by commercial ELISA kit for the detection of specific IgM and IgG antibodies against cytomegalovirus. Results The data showed that most of the pregnant women (70.8%), especially those of ≥ 40 years of age (80.6%), has antibodies against cytomegalovirus, though these do not confer fully protective immunity against infection by different strains nor can prevent the re-activation of the latent one. Conversely, most of the youngest women are seronegative (44.4% in women < 25 years of age) and vulnerable during pregnancy. Conclusions Currently, cytomegalovirus screening for pregnant women is not mandatory in Italy. Considering that congenital cytomegalovirus is the leading non-genetic cause of sensorineural hearing loss, it would be extremely useful and cost-saving to screen women of childbearing age and women at early stage of pregnancy for cytomegalovirus infection in addition to increase awareness of cytomegalovirus infection and consequences among pregnant women, health care workers and the public.
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Affiliation(s)
- CLAUDIA MARIA TROMBETTA
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
- Correspondence: Claudia Maria Trombetta, Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy - E-mail:
| | - SIMONETTA VIVIANI
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - EMANUELE MONTOMOLI
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
- VisMederi srl, Siena, Italy
| | - SERENA MARCHI
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
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Porobic-Jahic H, Skokic F, Ahmetagic S, Piljic D, Jahic R, Petrovic J. Cytomegalovirus Infection in Pregnancy - Our Experiences. Med Arch 2020; 73:149-153. [PMID: 31404123 PMCID: PMC6643335 DOI: 10.5455/medarh.2019.73.149-153] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Introduction Cytomegalovirus (CMV) infection is ubiquitous. It affects all age groups, and its clinical picture ranges from mild to severe, especially as a congenital infection in neonates. Aim To determine frequency of CMV infection in pregnant women in Tuzla Canton (TC) and the risk factors that lead to the infection. Methods This prospective study included 300 pregnant women from TC aged 18 to 42 years. CMV serology was performed on all participants, and in case of acute infection additionally IgG avidity test. Participants also completed the questionnaire on the risk factors for CMV infection. Results The median age of the 300 women was 28 ±4.97 years. There were 161participants (53.6%) who classified their environment as urban and 295 (98.33%) were married. More than half of the women had completed secondary school 168 (56%). Positive IgG antibodies to CMV had 280 (93.0%) women. Positive IgM and IgG antibodies had 9 (3.0%) participants, but all of them had high IgG avidity, which indicates reinfection or recurrent CMV infection. There was a statistically significant higher number of seropositive participants living in rural areas than those living in urban areas (p= 0.048). Also, there was significantly higher percentage of positive anti-CMV IgG in pregnant women with lower education (p=0.04). Conclusion In our region there is high seropositivity rates of IgG antibodies to CMV in pregnant women. No case of primary CMV infection was proven. The risk factors for CMV infection have been proven to be rural environment and lower level of education.
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Affiliation(s)
- Humera Porobic-Jahic
- Clinic for Infectious Diseases, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina
| | - Fahrija Skokic
- Clinic for Pediatric Diseases, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina
| | - Sead Ahmetagic
- Clinic for Infectious Diseases, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina
| | - Dilista Piljic
- Clinic for Infectious Diseases, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina
| | - Rahima Jahic
- Clinic for Infectious Diseases, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina
| | - Jasminka Petrovic
- Clinic for Infectious Diseases, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina
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Coppola T, Mangold JF, Cantrell S, Permar SR. Impact of Maternal Immunity on Congenital Cytomegalovirus Birth Prevalence and Infant Outcomes: A Systematic Review. Vaccines (Basel) 2019; 7:E129. [PMID: 31561584 PMCID: PMC6963523 DOI: 10.3390/vaccines7040129] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 09/17/2019] [Accepted: 09/22/2019] [Indexed: 11/16/2022] Open
Abstract
Congenital cytomegalovirus (cCMV) is the leading non-genetic cause of sensorineural hearing loss (SNHL), and efforts are geared towards prevention through vaccine development. Transmission rates following primary maternal infection occur at rates of 30-40%, however reported placental rates upon non-primary maternal infection is reported to be less than <4%. There is significant debate about whether this reduction in transmission rate is due to pre-existing maternal immunity, which could identify possible immunologic targets for vaccines. To address this question, we performed a systemic review of the literature using Preferred Reporting Items for Systematic Review and Analysis (PRISMA) guidelines. We identified cohort studies in high CMV seroprevalent (>80%) areas or in developing regions that examined a cohort of at least 50 infants for congenital CMV acquisition. We identified 19 articles that met criteria and were further categorized based on pre-conception serology, maternal seroprevalence, or previously known seroprevalence. Birth prevalence rates ranged from 0.4% to 6% (median 1.1%), with the studies reporting on clinical outcome (16/19 studies) noting the majority of infected infants as asymptomatic. We also utilized a recent study that differentiated primary maternal infections from chronic infections in a highly seropositive population to calculate a placental transmission rate in women with pre-existing immunity compared to that of no pre-existing immunity. This work confirms a low cCMV birth prevalence in highly seropositive populations, indicates via a calculated placental transmission rate that the CMV placental transmission rate is lower in non-primary infection than that of primary infection, and reveals gaps in data for further research aiming to identify targets for vaccine development.
