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Coste-Mazeau P, Hamon M, Ribot É, Hantz S, Alain S. [Implementation of screening for cytomegalovirus congenital infection in a French type 3 maternity]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2024; 52:403-409. [PMID: 38272182 DOI: 10.1016/j.gofs.2024.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 01/10/2024] [Accepted: 01/11/2024] [Indexed: 01/27/2024]
Abstract
OBJECTIVES Congenital cytomegalovirus (CMV) infection is the most common congenital infection and the leading cause of infectious neurosensorial disability in newborns. We wanted to organize the management of women from the beginning of pregnancy allowing access to antenatal treatment with valaciclovir, recognized since 2020 as limiting materno-fetal transmission. To this end, we set up and evaluated the interest of systematic screening for CMV infection in our maternity. We wanted to organize care for women from the very start of pregnancy. METHODS Retrospective and comparative descriptive study carried out at the CHRU de Limoges from July 2017 to December 2019 (targeted screening), then from January 2020 to June 2022, during which period we implemented systematized screening by iterative serologies at the 3rd, 6th, 8th months and before delivery. Our main evaluation criteria were the seroprevalence of CMV infection and the rate of congenital infection. We then described our cases of infection (primary or secondary) during pregnancy. RESULTS CMV seroprevalence in our pregnant women increased significantly from 52.7% (779/1478 women screened) to 58.4% (3852/6599 women screened) between the 2 study periods (P=0.04). We diagnosed 11 infections during the first part of the study vs. 27 during the second, with a significant increase in primary infections from 0.14% (9/6524 births) to 0.37% (24/6426 births) (P=0.008). Only 3 secondary infections were diagnosed during the second study period. The rate of congenital infections remained stable between the 2 study periods (6 children/6524=0.09% vs. 8 children/6426=0.12%; P=0.57). CONCLUSION Our results confirmed the interest of screening for CMV infection, while modifying the screening strategy we had initiated.
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Affiliation(s)
- Perrine Coste-Mazeau
- Service de gynécologie obstétrique, hôpital Mère-Enfant, CHRU de Limoges, 8, avenue Dominique-Larrey, 87000 Limoges, France; Inserm, RESINFIT, U 1092, université de Limoges, CHU de Limoges, 1, rue du Pr Descottes, 87000 Limoges, France; Service de virologie, Centre national de référence des Herpès virus, CHU de Limoges, 2, avenue Martin-Luther-King, 87000 Limoges, France.
| | - Magali Hamon
- Service de gynécologie obstétrique, hôpital Mère-Enfant, CHRU de Limoges, 8, avenue Dominique-Larrey, 87000 Limoges, France
| | - Élodie Ribot
- Service de virologie, Centre national de référence des Herpès virus, CHU de Limoges, 2, avenue Martin-Luther-King, 87000 Limoges, France
| | - Sébastien Hantz
- Inserm, RESINFIT, U 1092, université de Limoges, CHU de Limoges, 1, rue du Pr Descottes, 87000 Limoges, France; Service de virologie, Centre national de référence des Herpès virus, CHU de Limoges, 2, avenue Martin-Luther-King, 87000 Limoges, France
| | - Sophie Alain
- Inserm, RESINFIT, U 1092, université de Limoges, CHU de Limoges, 1, rue du Pr Descottes, 87000 Limoges, France; Service de virologie, Centre national de référence des Herpès virus, CHU de Limoges, 2, avenue Martin-Luther-King, 87000 Limoges, France.
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Payne H, Barnabas S. "Congenital cytomegalovirus in Sub-Saharan Africa-a narrative review with practice recommendations". Front Public Health 2024; 12:1359663. [PMID: 38813410 PMCID: PMC11134569 DOI: 10.3389/fpubh.2024.1359663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 04/24/2024] [Indexed: 05/31/2024] Open
Abstract
Cytomegalovirus (CMV) is the most common cause of congenital infection internationally, occurring in 0.67% of births, and increasingly recognised as a major public health burden due to the potential for long-term neurodevelopmental and hearing impairment. This burden includes estimates of 10% of childhood cerebral palsy and up to 25% of childhood deafness. In Sub-Saharan Africa, where CMV-seroprevalence is almost ubiquitous, prevalence of congenital CMV (cCMV) is higher than the global average, and yet there is a dearth of research and initiatives to improve recognition, diagnosis and treatment. This narrative review outlines the epidemiology and clinical presentation of cCMV, discusses issues of case identification and treatment in Sub-Saharan Africa, and recommends a framework of strategies to address these challenges. Considering the significant burden of cCMV disease in this setting, it is undoubtably time we embark upon improving diagnosis and care for these infants.
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Affiliation(s)
- Helen Payne
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, University of Stellenbosch, Cape Town, South Africa
- Section of Paediatric Infectious Disease, Imperial College London, London, United Kingdom
| | - Shaun Barnabas
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, University of Stellenbosch, Cape Town, South Africa
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Mocanu AG, Stoian DL, Daescu AMC, Motofelea AC, Ciohat IM, Navolan DB, Vilibic-Cavlek T, Bogdanic M, Nemescu D, Tomescu L, Carabineanu A. The Impact of Latent Cytomegalovirus Infection on Spontaneous Abortion History and Pregnancy Outcomes in Romanian Pregnant Women. Microorganisms 2024; 12:731. [PMID: 38674675 PMCID: PMC11052013 DOI: 10.3390/microorganisms12040731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 03/26/2024] [Accepted: 03/29/2024] [Indexed: 04/28/2024] Open
Abstract
Cytomegalovirus (CMV), a DNA virus that belongs to the Orthoherpesviridae family, infects 40-100% of people. Primary/non-primary CMV infection during pregnancy could cause fetal disabilities. After primary infection, CMV causes a latent infection and resides in cells of the myeloid compartment (CD34+, monocytes). Few studies have analyzed the impact of latent CMV infections on miscarriage history, pregnancy complications, and neonatal outcomes. METHODS Serum samples from 806 pregnant women (28.29 ± 4.50 years old) who came for a consultation at the Timisoara Clinical Emergency City Hospital between 2008 and 2010 were tested for anti-CMV IgM/IgG antibodies, and data about demography, obstetrical history, pregnancy complications, birth, and neonate were collected. The data were compared between the groups with and without latent CMV infection, and statistical significance was calculated. RESULTS We did not find a difference regarding cesarean section (OR = 0.916, p = 0.856), placental abruption (OR = 1.004, p = 1.00), pregnancy-induced hypertension rate (OR = 1.078, p = 1.00), secondary sex ratio (0.882, p = 0.857), APGAR score (p = 0.225), gestational age at birth (p = 0.434), or birth weight (p = 0.365). A borderline significant difference was found regarding the presence of miscarriage history: OR = 8.467, p = 0.051. CONCLUSIONS The presence of latent CMV infection does not affect the likelihood of complications in healthy women. A borderline significantly higher prevalence of miscarriage history was found in women with latent CMV infection.
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Affiliation(s)
- Adelina Geanina Mocanu
- Department of Obstetrics-Gynecology, Victor Babes University of Medicine and Pharmacy Timisoara, P-ta Eftimie Murgu nr. 2, 300041 Timisoara, Romania; (A.G.M.); (L.T.)