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Affiliation(s)
- Tiziana Coppola
- Department of Pediatrics, Duke University Hospital, Durham, NC, 27701, USA.
| | | | - Sarah Cantrell
- Medical Center Library & Archives, Duke University, Durham, NC, 27701, USA.
| | - Sallie R Permar
- Department of Pediatrics, Duke University Hospital, Durham, NC, 27701, USA.
- Duke HumanVaccine Institute, Durham, NC, 27701, USA.
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Saajan AM, Nyindo M, Gidabayda JG, Abdallah MS, Jaffer SH, Mukhtar AG, Khatibu TM, Philemon R, Kinabo GD, Mmbaga BT. TORCH Antibodies Among Pregnant Women and Their Newborns Receiving Care at Kilimanjaro Christian Medical Centre, Moshi, Tanzania. East Afr Health Res J 2017; 1:95-104. [PMID: 34308164 PMCID: PMC8279299 DOI: 10.24248/eahrj-d-16-00340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 08/01/2017] [Indexed: 11/20/2022] Open
Abstract
Background: Toxoplasmosis, other (syphilis, varicella-zoster, parvovirus B19, and hepatitis B), rubella, cytomegalovirus (CMV), and herpes simplex virus type 1 and type 2 (HSV-1 and HSV-2) – known by the acronym TORCH – is a group of infections affecting both mothers and their unborn babies with adverse short- and long-term outcomes. The majority of infected mothers are asymptomatic, which leaves only speculation as to the probable cause of many congenital anomalies, stillbirths, prematurity, and death resulting from TORCH infections. The main objective of this study was to investigate previous exposure to TORCH infections by measuring the seroprevalence of TORCH antibodies in pregnant women and their newborns receiving care at Kilimanjaro Christian Medical Centre (KCMC), Moshi, Tanzania. Methods: This was a cross-sectional, hospital-based study conducted at KCMC from December 2013 to April 2014. Of 350 pregnant women enrolled in the study, we tested 347 pregnant women attending the antenatal clinic and who opted to deliver at KCMC. Cord blood was collected and analysed for 309 of their newborns. To identify immunoglobulin G (IgG) and immunoglobulin M (IgM) antibodies in mothers and IgM antibodies in newborns, we used enzyme-linked immunosorbent assay testing. A structured questionnaire was used to collect data of mothers and their newborns. Data analysis was done using SPSS version 20. Results: The seroprevalence of IgG antibodies to TORCH infections among pregnant women was 154 (44.4%) for toxoplasmosis, 311 (89.6%) for rubella, 343 (98.6%) for CMV, and 346 (99.7%) for HSV-1 and HSV-2; 141 (40.6%) had been exposed to all 4 infections. For HSV-1 and HSV-2, the IgM antibodies were found in 137 (39.5%) of the 347 pregnant women included in this study. Age above 35 years (OR 6.15; 95% CI, 1.22–31.1; P=.028) and multiparity (OR 1.63; 95% CI, 1.01–2.62; P=.045) were associated with higher risk of being exposed to all TORCH infections. A total of 11 newborns had IgM antibodies to HSV-1 and HSV-2 giving a seroprevalence of 3.6%, and one newborn had IgM antibodies to rubella, giving a seroprevalence of 0.3%. None of the newborns had antibodies to toxoplasmosis and CMV. Conclusion: Exposure to TORCH infections was high among pregnant women in our population. Older age and multi-parity were associated with a higher risk of being exposed to all TORCH infections. Seroprevalence to HSV-1 and HSV-2 was high in newborns. The higher IgM antibodies to HSV-1 and HSV-2 among pregnant mothers and their newborns may disturb maternal, fetal, and neonatal health, and therefore we recommend establishing treatment protocol to support management of pregnant women and newborns who are seropositive for IgM antibodies.
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Affiliation(s)
- Aliasgher M Saajan
- Department of Paediatrics and Child Health, Kilimanjaro Christian Medical Centre, Moshi, Tanzania.,Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Mramba Nyindo
- Department of Paediatrics and Child Health, Kilimanjaro Christian Medical Centre, Moshi, Tanzania.,Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Joshua G Gidabayda
- Department of Paediatrics and Child Health, Kilimanjaro Christian Medical Centre, Moshi, Tanzania.,Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Mohammed S Abdallah
- Department of Paediatrics and Child Health, Kilimanjaro Christian Medical Centre, Moshi, Tanzania.,Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | | | | | - Tima M Khatibu
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Rune Philemon
- Department of Paediatrics and Child Health, Kilimanjaro Christian Medical Centre, Moshi, Tanzania.,Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Grace D Kinabo
- Department of Paediatrics and Child Health, Kilimanjaro Christian Medical Centre, Moshi, Tanzania.,Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Blandina T Mmbaga
- Department of Paediatrics and Child Health, Kilimanjaro Christian Medical Centre, Moshi, Tanzania.,Kilimanjaro Christian Medical University College, Moshi, Tanzania.,Kilimanjaro Clinical Research Institute, Moshi, Tanzania
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Prevalence, Characteristics, and One-Year Follow-Up of Congenital Cytomegalovirus Infection in Isfahan City, Iran. Interdiscip Perspect Infect Dis 2016; 2016:7812106. [PMID: 28070187 PMCID: PMC5192306 DOI: 10.1155/2016/7812106] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2016] [Accepted: 11/08/2016] [Indexed: 11/17/2022] Open
Abstract
Introduction. Need of neonatal screening for Cytomegalovirus (CMV) infection is under debate, in part because of limited data on importance of the disease regarding the prevalence of congenital CMV (cCMV) infection and associated morbidity and mortality. We aimed to evaluate the prevalence and prognosis of cCMV infection in Iran, where there is high maternal seroprevalence of CMV. Methodology. This prospective study was conducted in Isfahan city, Iran, from 2014 to 2016. CMV was investigated in urine specimens by using the real-time polymerase chain reaction (RT-PCR) method. CMV-infected infants were examined for clinical and laboratory findings attributed to CMV infection and followed up for one year. Results. Among 1617 studied neonates, eight (0.49%) were positive for CMV infection. CMV-infected neonates were more likely to be preterm than noninfected ones (25% versus 4.5%, p = 0.0508), and they had lower birth weight. Three out of the eight CMV-infected neonates had transient symptoms at birth. At follow-up, one case had mild hearing loss. Most patients had impaired growth during the one-year follow-up. Conclusions. The primary object of this study was determination of prevalence of cCMV infection in Iran as a developing country, which was at the lower range compared with other such countries. cCMV infection may result in short-term impairment in growth.
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Mujtaba G, Khurshid A, Sharif S, Alam MM, Aamir UB, Shaukat S, Angez M, Rana MS, Umair M, Shah AA, Zaidi SSZ. Distribution of Cytomegalovirus Genotypes among Neonates Born to Infected Mothers in Islamabad, Pakistan. PLoS One 2016; 11:e0156049. [PMID: 27367049 PMCID: PMC4930188 DOI: 10.1371/journal.pone.0156049] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 05/09/2016] [Indexed: 01/27/2023] Open
Abstract
Background Congenital cytomegalovirus (cCMV) infection contributes to considerable long-term sequelae in neonates and children all over the world. The association between viral genotypes and severity of clinical cytomegalovirus (CMV) infection is yet to be defined. The objective of this study was to find the impact of active CMV infection during pregnancy and the clinical significance of genotypes in neonates with congenital cytomegalovirus infections in Pakistan. Methods A total of 409 blood samples from pregnant women seeking health care services at the two antenatal hospitals of Islamabad during January to December 2012 were tested by ELISA and nested-PCR. Pregnant women with active infection (detected as IgM positive, PCR positive or positive on both assays) were followed until delivery, to detect the outcome of overt cCMV infection in neonates. Genetic characterization of CMV strains was performed by sequence analysis of envelope glycoproteins: gB, gN and gH to detect the contributing CMV genotypes. Results The seroprevalence of anti-CMV IgG and IgM was 97.5% (399 out of 409) and 12.7% (52 out of 409), respectively, while 20% (82/409) pregnant women were found positive for CMV DNA by PCR. Logistic regression analysis showed a significant association of active infection with parity [OR = 2.56, 95% CI = 1.82–2.62, p = 0.04], febrile illness [OR = 1.84, 95% CI = 1.76–3.65, p = 0.01] and jaundice [OR = 22.5, 95% CI = 4.53–85.02, p = 0.002]. We were able to isolate virus in 41 out of 70 neonates; 36.6% (15 out of 41) of them were symptomatic at birth while 63.4% (26 out of 41) were asymptomatic. The most prominent clinical feature observed in symptomatic neonates was hepatosplenomegaly (26.6%; 4 out of 15). All three genotypes gB, gN and gH were found with the highest frequency of gB1 genotype, found in 75% infants with hepatic damage. Phylogenetic analysis of Pakistani strains showed 96%-100% homology to their prototype strains. Conclusions Active CMV infection during pregnancy is a major cause of congenital CMV infection with comparable distribution of all three genotypes: gB, gN and gH in symptomatic and asymptomatic neonates. Our findings emphasize to conduct a comprehensive large scale survey and introduction of country wide routine screening at maternity clinics for early diagnosis of CMV to reduce its associated devastating outcomes.