- Doctoral School, Victor Babes University of Medicine and Pharmacy Timisoara, P-ta Eftimie Murgu nr. 2, 300041 Timisoara, Romania
| | - Dana Liana Stoian
- Department of Endocrinology, Victor Babes University of Medicine and Pharmacy Timisoara, P-ta Eftimie Murgu nr. 2, 300041 Timisoara, Romania;
| | - Ana-Maria Cristina Daescu
- Department of Psychiatry, Victor Babes University of Medicine and Pharmacy Timisoara, P-ta Eftimie Murgu nr. 2, 300041 Timisoara, Romania;
| | - Alexandru Catalin Motofelea
- Department of Internal Medicine, Victor Babes University of Medicine and Pharmacy Timisoara, P-ta Eftimie Murgu nr. 2, 300041 Timisoara, Romania;
| | - Ioana Mihaela Ciohat
- Laboratory of Antenatal Medicine, Timisoara City Emergency Hospital, 300202 Timisoara, Romania;
| | - Dan Bogdan Navolan
- Department of Obstetrics-Gynecology, Victor Babes University of Medicine and Pharmacy Timisoara, P-ta Eftimie Murgu nr. 2, 300041 Timisoara, Romania; (A.G.M.); (L.T.)
| | - Tatjana Vilibic-Cavlek
- Department of Virology, Croatian Institute of Public Health, 10000 Zagreb, Croatia;
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Maja Bogdanic
- Department of Virology, Croatian Institute of Public Health, 10000 Zagreb, Croatia;
| | - Dragos Nemescu
- Department of Obstetrics-Gynecology, Gr. T. Popa University of Medicine and Pharmacy Iasi, Universitatiistr. nr. 16, 700115 Iasi, Romania;
| | - Larisa Tomescu
- Department of Obstetrics-Gynecology, Victor Babes University of Medicine and Pharmacy Timisoara, P-ta Eftimie Murgu nr. 2, 300041 Timisoara, Romania; (A.G.M.); (L.T.)
| | - Adrian Carabineanu
- Department of Surgery, Victor Babes University of Medicine and Pharmacy Timisoara, P-ta Eftimie Murgu nr. 2, 300041 Timisoara, Romania;
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Benou S, Hatzidaki E, Kalaintzi A, Grivea I, Baltogianni M, Giapros V, Thomaidou A, Sarafidis K, Tsichla S, Sinopidis X, Papachatzi E, Karatza A, Lagadinou M, Dassios T, Dimitriou G, Papaevangelou V, Gkentzi D. Knowledge and attitudes of medical students about clinical aspects of congenital cytomegalovirus infection in newborns: A nationwide cross-sectional study in Greece. Front Med (Lausanne) 2023; 10:1256704. [PMID: 38034533 PMCID: PMC10687632 DOI: 10.3389/fmed.2023.1256704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 10/30/2023] [Indexed: 12/02/2023] Open
Abstract
Introduction Cytomegalovirus (CMV) is the most frequent cause of congenital infection worldwide causing severe morbidity in newborns, infants, and children. Despite the clinical importance of congenital CMV (cCMV) infection, studies conducted so far indicate that there is limited awareness in the medical community in the field. The aim of this study was to assess Greek medical students' knowledge on cCMV infection. Methods We performed a questionnaire-based nationwide cross-sectional study. A convenience sample of medical students from seven medical schools was enrolled. Results Of the 562 respondents, 54,8% considered themselves undereducated on cCMV infection. However, almost half of the participants could correctly recognize some basic principles of cCMV infection including ways of transmission, diagnosis and treatment, while there were aspects of cCMV infection with knowledge deficit. The year of study had a positive impact on the level of knowledge with students of higher years of study being of more sufficient education on the specific topic. Conclusion Overall, our study indicates a discrepancy between self-reported awareness and the level of knowledge among medical students in Greece. Further educational opportunities about cCMV should be offered, particularly in areas of the curriculum involving the care of women and children. Establishing medical students' solid background on the disease burden and educating them about preventative strategies for at-risk populations, should be the main pillars of such efforts in order to promote confidence in managing these cases in their future professional careers.
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Affiliation(s)
| | - Eleftheria Hatzidaki
- Department of Neonatology/ NICU, School of Medicine, University of Crete, Heraklion, Greece
| | - Anna Kalaintzi
- Department of Paediatrics, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Ioanna Grivea
- Department of Paediatrics, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Maria Baltogianni
- Neonatal Intensive Care Unit, University of Ioannina, Faculty of Medicine, Ioannina, Greece
| | - Vasileios Giapros
- Neonatal Intensive Care Unit, University of Ioannina, Faculty of Medicine, Ioannina, Greece
| | - Agathi Thomaidou
- Department of Neonatology, School of Medicine, Aristotle University of Thessaloniki, Hippokrateion General Hospital, Thessaloniki, Greece
| | - Kosmas Sarafidis
- Department of Neonatology, School of Medicine, Aristotle University of Thessaloniki, Hippokrateion General Hospital, Thessaloniki, Greece
| | | | | | | | | | | | | | | | - Vassiliki Papaevangelou
- Third Department of Paediatrics, National and Kapodistrian University of Athens, School of Medicine, University General Hospital ATTIKON, Chaidari, Athens, Greece
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Boppana SB, van Boven M, Britt WJ, Gantt S, Griffiths PD, Grosse SD, Hyde TB, Lanzieri TM, Mussi-Pinhata MM, Pallas SE, Pinninti SG, Rawlinson WD, Ross SA, Vossen ACTM, Fowler KB. Vaccine value profile for cytomegalovirus. Vaccine 2023; 41 Suppl 2:S53-S75. [PMID: 37806805 DOI: 10.1016/j.vaccine.2023.06.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 04/28/2023] [Accepted: 06/02/2023] [Indexed: 10/10/2023]
Abstract
Cytomegalovirus (CMV) is the most common infectious cause of congenital malformation and a leading cause of developmental disabilities such as sensorineural hearing loss (SNHL), motor and cognitive deficits. The significant disease burden from congenital CMV infection (cCMV) led the US National Institute of Medicine to rank CMV vaccine development as the highest priority. An average of 6.7/1000 live births are affected by cCMV, but the prevalence varies across and within countries. In contrast to other congenital infections such as rubella and toxoplasmosis, the prevalence of cCMV increases with CMV seroprevalence rates in the population. The true global burden of cCMV disease is likely underestimated because most infected infants (85-90 %) have asymptomatic infection and are not identified. However, about 7-11 % of those with asymptomatic infection will develop SNHL throughout early childhood. Although no licensed CMV vaccine exists, several candidate vaccines are in development, including one currently in phase 3 trials. Licensure of one or more vaccine candidates is feasible within the next five years. Various models of CMV vaccine strategies employing different target populations have shown to provide substantial benefit in reducing cCMV. Although CMV can cause end-organ disease with significant morbidity and mortality in immunocompromised individuals, the focus of this vaccine value profile (VVP) is on preventing or reducing the cCMV disease burden. This CMV VVP provides a high-level, comprehensive assessment of the currently available data to inform the potential public health, economic, and societal value of CMV vaccines. The CMV VVP was developed by a working group of subject matter experts from academia, public health groups, policy organizations, and non-profit organizations. All contributors have extensive expertise on various elements of the CMV VVP and have described the state of knowledge and identified the current gaps. The VVP was developed using only existing and publicly available information.
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Affiliation(s)
- Suresh B Boppana
- Departments of Pediatrics and Microbiology, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Michiel van Boven
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, and Julius Center for Health Sciences and Primary Care, Department of Epidemiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - William J Britt
- Departments of Pediatrics, Microbiology, and Neurobiology, Heersink School of Medicine, University of Alabama at Birmingham, USA
| | - Soren Gantt
- Centre de recherche du CHU Sainte-Justine, Montréal, QC H3T 1C5, Canada
| | - Paul D Griffiths
- Emeritus Professor of Virology, University College London, United Kingdom
| | - Scott D Grosse
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA
| | - Terri B Hyde
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Tatiana M Lanzieri
- Measles, Rubella, and Cytomegalovirus Epidemiology Team, Viral Vaccine Preventable Diseases Branch / Division of Viral Diseases. National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Marisa M Mussi-Pinhata
- Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, Brazil
| | - Sarah E Pallas
- Global Immunization Division, Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA 30329-4027, USA
| | - Swetha G Pinninti
- Departments of Pediatrics and Microbiology, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - William D Rawlinson
- Serology and Virology Division, NSW Health Pathology Randwick, Prince of Wales Hospital, Sydney, Australia; School of Biotechnology and Biomolecular Sciences, and School of Medical Sciences, University of New South Wales, Sydney, Australia
| | - Shannon A Ross
- Departments of Pediatrics and Microbiology, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ann C T M Vossen
- Department of Medical Microbiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Karen B Fowler
- Departments of Pediatrics and Epidemiology, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
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Barry PA, Iyer SS, Gibson L. Re-Evaluating Human Cytomegalovirus Vaccine Design: Prediction of T Cell Epitopes. Vaccines (Basel) 2023; 11:1629. [PMID: 38005961 PMCID: PMC10674879 DOI: 10.3390/vaccines11111629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 10/05/2023] [Accepted: 10/09/2023] [Indexed: 11/26/2023] Open
Abstract
HCMV vaccine development has traditionally focused on viral antigens identified as key targets of neutralizing antibody (NAb) and/or T cell responses in healthy adults with chronic HCMV infection, such as glycoprotein B (gB), the glycoprotein H-anchored pentamer complex (PC), and the unique long 83 (UL83)-encoded phosphoprotein 65 (pp65). However, the protracted absence of a licensed HCMV vaccine that reduces the risk of infection in pregnancy regardless of serostatus warrants a systematic reassessment of assumptions informing vaccine design. To illustrate this imperative, we considered the hypothesis that HCMV proteins infrequently detected as targets of T cell responses may contain important vaccine antigens. Using an extant dataset from a T cell profiling study, we tested whether HCMV proteins recognized by only a small minority of participants encompass any T cell epitopes. Our analyses demonstrate a prominent skewing of T cell responses away from most viral proteins-although they contain robust predicted CD8 T cell epitopes-in favor of a more restricted set of proteins. Our findings raise the possibility that HCMV may benefit from evading the T cell recognition of certain key proteins and that, contrary to current vaccine design approaches, including them as vaccine antigens could effectively take advantage of this vulnerability.