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Affiliation(s)
- Ghulam Mujtaba
- Department of Microbiology, Quaid-i-Azam University, Islamabad, Pakistan
| | - Adnan Khurshid
- Department of Virology, National Institute of Health, Islamabad, Pakistan
| | - Salmaan Sharif
- Department of Virology, National Institute of Health, Islamabad, Pakistan
| | | | - Uzma Bashir Aamir
- Department of Virology, National Institute of Health, Islamabad, Pakistan
| | - Shahzad Shaukat
- Department of Virology, National Institute of Health, Islamabad, Pakistan
| | - Mehar Angez
- Department of Virology, National Institute of Health, Islamabad, Pakistan
| | | | - Massab Umair
- Department of Virology, National Institute of Health, Islamabad, Pakistan
| | - Aamer Ali Shah
- Department of Microbiology, Quaid-i-Azam University, Islamabad, Pakistan
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Akende O, Akanbi OA, Oluremi AS, Okonko IO, Opaleye OO. Prevalence of Cytomegalovirus IgG Antibodies among Pregnant Women Visiting Antenatal Clinic, LAUTECH Teaching Hospital in Osogbo, Osun State, Nigeria. J Immunoassay Immunochem 2016; 37:289-95. [PMID: 26745015 DOI: 10.1080/15321819.2015.1132230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Cytomegalovirus (CMV) is one of the predominant viral infections that lead to congenital diseases and teratogenic risks during the perinatal stage. There is paucity of seroepidemiological data on anti-CMV IgG antibody in pregnant women in Osogbo, Osun State, Nigeria. This study was aimed at determining the seroprevalence of Cytomegalovirus IgG antibody among pregnant women visiting antenatal clinic, LAUTECH Teaching Hospital, Osogbo, Nigeria. One hundred and seventy-four sera from the pregnant women were screened by Enzyme linked Immunosorbent Assay (ELISA) for cytomegalovirus (CMV) IgG antibody. Data analysis was done using SPSS software. In this study, 105 of the 174 pregnant women were seropositive for CMV IgG antibodies giving an antibody prevalence of 60%. There was no association found between CMV IgG seropositivity and the subjects' demographic characteristics, however, the 60.0% prevalence of CMV-IgG antibody observed amongst pregnant women in this study demands for vaccines and regular testing for the presence of CMV and its related risk factors in antenatal clinic.