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Affiliation(s)
- Peter A. Barry
- Department of Pathology and Laboratory Medicine, Center for Immunology and Infectious Diseases, University of California Davis School of Medicine, Sacramento, CA 95817, USA;
- California National Primate Research Center, University of California, Davis, CA 95616, USA
| | - Smita S. Iyer
- Department of Pathology, University of Pittsburgh, Pittsburgh, PA 15261, USA;
| | - Laura Gibson
- Departments of Medicine and of Pediatrics, Infectious Diseases and Immunology, University of Massachusetts Chan Medical School, Worcester, MA 01655, USA
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Han L, Li R, Xiong W, Hu Y, Wu J, Liu X, Nie H, Qin W, Ling L, Li M. Prevalence of preconception TORCH infections and its influential factors: evidence from over 2 million women with fertility desire in southern China. BMC Womens Health 2023; 23:425. [PMID: 37563634 PMCID: PMC10416474 DOI: 10.1186/s12905-023-02560-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 07/21/2023] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND TORCH (Toxoplasma gondii [TOX], Cytomegalovirus [CMV], Rubella virus [RV], and Herpes simplex virus [HSV]) represents pathogens known to traverse the maternal-fetal barrier and cause severe neonatal anomalies. We aimed to assess the prevalence of preconception TOX, CMV, and RV infections among women with fertility desire in southern China, and identify related risk factors. METHODS Data were obtained from a population-based cross-sectional study conducted as part of the National Free Preconception Health Examination Project. Women planning to conceive within the next 6 months in Guangdong Province were enrolled between 2014 and 2019. Information on sociodemographic, gynecological, and obstetric characteristics was collected. Sera were analyzed for TOX IgG, CMV IgG, and RV IgG antibodies using an enzyme-linked immunosorbent assay. Descriptive, univariate, and multivariate logistic regression analyses were performed to assess the association between TORCH infections and related factors. RESULTS Among 2,409,137 participants, the prevalence of IgG antibodies for TOX, CMV, and RV was 3.20% (95% CI: 3.18-3.22%), 77.67% (95% CI: 77.62-77.71%) and 76.03% (95% CI: 75.98-76.07%), respectively. Of all participants, 141,047 women (5.85%, 95% CI:5.83-5.88%) reported a history of immunization for RV. Women living in the Pearl River Delta, a more developed region, have significantly lower vaccination rates than those living in other regions. The seropositivity of TOX IgG was highest among women aged 35 years and above, with primary or lower education levels, and rural registration. Factors such as being older, having a higher educational level, and being of other ethnicities were associated with a higher prevalence of naturally acquired CMV and RV infections. Women living in the Pearl River Delta showed a higher risk of TOX, CMV, and RV infections, with aORs of 2.21, 4.45, and 1.76, respectively. A history of pregnancy, gynecological diseases, and sexually transmitted infections were potentially associated with TORCH infections, but this association varied across pathogens. CONCLUSION The findings of this study update the baseline of preconception TORCH infections among women with fertility desire in southern China, helping to estimate the risk of congenital infection and guide the development and implementation of effective prevention measures for preconception TORCH infections.
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Affiliation(s)
- Lu Han
- NHC Key Laboratory of Male Reproduction and Genetics, Guangdong Provincial Reproductive Science Institute (Guangdong Provincial Fertility Hospital), 510600, Guangzhou, China
| | - Rui Li
- Faculty of Medical Statistics, School of Public Health, Sun Yat-sen University, 510080, Guangzhou, Guangdong, China
| | - Wenxue Xiong
- Faculty of Medical Statistics, School of Public Health, Sun Yat-sen University, 510080, Guangzhou, Guangdong, China
| | - Yang Hu
- NHC Key Laboratory of Male Reproduction and Genetics, Guangdong Provincial Reproductive Science Institute (Guangdong Provincial Fertility Hospital), 510600, Guangzhou, China
| | - Jiabao Wu
- NHC Key Laboratory of Male Reproduction and Genetics, Guangdong Provincial Reproductive Science Institute (Guangdong Provincial Fertility Hospital), 510600, Guangzhou, China
| | - Xiaohua Liu
- NHC Key Laboratory of Male Reproduction and Genetics, Guangdong Provincial Reproductive Science Institute (Guangdong Provincial Fertility Hospital), 510600, Guangzhou, China
| | - Hua Nie
- NHC Key Laboratory of Male Reproduction and Genetics, Guangdong Provincial Reproductive Science Institute (Guangdong Provincial Fertility Hospital), 510600, Guangzhou, China
| | - Weibing Qin
- NHC Key Laboratory of Male Reproduction and Genetics, Guangdong Provincial Reproductive Science Institute (Guangdong Provincial Fertility Hospital), 510600, Guangzhou, China
| | - Li Ling
- Faculty of Medical Statistics, School of Public Health, Sun Yat-sen University, 510080, Guangzhou, Guangdong, China.
- Clinical research design division, Clinical research center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China.
| | - Mingzhen Li
- NHC Key Laboratory of Male Reproduction and Genetics, Guangdong Provincial Reproductive Science Institute (Guangdong Provincial Fertility Hospital), 510600, Guangzhou, China.
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Kalb S, Diaz-Decaro J, Tossonian H, Natenshon A, Panther L, Mansi J, Gibson L. A Qualitative Assessment of Clinical Practice Guidelines and Patterns for Congenital Cytomegalovirus in the United States. Int J Neonatal Screen 2023; 9:37. [PMID: 37489490 PMCID: PMC10366839 DOI: 10.3390/ijns9030037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 06/16/2023] [Accepted: 06/23/2023] [Indexed: 07/26/2023] Open
Abstract
Cytomegalovirus (CMV) infection during pregnancy may result in long-term health problems for children with congenital CMV (cCMV). Currently, no prevention or treatment interventions are approved by the Food and Drug Administration for a cCMV indication. Healthcare provider and public awareness is low, and formal clinical practice guidelines and local practice patterns vary. A pilot study of eight cCMV experts was performed using qualitative semi-structured interviews to better understand clinical practice guidelines and patterns in the United States. Results from participant interviews highlighted the need for better prenatal diagnostic techniques, broader neonatal screening opportunities, and more robust evidence supporting intervention strategies. Healthcare provider and public partnerships are essential for advancing cCMV guidelines and improving care delivery. Our results provide a preliminary knowledge base and framework for developing a consensus cCMV research agenda to address evidence gaps that limit the revision of clinical practice guidelines. The changes in clinical practice patterns that may arise as a result of further research have the potential to reduce risk during pregnancy and improve care for children with cCMV infection.
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Affiliation(s)
| | | | | | | | | | | | - Laura Gibson
- Departments of Medicine and of Pediatrics, UMass Chan Medical School, Worcester, MA 01655, USA
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Greye H, Wex T, Taneva E, Redlich A, Costa SD, Rissmann A. Cytomegalovirus seronegativity rate in pregnant women and primary cytomegalovirus infection during pregnancy in rural Germany. BMC Pregnancy Childbirth 2023; 23:299. [PMID: 37118680 PMCID: PMC10148470 DOI: 10.1186/s12884-023-05612-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 04/14/2023] [Indexed: 04/30/2023] Open
Abstract
BACKGROUND Congenital cytomegalovirus (CMV) infection is the most common congenital infection worldwide and one of the leading causes of congenital hearing loss in newborns. The aim of this study was to determine the seroprevalence rate for cytomegalovirus in pregnant women and the rate of CMV serological testing utilised during pregnancy in a rural region in Germany. METHODS Retrospective data on the prevalence of CMV IgG and IgM antibodies were obtained from 3,800 women, identified in the study group of 19,511 pregnant women from outpatient settings whose samples were collected between 1 and 2014 and 30 April 2018. In addition, the serological CMV status in regards to various billing methods was further analyzed. RESULTS Serological CMV tests were performed in 3,800 (19.5%) out of 19,511 pregnant women. 2,081 (54.8%) of these women were CMV seronegative. Among those, seroconversion rate of 0.37-1.42% was identified. A proportion of 2,710 (14.7%) of all 18,460 women with statutory health insurance made use of the CMV testing as an individual health service. CONCLUSIONS The low uptake of CMV serological testing in the study population covered indicates low risk awareness among pregnant women and their healthcare professionals. Presented seronegativity rates and routine seroconversion rate, demonstrate importance to improve intervention strategy to prevent feto-maternal CMV transmission.