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Affiliation(s)
- Oluwatosin Akende
- a Department of Medical Microbiology and Parasitology , College of Health Sciences, Ladoke Akintola University of Technology , Osogbo , Nigeria
| | - Olusola Anuoluwapo Akanbi
- a Department of Medical Microbiology and Parasitology , College of Health Sciences, Ladoke Akintola University of Technology , Osogbo , Nigeria
| | - Adeolu Sunday Oluremi
- a Department of Medical Microbiology and Parasitology , College of Health Sciences, Ladoke Akintola University of Technology , Osogbo , Nigeria
| | - Iheanyi Omezuruike Okonko
- b Medical Microbiology Unit, Department of Microbiology , University of Port Harcourt , Port Harcourt , Rivers State , Nigeria
| | - Oluyinka Oladele Opaleye
- a Department of Medical Microbiology and Parasitology , College of Health Sciences, Ladoke Akintola University of Technology , Osogbo , Nigeria
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Maingi Z, Nyamache AK. Seroprevalence of Cytomegalo Virus (CMV) among pregnant women in Thika, Kenya. BMC Res Notes 2014; 7:794. [PMID: 25392013 PMCID: PMC4247150 DOI: 10.1186/1756-0500-7-794] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Accepted: 10/24/2014] [Indexed: 11/16/2022] Open
Abstract
Background The fetal consequences of CMV infection have made it one of the most serious infections contracted during pregnancy. Despite the posed teratogenic risk during pregnancy, there is no national screening test for CMV infection is available during pregnancy in Kenya. Thus little is known on its epidemiological data that is necessary for health planners and care providers. Methods A cross sectional study was conducted at Thika district level 5 hospital, Kenya to investigate seroprevalence of CMV infections and associated possible risk factors among pregnant women. Structured questionnaires were used to gather socio-demographic data and ELISA was used to detect CMV infections using IgG and IgM. Results Out of 260 pregnant women, 201 (77.3%) were CMV IgG 21(8.1%) CMV IgM being on acute stage of the disease. Marital status (OR = 3.7533, 95% CI =3.0231-6.9631, P < 0.0001), parity (OR = 3.7533, 95% CI = 3.0231-6.9631, P < 0.0001), and education (OR = 3.7533, 95% CI = 3.0231-6.9631, P < 0.0001), history of blood transfusion (OR = 0.0374, 95% CI = 0.00120-0.1168, OR = 0.3804) were found to significantly influence seropostivity in univariate analysis. Conclusion The 88.4% CMV prevalence rate being detected among pregnant women calls for vaccine and routine screening for CMV infections and its associated risk factors in this kind of settings.
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Cytomegalovirus seroprevalence in pregnant women and association with adverse pregnancy/neonatal outcomes in Jiangsu Province, China. PLoS One 2014; 9:e107645. [PMID: 25211647 PMCID: PMC4161444 DOI: 10.1371/journal.pone.0107645] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Accepted: 08/21/2014] [Indexed: 12/31/2022] Open
Abstract
Background In this study, we aimed to determine the provincial population-based seroprevalence in pregnant women and to further explore the association of maternal CMV infection status and adverse pregnancy/neonatal/growth outcomes in Jiangsu, China. Methods In this case-control study, the sera from 527 pregnant women with adverse pregnancy/neonatal outcomes and 496 mothers of healthy infants in Jiangsu Province, collected at gestation age of 15–20 weeks, were tested for anti-CMV IgG, IgM and IgG avidity. Adverse pregnancy/neonatal outcomes were identified based on pregnancy/neonatal outcomes. Results The overall seroprevalence of anti-CMV IgG was 98.7%, with 99.4% and 98.0% in the case and control groups, respectively (P = 0.039). The prevalence of anti-CMV IgG+/IgM+, was higher in the case group than that in the control group (3.8% vs. 1.6%, P = 0.033). Anti-CMV IgG avidity assay showed that none in the control group were primarily infected, but five (0.9%) in the case group underwent primary infection (P = 0.084); all five infants of these women presented severe adverse neonatal/growth outcomes. Exact logistic regression analysis showed that anti-CMV IgG+/IgM+ was associated with adverse pregnancy/neonatal/growth outcomes (aOR = 2.44, 95% CI 1.01–6.48, P = 0.047). Maternal low education level and prior abnormal pregnancies also were risk factors for adverse pregnancy/neonatal outcomes. Conclusions In populations with very high prevalence of latent CMV infection, active maternal CMV infection during pregnancy might be a risk factor for adverse pregnancy/neonatal outcomes.