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Affiliation(s)
- Hannah Greye
- Malformation Monitoring Centre Saxony-Anhalt, Medical Faculty Otto-von-Guericke-University, Leipziger Straße 44, D-39120, Magdeburg, Germany
| | - Thomas Wex
- Medical Laboratory for Clinical Chemistry, Microbiology, Infectious Diseases and Genetics "Prof. Schenk/Dr. Ansorge & Colleagues", Schwiesaustraße 11, D-39124, Magdeburg, Germany
| | - Elina Taneva
- Medical Laboratory for Clinical Chemistry, Microbiology, Infectious Diseases and Genetics "Prof. Schenk/Dr. Ansorge & Colleagues", Schwiesaustraße 11, D-39124, Magdeburg, Germany
| | - Anke Redlich
- Department of Obstetrics and Gynaecology, University Hospital Magdeburg, Gerhart-Hauptmann-Strasse 35, D-39108, Magdeburg, Germany
| | - Serban-Dan Costa
- Department of Obstetrics and Gynaecology, University Hospital Magdeburg, Gerhart-Hauptmann-Strasse 35, D-39108, Magdeburg, Germany
| | - Anke Rissmann
- Malformation Monitoring Centre Saxony-Anhalt, Medical Faculty Otto-von-Guericke-University, Leipziger Straße 44, D-39120, Magdeburg, Germany.
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Ben Shoham A, Schlesinger Y, Miskin I, Kalderon Z, Michelson-Cohen R, Wiener-Well Y. Cytomegalovirus (CMV) seroprevalence among women at childbearing age, maternal and congenital CMV infection: policy implications of a descriptive, retrospective, community-based study. Isr J Health Policy Res 2023; 12:16. [PMID: 37098565 PMCID: PMC10131385 DOI: 10.1186/s13584-023-00566-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 04/20/2023] [Indexed: 04/27/2023] Open
Abstract
BACKGROUND Maternal CMV infection during pregnancy, either primary or non-primary, may be associated with fetal infection and long-term sequelae. While guidelines recommend against it, screening for CMV in pregnant women is a prevalent clinical practice in Israel. Our aim is to provide updated, local, clinically relevant, epidemiological information about CMV seroprevalence among women at childbearing age, the incidence of maternal CMV infection during pregnancy and the prevalence of congenital CMV (cCMV), as well as to provide information about the yield of CMV serology testing. METHODS We performed a descriptive, retrospective study of women at childbearing age who were members of Clalit Health Services in the district of Jerusalem and had at least one gestation during the study period (2013-2019). We utilized serial serology tests to determine CMV serostatus at baseline and at pre/periconception and identified temporal changes in CMV serostatus. We then conducted a sub-sample analysis integrating inpatient data on newborns of women who gave birth in a single large medical center. cCMV was defined as either positive urine CMV-PCR test in a sample collected during the first 3 weeks of life, neonatal diagnosis of cCMV in the medical records, or prescription of valganciclovir during the neonatal period. RESULTS The study population Included 45,634 women with 84,110 associated gestational events. Initial CMV serostatus was positive in 89% women, with variation across different ethno-socioeconomic subgroups. Based on consecutive serology tests, the detected incidence rate of CMV infection was 2/1000 women follow-up years, among initially seropositive women, and 80/1000 women follow-up years, among initially seronegative women. CMV infection in pregnancy was identified among 0.2% of women who were seropositive at pre/periconception and among 10% of women who were seronegative. In a subsample, which included 31,191 associated gestational events, we identified 54 newborns with cCMV (1.9/1000 live births). The prevalence of cCMV among newborns of women who were seropositive at pre/periconception was lower than among newborns of women who were seronegative (2.1 vs. 7.1/1000). Frequent serology tests among women who were seronegative at pre/periconception detected most primary CMV infections in pregnancy that resulted in cCMV (21/24). However, among women who were seropositive, serology tests prior to birth detected none of the non-primary infections that resulted in cCMV (0/30). CONCLUSIONS In this retrospective community-based study among women of childbearing age characterized by multiparity and high seroprevalence of CMV, we find that consecutive CMV serology testing enabled to detect most primary CMV infections in pregnancy that led to cCMV in newborns but failed to detect non-primary CMV infections in pregnancy. Conducting CMV serology tests among seropositive women, despite guidelines' recommendations, has no clinical value, while it is costly and introduces further uncertainties and distress. We thus recommend against routine CMV serology testing among women who were seropositive in a prior serology test. We recommend CMV serology testing prior to pregnancy only among women known to be seronegative or women whose serology status is unknown.
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Affiliation(s)
- Assaf Ben Shoham
- Clalit Health Services, Yehuda Burla 26/28, 9371426, Jerusalem, Israel.
| | - Yechiel Schlesinger
- Wilf Children's Hospital, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ian Miskin
- Clalit Health Services, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ziva Kalderon
- Clalit Health Services, Yehuda Burla 26/28, 9371426, Jerusalem, Israel
| | - Rachel Michelson-Cohen
- Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Yonit Wiener-Well
- Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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Nuévalos M, García-Ríos E, Mancebo FJ, Martín-Martín C, Pérez-Romero P. Novel monoclonal antibody-based therapies: implications for the treatment and prevention of HCMV disease. Trends Microbiol 2023; 31:480-497. [PMID: 36624009 DOI: 10.1016/j.tim.2022.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 12/07/2022] [Accepted: 12/12/2022] [Indexed: 01/09/2023]
Abstract
Human cytomegalovirus (HCMV) is an important pathogen worldwide. Although HCMV infection is often asymptomatic in immunocompetent individuals, it can cause severe or even life-threatening symptoms in immunocompromised patients. Due to limitations of antiviral treatments, it is necessary to search for new therapeutic alternatives. Recent studies have highlighted the contribution of antibodies in protecting against HCMV disease, including neutralizing and non-neutralizing antibodies. Given the immunocompromised target population, monoclonal antibodies (mAbs) may represent an alternative to the clinical management of HCMV infection. In this context, we provide a synthesis of recent data revising the literature supporting and arguing about the role of the humoral immunity in controlling HCMV infection. Additionally, we review the state of the art in the development of therapies based on mAbs.
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Affiliation(s)
- Marcos Nuévalos
- National Center for Microbiology, Instituto de Salud Carlos III, Majadahonda, 28220 Madrid, Spain
| | - Estéfani García-Ríos
- National Center for Microbiology, Instituto de Salud Carlos III, Majadahonda, 28220 Madrid, Spain; Department of Science, Universidad Internacional de Valencia-VIU, 46002 Valencia, Spain.
| | - Francisco J Mancebo
- National Center for Microbiology, Instituto de Salud Carlos III, Majadahonda, 28220 Madrid, Spain
| | - Clara Martín-Martín
- National Center for Microbiology, Instituto de Salud Carlos III, Majadahonda, 28220 Madrid, Spain
| | - Pilar Pérez-Romero
- National Center for Microbiology, Instituto de Salud Carlos III, Majadahonda, 28220 Madrid, Spain.