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Epidemiology of Toxoplasma and CMV serology and of GBS colonization in pregnancy and neonatal outcome in a Sicilian population. Ital J Pediatr 2014; 40:23. [PMID: 24559197 PMCID: PMC3936856 DOI: 10.1186/1824-7288-40-23] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Accepted: 02/19/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Aim of our study is to analyze the immunological status in pregnancy for two main TORCH agents, Toxoplasma and Cytomegalovirus (CMV), and the results of group B streptococcus (GBS) screening, assessing the risk for congenital infection in a population from Palermo, Italy. METHODS We retrospectively analyzed the medical records of all inborn live newborns who were born in our division during 2012, gathering information about the mother, the pregnancy and neonatal hospitalization at birth. Whenever data were available, we categorized the serologic status of the mothers for Toxoplasma and CMV. We also considered the results of rectal and vaginal swabs for GBS. We compared the results in Italian and immigrant mothers. The neonatal outcome was evaluated in all cases at risk. RESULTS Prevalence of anti-Toxo IgG antibodies was 17.97%, and was significantly higher in immigrant women (30% vs 16.4% in Italian women; p = 0.0008). Prevalence of anti-CMV IgG antibodies was 65.87%. Again, it was significantly higher in immigrant women (91.4% vs 62.5%, p = 3.31e-08). We compared those data with a previous study performed in our hospital in 2005-2006, and found that the prevalence of anti-Toxoplasma and anti-CMV antibodies in our population has remained stable, both in the immigrant and in the local population. Seroconversion rates and neonatal infections were rare: no seroconversions were observed for Toxoplasma, 4 seroconversions for CMV. One neonatal Toxoplasma infection and two neonatal CMV infections were documented. In some cases with dubious patterns or probable persistence of IgM, we performed additional tests and follow-up. Vaginal and rectal swabs were positive for GBS in 7.98% of cases, with no significant difference between the Italian and the immigrant population. No GBS neonatal sepsis was documented. CONCLUSIONS The prevalence of Toxoplasma IgG antibodies in pregnant women was low in our population, if compared with European countries and with other parts of Italy, and is significantly higher in immigrant women. The prevalence of CMV IgG antibodies was intermediate if compared to other countries, and it was higher in immigrant women. GBS positivity was low, and comparable in Italian and immigrant mothers. Neonatal infection was rare for all these agents.
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Neirukh T, Qaisi A, Saleh N, Rmaileh AA, Zahriyeh EA, Qurei L, Dajani F, Nusseibeh T, Khamash H, Baraghithi S, Azzeh M. Seroprevalence of Cytomegalovirus among pregnant women and hospitalized children in Palestine. BMC Infect Dis 2013; 13:528. [PMID: 24206533 PMCID: PMC3830538 DOI: 10.1186/1471-2334-13-528] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Accepted: 11/04/2013] [Indexed: 12/20/2022] Open
Abstract
Background Human Cytomegalovirus (HCMV) is the most common cause of congenital infections. The maternal immune status plays a major role in the likelihood of congenital infection. The aim of this study is to shed light on the seroprevalence of HCMV in pregnant women, hospitalized children and newborns including cases of congenital infections in Palestine. Methods We analyzed HCMV IgG and IgM test results that had been ordered for pregnant women, hospitalized children and newborns in the years 2006–2012 at Al-Makassed Islamic Charitable Hospital (MICH) in East Jerusalem. Furthermore, we reviewed the medical charts of newborns and HCMV IgM-positive children. Results HCMV IgG was positive in 96.6% of pregnant women, in 88% of hospitalized children and in 98.4% of hospitalized newborns. HCMV IgM was positive in 11.5% of pregnant women, in 11.7% of hospitalized children and in 2% of hospitalized newborns respectively. The HCMV avidity assay revealed that 95% of IgM-positive pregnant women had high avidity (>60%) indicating that most Palestinian women were undergoing a recurrent HCMV infection. Real time PCR on limited number of cases indicated that 62.5% of infants, mostly born to IgM-positive mothers and 83.3% of HCMV IgM-positive children had detectable HCMV DNA in their urine. Out of the 249 newborns tested during this study period, four (1.6%) were subjected to Gancyclovir treatment because of symptomatic congenital HCMV infection. Conclusions This is the first report to provide an insight into HCMV seroprevalence in Palestine. Despite the high rate of seropositivity, the importance of HCMV testing during pregnancy should not be underestimated. A comprehensive study with a long term follow-up examination of offspring born to HCMV IgM-positive mothers would be required to provide estimates of an accurate percentage of symptomatic congenital HCMV infection in Palestine.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Maysa Azzeh
- Central Laboratory, Al-Makassed Islamic Charitable Hospital, East Jerusalem, Palestine.
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Chen J, Hu L, Wu M, Zhong T, Zhou YH, Hu Y. Kinetics of IgG antibody to cytomegalovirus (CMV) after birth and seroprevalence of anti-CMV IgG in Chinese children. Virol J 2012; 9:304. [PMID: 23228149 PMCID: PMC3544651 DOI: 10.1186/1743-422x-9-304] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2012] [Accepted: 12/06/2012] [Indexed: 12/12/2022] Open
Abstract
Background Prevalence of cytomegalovirus (CMV) infection is 90–100% in developing countries; however, the kinetics of anti-CMV IgG in infants remains elusive. Methods Sera from 112 mother-newborn pairs and longitudinal samples from 41 infants up to 2-year old were tested for anti-CMV IgG and IgM. Additionally, samples from 837 healthy children were included. Results Of 112 mothers, 108 (96.4%) were anti-CMV IgG positive; their 108 newborns were also seropositive. In a 2-year follow-up among 40 infants of positive mothers, anti-CMV IgG level in 8 individuals decreased with time and became undetectable by age of 3.5–8 months, and that in 32 others decreased at 1- and 3.5-month old, and then increased. Based on the positive IgM, rising IgG levels, and low anti-CMV IgG avidity index, 76.7% of the primary infections were demonstrated to occur during 1–3.5 months of age. The overall seroprevalence of anti-CMV in 837 children was 82.4%, which was generally constant from 2 to 8 years old (χ2 = 3.150, p = 0.790). Conclusions The maternally acquired anti-CMV IgG in infants disappears before 8-month old. Primary CMV infection in Chinese children mostly occurs during 1–3.5 months of age. Whether the relatively lower seroprevalence of anti-CMV in Chinese children found in this survey may reflect the positive rate in child-bearing age women in the future remains to be further studied.
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Affiliation(s)
- Jie Chen
- Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital, Nanjing Medical University, Jiangsu, China
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Early high CMV seroprevalence in pregnant women from a population with a high rate of congenital infection. Epidemiol Infect 2012. [PMID: 23200458 DOI: 10.1017/s0950268812002695] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Congenital cytomegalovirus (CMV) infection rates increase with maternal seroprevalence due to transmission from maternal non-primary infection. CMV seroprevalence estimates of pregnant women are needed for planning strategies against congenital CMV transmission. We aimed to determine the age-specific prevalence of serum antibodies for CMV in a representative age-stratified sample of unselected pregnant women from a Brazilian population. A total of 985 pregnant women, aged 12–46 years (median 24 years), were enrolled. Overall CMV seroprevalence was 97% (95% confidence interval 95.8–98.0), with age-specific (years) prevalence as follows: 12–19 (96.3%), 20–24 (97.7%), 25–29 (97.1%), and 30–46 (96.7%). CMV seroprevalence is almost universal (97%) and is found at similar levels in pregnant women of ages ranging from 12 to 46 years. Because high CMV seroprevalence is found even in women of a younger age in this population, this finding suggests that the majority of primary CMV infections occur early, in infancy or childhood. As a consequence, vaccines currently under development to prevent primary infection may not be a solution for the prevention of congenital CMV infection in this population.
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Velu PP, Gravett CA, Roberts TK, Wagner TA, Zhang JSF, Rubens CE, Gravett MG, Campbell H, Rudan I. Epidemiology and aetiology of maternal bacterial and viral infections in low- and middle-income countries. J Glob Health 2011; 1:171-88. [PMID: 23198117 PMCID: PMC3484781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Maternal morbidity and mortality in low- and middle-income countries has remained exceedingly high. However, information on bacterial and viral maternal infections, which are important contributors to poor pregnancy outcomes, is sparse and poorly characterised. This review aims to describe the epidemiology and aetiology of bacterial and viral maternal infections in low- and middle-income countries. METHODS A systematic search of published literature was conducted and data on aetiology and epidemiology of maternal infections was extracted from relevant studies for analysis. Searches were conducted in parallel by two reviewers (using OVID) in the following databases: Medline (1950 to 2010), EMBASE (1980 to 2010) and Global Health (1973 to 2010). RESULTS Data from 158 relevant studies was used to characterise the epidemiology of the 10 most extensively reported maternal infections with the following median prevalence rates: Treponema pallidum (2.6%), Neisseria gonorrhoeae (1.5%), Chlamydia trachomatis (5.8%), Group B Streptococcus (8.6%), bacterial vaginosis (20.9%), hepatitis B virus (4.3%), hepatitis C virus (1.4%), Cytomegalovirus (95.7% past infection), Rubella (8.9% susceptible) and Herpes simplex (20.7%). Large variations in the prevalence of these infections between countries and regions were noted. CONCLUSION This review confirms the suspected high prevalence of maternal bacterial and viral infections and identifies particular diseases and regions requiring urgent attention in public health policy planning, setting research priorities and donor funding towards reducing maternal morbidity and mortality in low- and middle-income countries.