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Greye H, Henning S, Freese K, Köhn A, Lux A, Radusch A, Redlich A, Schleef D, Seeger S, Thäle V, Rissmann A. Cross-sectional study to assess awareness of cytomegalovirus infection among pregnant women in Germany. BMC Pregnancy Childbirth 2022; 22:964. [PMID: 36566184 PMCID: PMC9789651 DOI: 10.1186/s12884-022-05312-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 12/19/2022] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Study aimed to assess awareness of congenital cytomegalovirus (CMV) infection and its determinants in pregnancy. METHODS Cross-sectional survey was conducted in five hospital-based maternity units in Germany. Pregnant women attending the maternity departments completed interviewer/self-administered survey questionnaire. High-risk group was defined according to contact with children under five years of age (at home or at work). Quantitative analyses using multivariable logistic regression were performed. RESULTS One thousand two hundred thirty-three pregnant women were included. 48.5% (n = 598) of women reported any knowledge about risk of CMV infection during pregnancy. CMV infection was less known than other infections or diseases (education about toxoplasmosis 95.5% (n = 1,177), listeriosis 60.5% (n = 746). 38% (n = 468) of participants received education about CMV. CMV awareness was associated with the level of education and employment in childcare or medical care. Only 32% (n = 394) of the women made use of serological screening for CMV during pregnancy (individual health service). 40.8% (n = 503) of pregnant women were classified as high-risk group. They had significantly higher knowledge and education about CMV, and msignificantlycant more often use of the serological screening. CONCLUSIONS Less than half of pregnant women surveyed were aware of potential risk associated with CMV infection during pregnancy. In our study,one-third third of pregnant women made use of the serological screening for CMV. Regarding the lack of current consensus on the role of serological CMV screening for pregnant women, hygiene preventive measures are the only evidence-based recommendation for pregnant women and knowledge increase could potentially have major public health impact.
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Affiliation(s)
- Hannah Greye
- grid.5807.a0000 0001 1018 4307Malformation Monitoring Centre Saxony-Anhalt, Medical Faculty Otto-Von-Guericke-University Magdeburg, Leipziger Straße 44, 39120 Magdeburg, Germany
| | - Stine Henning
- grid.5807.a0000 0001 1018 4307Malformation Monitoring Centre Saxony-Anhalt, Medical Faculty Otto-Von-Guericke-University Magdeburg, Leipziger Straße 44, 39120 Magdeburg, Germany
| | - Kristina Freese
- Department of Obstetrics and Gynaecology, St. Marienstift Hospital Magdeburg, Harsdorfer Straße 30, 39110 Magdeburg, Germany
| | - Andrea Köhn
- grid.5807.a0000 0001 1018 4307Malformation Monitoring Centre Saxony-Anhalt, Medical Faculty Otto-Von-Guericke-University Magdeburg, Leipziger Straße 44, 39120 Magdeburg, Germany
| | - Anke Lux
- grid.5807.a0000 0001 1018 4307Institute for Biometrics and Medical Informatics, Medical Faculty, Otto-Von-Guericke-University Magdeburg, Leipziger Straße 44, 39120 Magdeburg, Germany
| | - Anja Radusch
- Department of Gynaecology and Obstetrics, Perinatal Centre, St. Elisabeth and St. Barbara Halle, Mauerstraße 5, 06110 Halle (Saale), Germany
| | - Anke Redlich
- grid.5807.a0000 0001 1018 4307Department of Obstetrics and Gynaecology, Otto-Von-Guericke-University Magdeburg, Gerhart-Hauptmann-Straße 35, 39108 Magdeburg, Germany
| | - Daniela Schleef
- Department of Obstetrics and Gynecology, Hospital Magdeburg GmbH, Birkenallee 34, 39130 Magdeburg, Germany
| | - Sven Seeger
- Department of Gynaecology and Obstetrics, Perinatal Centre, St. Elisabeth and St. Barbara Halle, Mauerstraße 5, 06110 Halle (Saale), Germany
| | - Volker Thäle
- grid.9018.00000 0001 0679 2801Department of Obstetrics and Fetal Medicine, Martin Luther University Halle-Wittenberg, Ernst-Grube-Str. 40, 06120 Halle (Saale), Germany
| | - Anke Rissmann
- grid.5807.a0000 0001 1018 4307Malformation Monitoring Centre Saxony-Anhalt, Medical Faculty Otto-Von-Guericke-University Magdeburg, Leipziger Straße 44, 39120 Magdeburg, Germany
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Plotogea M, Isam AJ, Frincu F, Zgura A, Bacinschi X, Sandru F, Duta S, Petca RC, Edu A. An Overview of Cytomegalovirus Infection in Pregnancy. Diagnostics (Basel) 2022; 12:diagnostics12102429. [PMID: 36292118 PMCID: PMC9600407 DOI: 10.3390/diagnostics12102429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 09/22/2022] [Accepted: 10/03/2022] [Indexed: 11/16/2022] Open
Abstract
The objective of this review was to bring to attention cytomegalovirus (CMV) infection during pregnancy, taking into consideration all relevant aspects, such as maternal diagnosis, fetal infection and prevention, prenatal diagnosis, and postnatal prognosis. A literature review was performed regarding adult and congenital infection. General information regarding this viral infection and potential related medical conditions was provided, considering the issues of maternal infection during pregnancy, transmission to the fetus, and associated congenital infection management. Prenatal diagnosis includes maternal serum testing and the confirmation of the infection in amniotic fluid or fetal blood. Additionally, prenatal diagnosis requires imaging techniques, ultrasound, and complementary magnetic resonance to assess cortical and extracortical anomalies. Imaging findings can predict both fetal involvement and the postnatal prognosis of the newborn, but they are difficult to assess, even for highly trained physicians. In regard to fetal sequelae, the early diagnosis of a potential fetal infection is crucial, and methods to decrease fetal involvement should be considered. Postnatal evaluation is also important, because many newborns may be asymptomatic and clinical anomalies can be diagnosed when sequelae are permanent.
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Affiliation(s)
- Mihaela Plotogea
- Department of Obstetrics and Gynecology, “Nicolae Malaxa” Clinical Hospital, 022441 Bucharest, Romania
| | - Al Jashi Isam
- Faculty of Medicine, “Titu Maiorescu” University, 031593 Bucharest, Romania
- Correspondence: (A.J.I.); (F.F.)
| | - Francesca Frincu
- Department of Obstetrics and Gynecology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Correspondence: (A.J.I.); (F.F.)
| | - Anca Zgura
- Department of Obstetrics and Gynecology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Xenia Bacinschi
- Department of Obstetrics and Gynecology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Florica Sandru
- Department of Obstetrics and Gynecology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Simona Duta
- Department of Obstetrics and Gynecology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Razvan Cosmin Petca
- Department of Obstetrics and Gynecology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Antoine Edu
- Department of Obstetrics and Gynecology, “Nicolae Malaxa” Clinical Hospital, 022441 Bucharest, Romania
- Department of Obstetrics and Gynecology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
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The Impact of Latent Toxoplasma gondii Infection on Spontaneous Abortion History and Pregnancy Outcomes: A Large-Scale Study. Microorganisms 2022; 10:microorganisms10101944. [PMID: 36296220 PMCID: PMC9610914 DOI: 10.3390/microorganisms10101944] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 09/23/2022] [Accepted: 09/26/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Toxoplasma gondii (TG), a zoonotic protozoan parasite, belongs to a group of TORCH infectious agents, which can cause severe damage to the fetus if a primary infection occurs during pregnancy. After primary infection, TG rests lifelong in human organisms causing a latent infection. Most studies have analyzed the consequences of acute, but not latent, TG infection. This study analyzed the impact of latent toxoplasmosis on spontaneous abortion history, pregnancy complication rate and neonatal outcome. METHODS IgG and IgM anti-TG antibodies were tested in 806 pregnant women who were consulted at the Timisoara Clinical Emergency Hospital between 2008 and 2010. Demographic data, obstetrical history, and data about the pregnancy complications, birth and neonate were collected for each woman and comparisons between the groups, with and without latent TG infection, were made. RESULTS This study did not show differences between groups regarding the history of spontaneous abortion (OR = 1.288, p = 0.333), cesarean section (OR = 1.021, p = 0.884), placental abruption (OR 0.995, p = 0.266), pregnancy-induced hypertension rate (OR 1.083, p = 0.846), secondary sex ratio (1.043, p = 0.776), 1' APGAR score at birth (p = 0.544), gestational age at birth (p = 0.491) or birth weight (p = 0.257). CONCLUSIONS The observed differences between the rate of pregnancy complications in the two groups of pregnant women with and without latent infection with TG, did not reach a statistical significance.
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Prevalence of congenital cytomegalovirus infection in preterm, small for gestational age and low birth weight newborns: characteristics and cytokines profile. World J Pediatr 2022; 18:498-504. [PMID: 35503595 DOI: 10.1007/s12519-022-00551-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 03/31/2022] [Indexed: 10/18/2022]
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Niu J, Wang Z, Liu L, Zhang X, Niu D, Liu T, Qiao H, Lu R, Nan F, Tian Z, Wang B. Human cytomegalovirus IE2 may impair the cognitive ability of the hippocampus through the GluNRs/CaMKIIα/CREB signaling pathway in the Rosa26-LSL-IE2/Cre mouse. Behav Brain Res 2022; 419:113683. [PMID: 34838933 DOI: 10.1016/j.bbr.2021.113683] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 10/19/2021] [Accepted: 11/20/2021] [Indexed: 11/02/2022]
Abstract
Nowadays, there are few studies in vivo to explore the effects of Human Cytomegalovirus (HCMV) single gene such as immediate early protein 2 (IE2) on the nervous system, let alone the mechanism that IE2 causes cognitive impairment. In this study, the Rosa26-LSL-IE2/Cre mouse was used to show the effects of IE2 on the cognitive ability and the GluNRs/CaMKIIα/CREB signaling pathway in the hippocampus. We divided the mice into experimental and control groups based on the results of PCR firstly. After that, the cognitive abilities of the two groups were compared through new object recognition (NOR) and Morris water maze (MWM) tests. The results of the behavioral tests showed that the cognitive ability of the experimental mice was lower than that of the control group. It is known that changes in the expression levels of N-methyl D-aspartate receptor 1, 2A, and 2B (GluN1, GluN2A, GluN2B) affect synaptic plasticity and cause cognitive changes. Finally, we analyzed the expression levels of GluN1, GluN2A, GluN2B, and related signaling pathway molecules by qPCR and western blot. We found that the expression levels of the GluNRs/CaMKIIα/CREB signaling pathway were decreased in the experimental group. These results indicated that IE2 could affect the expression levels of GluNRs/CaMKIIα/CREB signaling pathway, which was closely related to the cognitive impairment of the experimental group. In summary, we used this novel mouse model to show that IE2 could cause cognitive impairment in the hippocampus, which might be related to the GluNRs/CaMKIIα/CREB signaling pathway. It is helpful to further understand the mechanism of the cognitive impairment induced by HCMV IE2.
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Affiliation(s)
- Junyun Niu
- Department of Pathogenic Biology, School of Basic Medicine, Qingdao University, Qingdao 266071, Shandong, PR China
| | - Zhifei Wang
- Department of Pathogenic Biology, School of Basic Medicine, Qingdao University, Qingdao 266071, Shandong, PR China
| | - Lili Liu
- Department of Pathogenic Biology, School of Basic Medicine, Qingdao University, Qingdao 266071, Shandong, PR China
| | - Xianjuan Zhang
- Department of Pathogenic Biology, School of Basic Medicine, Qingdao University, Qingdao 266071, Shandong, PR China
| | - Delei Niu
- Department of Pathogenic Biology, School of Basic Medicine, Qingdao University, Qingdao 266071, Shandong, PR China
| | - Ting Liu
- Department of Gastroenterology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, PR China
| | - Hongye Qiao
- Department of Pathogenic Biology, School of Basic Medicine, Qingdao University, Qingdao 266071, Shandong, PR China
| | - Ran Lu
- Department of Pathogenic Biology, School of Basic Medicine, Qingdao University, Qingdao 266071, Shandong, PR China
| | - Fulong Nan
- Department of Pathogenic Biology, School of Basic Medicine, Qingdao University, Qingdao 266071, Shandong, PR China
| | - Zibin Tian
- Department of Gastroenterology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, PR China.
| | - Bin Wang
- Department of Pathogenic Biology, School of Basic Medicine, Qingdao University, Qingdao 266071, Shandong, PR China.
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Hehnly C, Ssentongo P, Bebell LM, Burgoine K, Bazira J, Fronterre C, Kumbakumba E, Mulondo R, Mbabazi-Kabachelor E, Morton SU, Ngonzi J, Ochora M, Olupot-Olupot P, Mugamba J, Onen J, Roberts DJ, Sheldon K, Sinnar SA, Smith J, Ssenyonga P, Kiwanuka J, Paulson JN, Meier FA, Ericson JE, Broach JR, Schiff SJ. Cytomegalovirus infections in infants in Uganda: Newborn-mother pairs, neonates with sepsis, and infants with hydrocephalus. Int J Infect Dis 2022; 118:24-33. [PMID: 35150915 PMCID: PMC9058984 DOI: 10.1016/j.ijid.2022.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 01/30/2022] [Accepted: 02/04/2022] [Indexed: 11/24/2022] Open
Abstract
Objectives: To estimate the prevalence of cytomegalovirus (CMV) infections among newborn-mother pairs, neonates with sepsis, and infants with hydrocephalus in Uganda. Design and Methods: Three populations—newborn-mother pairs, neonates with sepsis, and infants (≤3 months) with nonpostinfectious (NPIH) or postinfectious (PIH) hydrocephalus—were evaluated for CMV infection at 3 medical centers in Uganda. Quantitative PCR (qPCR) was used to characterize the prevalence of CMV. Results: The overall CMV prevalence in 2498 samples across all groups was 9%. In newborn-mother pairs, there was a 3% prevalence of cord blood CMV positivity and 33% prevalence of maternal vaginal shedding. In neonates with clinical sepsis, there was a 2% CMV prevalence. Maternal HIV seropositivity (adjusted odds ratio [aOR] 25.20; 95% confidence interval [CI] 4.43–134.26; p = 0.0001), residence in eastern Uganda (aOR 11.06; 95% CI 2.30–76.18; p = 0.003), maternal age < 25 years (aOR 4.54; 95% CI 1.40–19.29; p = 0.02), and increasing neonatal age (aOR 1.08 for each day older; 95% CI 1.00–1.16; p = 0.05), were associated risk factors for CMV in neonates with clinical sepsis. We found a 2-fold higher maternal vaginal shedding in eastern (45%) vs western (22%) Uganda during parturition (n = 22/49 vs 11/50, the Fisher exact test; p = 0.02). In infants with PIH, the prevalence in blood was 24% and in infants with NPIH, it was 20%. CMV was present in the cerebrospinal fluid (CSF) of 13% of infants with PIH compared with 0.5% of infants with NPIH (n = 26/205 vs 1/194, p < 0.0001). Conclusions: Our findings highlight that congenital and postnatal CMV prevalence is substantial in this African setting, and the long-term consequences are uncharacterized.
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Affiliation(s)
- Christine Hehnly
- Institute for Personalized Medicine, Department of Biochemistry and Molecular Biology, The Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Paddy Ssentongo
- Center for Neural Engineering, Department of Engineering Science and Mechanics, The Pennsylvania State University, University Park, PA, USA; Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Lisa M Bebell
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Kathy Burgoine
- Neonatal Unit, Department of Paediatrics and Child Health, Mbale Regional Referral Hospital, Mbale, Uganda; Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom; Mbale Clinical Research Institute, Mbale Regional Referral Hospital, Mbale, Uganda
| | - Joel Bazira
- Department of Microbiology, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Claudio Fronterre
- Centre for Health Informatics, Computing, and Statistics, Lancaster University, Lancaster, United Kingdom
| | - Elias Kumbakumba
- Department of Pediatrics, Mbarara University of Science and Technology, Mbarara, Uganda
| | | | | | - Sarah U Morton
- Division of Newborn Medicine, Boston Children's Hospital and Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Joseph Ngonzi
- Department of Obstetrics and Gynaecology, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Moses Ochora
- Centre for Health Informatics, Computing, and Statistics, Lancaster University, Lancaster, United Kingdom
| | - Peter Olupot-Olupot
- Mbale Clinical Research Institute, Mbale Regional Referral Hospital, Mbale, Uganda; Busitema University, Busitema, Uganda
| | - John Mugamba
- CURE Children's Hospital of Uganda, Mbale, Uganda
| | - Justin Onen
- Mulago National Referral Hospital, Kampala, Uganda
| | - Drucilla J Roberts
- Department of Pathology, Massachusetts General Hospital, Boston, and Harvard Medical School, Boston, MA, USA
| | - Kathryn Sheldon
- Institute for Personalized Medicine, Department of Biochemistry and Molecular Biology, The Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Shamim A Sinnar
- Department of Medicine, The Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Jasmine Smith
- Institute for Personalized Medicine, Department of Biochemistry and Molecular Biology, The Pennsylvania State University College of Medicine, Hershey, PA, USA
| | | | - Julius Kiwanuka
- Department of Pediatrics, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Joseph N Paulson
- Department of Biostatistics, Product Development, Genentech Inc., San Francisco, CA, USA
| | | | - Jessica E Ericson
- Division of Pediatric Infectious Disease, The Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - James R Broach
- Institute for Personalized Medicine, Department of Biochemistry and Molecular Biology, The Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Steven J Schiff
- Center for Neural Engineering, Department of Engineering Science and Mechanics, The Pennsylvania State University, University Park, PA, USA; Center for Infectious Disease Dynamics, and Department of Physics, The Pennsylvania State University, University Park, PA, USA.