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Affiliation(s)
- Prasad Palani Velu
- Centre for Population Health Sciences and Global Health Academy, The University of Edinburgh, Scotland, UK
- Joint first or senior authorship
| | - Courtney A. Gravett
- Global Alliance to Prevent Prematurity and Stillbirth (GAPPS), Seattle Children’s Hospital, Seattle, Washington, USA
- Joint first or senior authorship
| | - Tom K. Roberts
- Centre for Population Health Sciences and Global Health Academy, The University of Edinburgh, Scotland, UK
| | - Thor A. Wagner
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
| | - Jian Shayne F. Zhang
- Centre for Population Health Sciences and Global Health Academy, The University of Edinburgh, Scotland, UK
| | - Craig E. Rubens
- Global Alliance to Prevent Prematurity and Stillbirth (GAPPS), Seattle Children’s Hospital, Seattle, Washington, USA
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
- Joint first or senior authorship
| | - Michael G. Gravett
- Global Alliance to Prevent Prematurity and Stillbirth (GAPPS), Seattle Children’s Hospital, Seattle, Washington, USA
- Department of Obstetrics and Gynecology, University of Washington, Seattle, Washington, USA
- Joint first or senior authorship
| | - Harry Campbell
- Centre for Population Health Sciences and Global Health Academy, The University of Edinburgh, Scotland, UK
- Joint first or senior authorship
| | - Igor Rudan
- Centre for Population Health Sciences and Global Health Academy, The University of Edinburgh, Scotland, UK
- Joint first or senior authorship
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Hamdan HZ, Abdelbagi IE, Nasser NM, Adam I. Seroprevalence of cytomegalovirus and rubella among pregnant women in western Sudan. Virol J 2011; 8:217. [PMID: 21569321 PMCID: PMC3112446 DOI: 10.1186/1743-422x-8-217] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2010] [Accepted: 05/11/2011] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Maternal cytomegalovirus (CMV) and rubella infections have adverse neonatal outcomes. Basic epidemiological data concerning CMV and rubella is necessary for health planners and care providers. METHODS A cross sectional study was conducted at El-Rahad hospital, Sudan to investigate seroprevalence of CMV and rubella infections and associated possible risk factors among pregnant women. Structured questionnaires were used to gather socio-demographic data and ELISA was used to detect CMV and rubella infections using IgG and IgM. RESULTS Out of 231 pregnant women, 167 (72.2%) and 151 (65.3%) were CMV-IgG and rubella-IgG positive, respectively. Only 6 (2.5%) and 8 women (3.4%) were CMV-IgM and rubella-IgM positive, respectively. While, high parity (OR = 14.7, 95%CI = 1.7 - 123.6; P = 0.01] and illiteracy (OR = 3.0, CI = 1.4 - 6.5; P = 0.004) were significantly associated with seropostive CMV-IgG in multivariate analysis, none of the other obstetrical and medical characteristics were significantly associated with CMV or rubella infections. CONCLUSION CMV prevalence was 72.2% and rubella susceptibility among pregnant women was 34.6%. Rubella vaccine and routine screening for rubella and CMV should be introduced for pregnant women in this setting. Further research is needed.
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Affiliation(s)
- Hamdan Z Hamdan
- Department of Biochemistry, Faculty of Medicine, Al-Neelain University, Khartoum, Sudan
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Diagnosis and screening for cytomegalovirus infection in pregnant women in Cuba as prognostic markers of congenital infection in newborns: 2007-2008. Pediatr Infect Dis J 2010; 29:1105-10. [PMID: 20622711 DOI: 10.1097/inf.0b013e3181eb7388] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Human cytomegalovirus (HCMV) has established itself as the most significant cause of congenital infection in the developed world. The objective of this research was prenatal identification of pregnant women at risk for developing active infection due to HCMV as well as to diagnose congenitally infected newborns. METHODS A diagnostic algorithm based on specific immunoglobulin G (IgG), IgM, and, IgG avidity was used to screen serum from 1131 pregnant women enrolled prospectively from 3 municipalities from Havana City, Cuba during 2007-2008. Qualitative multiplex nested PCR and quantitative real time-based PCR testing for HCMV DNA were performed on urine and saliva specimens from women detected with active infection and from their newborns. RESULTS Most women were seropositive to HCMV (92.7%), with 2.38% (27 women) having active infection. Primary infection was detected in 20 pregnant women (1.77%) while 7 patients (0.62%) had active nonprimary infection. HCMV DNA was detected in specimens from 9 of the 27 pregnant women by both PCR methods. HCMV congenital infection was diagnosed in 12 (1.06%) of the 26 live children born from 25 mothers with active infection, for a vertical transmission rate of 46.2%. Two fetal deaths were reported from 2 women with active infection; furthermore 2 newborns were symptomatic at birth and 2 showed sequelae during the follow-up done until 6 months age. CONCLUSIONS Mothers with active infection during the pregnancy and with HCMV excretion had significant risks, RR = 1.16 and RR = 1.35, respectively, to have congenitally infected children.
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