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Mahallawi W, Khabour OF, Al-Saedi A, Almuzaini Z, Ibrahim N. Human Cytomegalovirus Seroprevalence Among Blood Donors in the Madinah Region, Saudi Arabia. Cureus 2022; 14:e21860. [PMID: 35265404 PMCID: PMC8897812 DOI: 10.7759/cureus.21860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2022] [Indexed: 12/03/2022] Open
Abstract
Background and objective Human cytomegalovirus (HCMV), a double-stranded DNA virus of the Herpesviridae family, can remain latent for long periods of time. HCMV may cause severe illness in immunocompromised patients and is associated with congenital anomalies. This study aimed to determine the anti-HCMV immunoglobulin G (IgG) and IgM antibody seroprevalence among blood-donating Saudi men in the Madinah region. Methods A total of 375 blood-donating Saudi men were recruited from the Central Blood Bank in Madinah, the Kingdom of Saudi Arabia (KSA), and stratified into three age groups: 18-30, 31-40, and 41-61 years. Anti-HCMV IgG and IgM antibody levels were measured by enzyme-linked immunosorbent assay (ELISA). Pearson’s correlation coefficient was used to correlate antibody levels with variables. Results Most of the tested samples (95.73%, n=356) were positive for anti-HCMV IgG antibodies, but only 1.6% (n=6) were positive for both IgM and IgG antibodies, and all of them belonged to the age groups of 31-40 and 41-61 years. A strong inverse correlation was found between anti-HCMV IgG antibody levels and age (r=−0.51, p<0.0001). Additionally, there was an inverse correlation between anti-HCMV IgG antibody levels and body mass index (BMI) (r=−0.11, p=0.036). No correlations were found between anti-HCMV IgG levels and hemoglobin levels or blood groups of the participants. Conclusions Blood-donating Saudi men in Madinah had a high seroprevalence of anti-HCMV IgG antibodies, indicating previous viral exposure. Age and BMI might influence the humoral immunologic memory response against HCMV, which appears to be endemic in Madinah.
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Zenebe MH, Mekonnen Z, Loha E, Padalko E. Seroprevalence and associated factors of maternal cytomegalovirus in Southern Ethiopia: a cross-sectional study. BMJ Open 2021; 11:e051390. [PMID: 34675017 PMCID: PMC8532544 DOI: 10.1136/bmjopen-2021-051390] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES The aim of this study was to assess the seroprevalence and associated factors of cytomegalovirus (CMV) among pregnant women in Southern Ethiopia. DESIGN Cross-sectional study. SETTING The study was conducted in Hawassa University comprehensive and specialised hospital. Hawassa, Southern Ethiopia. PARTICIPANTS A total of 600 consecutive pregnant women attending the delivery ward were recruited for the study from August to October 2020. OUTCOME MEASURES The study assessed the rate of maternal anti-CMV IgG and IgM antibodies. The association of obstetric history, sociodemographic and behavioural characteristics with seropositivity of CMV was also evaluated based on the collected data using structured questioners. RESULTS Seropositivity for CMV IgM antibodies was 8.2% (49/600) (95% CI 6% to 10.5%), whereas the CMV IgG was 88.7% (532/600), (95% CI 89.5% to 94.0%). Seroprevalence of CMV IgM was higher in women of older age, currently unmarried, having nursery schooled children and with any of the detected curable sexually transmitted infections, while seroprevalence of CMV IgG was significantly associated only with women having nursery schooled children. Seroprevalence was not significantly associated with previous adverse pregnancy outcome, gravidity, being a child daycare occupant mother and newborn birth weight. CONCLUSION In the present study, we identified a high rate of CMV IgM and CMV IgG seroprevalence among pregnant women in Southern Ethiopia. Given that there is no existing CMV diagnosis, special attention should be designed to pregnant women in parallel to the existing antenatal care facility. Besides, training healthcare professionals will support awareness conception among pregnant women concerning the sequels of CMV infection during pregnancy.
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Affiliation(s)
- Mengistu Hailemariam Zenebe
- Medical Laboratory Sciences, Hawassa University College of Medicine and Health Sciences, Hawassa, South Ethiopia, Ethiopia
- Department of Diagnostic Sciences, Ghent University Faculty of Medicine and Health Sciences, Gent, Belgium
- Medical Laboratory Sciences, Jimma University Institute of Health, Jimma, Ethiopia
| | - Zeleke Mekonnen
- Medical Laboratory Sciences, Jimma University Institute of Health, Jimma, Ethiopia
| | - Eskindir Loha
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Chr Michelson Institute, Bergen, Norway
| | - Elizaveta Padalko
- Department of Diagnostic Sciences, Ghent University Hospital, Ghent, Belgium
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20
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Zhou Q, Wang Q, Shen H, Zhang Y, Zhang S, Li X, Acharya G. Seroprevalence of Cytomegalovirus and Associated Factors Among Preconception Women: A Cross-Sectional Nationwide Study in China. Front Public Health 2021; 9:631411. [PMID: 34513776 PMCID: PMC8425481 DOI: 10.3389/fpubh.2021.631411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 07/26/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Cytomegalovirus seroconversion during pregnancy is common and has a substantial risk of congenital infection with longterm sequale. Screening during pregnancy or vaccination have not been shown to be effective for eliminating congenital infections. Preconception screening policy has not been evaluated adequately in a large scale. This nationwide study aimed to investigate epidemiological features of cytomegalovirus seropositivity and its geographic variation among Chinese women planning a pregnancy to gather epidemiological evidence as an essential for developing novel prevention strategies. Method: This cross-sectional sero-epidemiological survey enrolled women intending to become pregnant within 6 months in mainland China during 2010-2012. The primary outcomes in this study were cytomegalovirus Immunoglobulin G and M seropositivity. Secondary outcomes were the associations between Immunoglobulin G and Immunoglobulin M, with socio-demographic characteristics, including age, occupation, education level, place of residence, and ethnicity. The overall seropositivity and regional disparity was analyzed on the individual and regional level, respectively. Results: This study included data from 1,564,649 women from 31 provinces in mainland China. Among participants, 38.6% (n = 603,511) were cytomegalovirus immunoglobulin G+, 0.4% (n = 6,747) were immunoglobulin M+, and 0.2% (n = 2,879) were immunoglobulin M+ and immunoglobulin G+. On individual level, participant's age, ethnicity, and residing region were significantly associated with IgG+, IgM+, and IgM+IgG+ (P < 0.001), while occupation, education level, and place of residence were not statistically significant (P > 0.05). On regional level, cytomegalovirus immunoglobulin G and immunoglobulin M seropositivity was highest in the eastern region (49.5 and 0.5%, respectively), and lowest in the western region (26.9 and 0.4%, respectively). This geographic variation was also noted at the provincial level, characterized by higher provincial immunoglobulin M+ and immunoglobulin G+ rates associated with higher immunoglobulin G seropositivity. In the subgroup analysis of immunoglobulin G seropositivity, areas of higher immunoglobulin G positivity had a higher rate of immunoglobulin M+, indicating an expected increased risk of reinfection and primary infection. Conclusions: A substantial proportion of women (>60%) were susceptible to cytomegalovirus in preconception period in China, and immunoglobulin G seropositivity was seen at a low-medium level with substantial geographic variation. Integration of cytomegalovirus antibody testing in preconception screening program based on regional immunoglobulin G seropositivity, should be considered to promote strategies directed toward preventing sero-conversion during pregnancy to reduce the risk of this congenital infection.
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Affiliation(s)
- Qiongjie Zhou
- Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China.,Women's Health and Perinatology Research Group, Department of Clinical Medicine, UiT - The Arctic University of Norway, Tromsø, Norway
| | - Qiaomei Wang
- Department of Maternal and Child Health, National Health and Family Planning Commission of the People's Republic of China, Beijing, China
| | - Haiping Shen
- Department of Maternal and Child Health, National Health and Family Planning Commission of the People's Republic of China, Beijing, China
| | - Yiping Zhang
- Department of Maternal and Child Health, National Health and Family Planning Commission of the People's Republic of China, Beijing, China
| | - Shikun Zhang
- Department of Maternal and Child Health, National Health and Family Planning Commission of the People's Republic of China, Beijing, China
| | - Xiaotian Li
- Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China.,Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Shanghai, China
| | - Ganesh Acharya
- Women's Health and Perinatology Research Group, Department of Clinical Medicine, UiT - The Arctic University of Norway, Tromsø, Norway.,Department of Clinical Science, Intervention and Technology (CLINTEC), Division of Obstetrics and Gynecology, Karolinska Institute, Stockholm, Sweden
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21
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Ross SA, Kimberlin D. Clinical outcome and the role of antivirals in congenital cytomegalovirus infection. Antiviral Res 2021; 191:105083. [PMID: 33964331 DOI: 10.1016/j.antiviral.2021.105083] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 04/22/2021] [Accepted: 04/27/2021] [Indexed: 11/15/2022]
Abstract
Congenital cytomegalovirus (cCMV) infection is a leading cause of hearing loss and neurological disabilities in children worldwide. Although a minority of infants with cCMV will have symptoms at a birth, these children are at high risk of long-term sequelae. Most infants with cCMV have no clinical signs at birth (asymptomatic), but 10-15% will develop hearing loss. The diagnosis of cCMV relies on detection of the virus from urine or saliva within the first three weeks of life, with saliva PCR being the preferred method due to ease of collection and high sensitivity of the assay. Measures to prevent mother-to-child transmission of CMV are limited, and antiviral therapy with valganciclovir for 6 months is the standard of care for infants with symptomatic cCMV. As more infants with cCMV are being identified through newborn screening, studies are urgently needed to address antiviral treatment in asymptomatic infants and the implementation of prevention strategies to prevent fetal infection. This article is part of the symposium "New drugs and vaccines for DNA virus infections: a symposium in memory of Mark Prichard."
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Affiliation(s)
- Shannon A Ross
- Departments of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA; Departments of Microbiology, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - David Kimberlin
- Departments of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA
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22
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Guo X, Wang H, You R, Tang J, Wang J, Song Q, Huang Y, Zhang X, Zhang S, Li T, Ge S, Wu T, Zhang J, Xia N. Elimination of human cytomegalovirus DNA degradation in urine. J Med Virol 2021; 93:5033-5039. [PMID: 33942328 DOI: 10.1002/jmv.27035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 04/13/2021] [Accepted: 04/16/2021] [Indexed: 11/10/2022]
Abstract
Congenital cytomegalovirus infection (cCMVi) is an important cause of sensorineural hearing loss in newborns. Detection of human cytomegalovirus (HCMV) DNA in urine has been used to screen for cCMVi in newborns. However, the matrix effect of urine on HCMV DNA detection is unclear. To evaluate the matrix effect of urine on HCMV DNA detection and optimize the sample process strategy to eliminate or minimize the impact of urine on HCMV DNA detection, DNA in spiked samples was extracted using different DNA extraction methods, and urine samples that could inhibit HCMV DNA detection were mixed to evaluate the inhibitory substances, inhibitory mechanism, and elimination of the inhibitory effect. The optimal urine sample process strategy was evaluated using 42 adult female urine samples and 42 newborn urine samples spiked with HCMV. Some urine samples were found to inhibit HCMV DNA detection due to DNA degradation. The addition of ≥5 mM EDTA to the urine before extraction eliminated the inhibitory effect of urine and did not affect the detection results of urine exhibiting no inhibition. Of the 42 adult female and 42 newborn urine samples, four and two samples, respectively, could inhibit HCMV DNA detection. However, the inhibitory effects of these six urine samples were eliminated after the addition of EDTA. The collective results indicate that the addition of EDTA can completely eliminate the impact of inhibitors present in urine on HCMV DNA extraction and improve the detection of HCMV in urine.
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Affiliation(s)
- Xiaoyi Guo
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Collaborative Innovation Centers of Biological Products, School of Life Science and School of Public Health, Xiamen University, Xiamen, Fujian, China
| | - Han Wang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Collaborative Innovation Centers of Biological Products, School of Life Science and School of Public Health, Xiamen University, Xiamen, Fujian, China
| | - Ruilan You
- The Clinical Laboratory of Xiamen International Travel Healthcare Center, Xiamen, Fujian, China
| | - Jiabao Tang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Collaborative Innovation Centers of Biological Products, School of Life Science and School of Public Health, Xiamen University, Xiamen, Fujian, China
| | - Jin Wang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Collaborative Innovation Centers of Biological Products, School of Life Science and School of Public Health, Xiamen University, Xiamen, Fujian, China
| | - Qiaoqiao Song
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Collaborative Innovation Centers of Biological Products, School of Life Science and School of Public Health, Xiamen University, Xiamen, Fujian, China
| | - Yue Huang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Collaborative Innovation Centers of Biological Products, School of Life Science and School of Public Health, Xiamen University, Xiamen, Fujian, China
| | - Xuejie Zhang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Collaborative Innovation Centers of Biological Products, School of Life Science and School of Public Health, Xiamen University, Xiamen, Fujian, China
| | - Shiyin Zhang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Collaborative Innovation Centers of Biological Products, School of Life Science and School of Public Health, Xiamen University, Xiamen, Fujian, China
| | - Tingdong Li
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Collaborative Innovation Centers of Biological Products, School of Life Science and School of Public Health, Xiamen University, Xiamen, Fujian, China
| | - Shengxiang Ge
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Collaborative Innovation Centers of Biological Products, School of Life Science and School of Public Health, Xiamen University, Xiamen, Fujian, China
| | - Ting Wu
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Collaborative Innovation Centers of Biological Products, School of Life Science and School of Public Health, Xiamen University, Xiamen, Fujian, China
| | - Jun Zhang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Collaborative Innovation Centers of Biological Products, School of Life Science and School of Public Health, Xiamen University, Xiamen, Fujian, China
| | - Ningshao Xia
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Collaborative Innovation Centers of Biological Products, School of Life Science and School of Public Health, Xiamen University, Xiamen, Fujian, China.,The Research Unit of Frontier Technology of Structural Vaccinology of Chinese Academy of Medical Sciences, Beijing, China
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23
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Boppana SB, Britt WJ. Recent Approaches and Strategies in the Generation of Anti-human Cytomegalovirus Vaccines. Methods Mol Biol 2021; 2244:403-463. [PMID: 33555597 DOI: 10.1007/978-1-0716-1111-1_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Human cytomegalovirus is the largest human herpesvirus and shares many core features of other herpesviruses such as tightly regulated gene expression during genome replication and latency as well as the establishment of lifelong persistence following infection. In contrast to stereotypic clinical syndromes associated with alpha-herpesvirus infections, almost all primary HCMV infections are asymptomatic and acquired early in life in most populations in the world. Although asymptomatic in most individuals, HCMV is a major cause of disease in hosts with deficits in adaptive and innate immunity such as infants who are infected in utero and allograft recipients following transplantation. Congenital HCMV is a commonly acquired infection in the developing fetus that can result in a number of neurodevelopmental abnormalities. Similarly, HCMV is a major cause of disease in allograft recipients in the immediate and late posttransplant period and is thought to be a major contributor to chronic allograft rejection. Even though HCMV induces robust innate and adaptive immune responses, it also encodes a vast array of immune evasion functions that are thought aid in its persistence. Immune correlates of protective immunity that prevent or modify intrauterine HCMV infection remain incompletely defined but are thought to consist primarily of adaptive responses in the pregnant mother, thus making congenital HCMV a potentially vaccine modifiable disease. Similarly, HCMV infection in allograft recipients is often more severe in recipients without preexisting adaptive immunity to HCMV. Thus, there has been a considerable effort to modify HCMV specific immunity in transplant recipient either through active immunization or passive transfer of adaptive effector functions. Although efforts to develop an efficacious vaccine and/or passive immunotherapy to limit HCMV disease have been underway for nearly six decades, most have met with limited success at best. In contrast to previous efforts, current HCMV vaccine development has relied on observations of unique properties of HCMV in hopes of reproducing immune responses that at a minimum will be similar to that following natural infection. However, more recent findings have suggested that immunity following naturally acquired HCMV infection may have limited protective activity and almost certainly, is not sterilizing. Such observations suggest that either the induction of natural immunity must be specifically tailored to generate protective activity or alternatively, that providing targeted passive immunity to susceptible populations could be prove to be more efficacious.
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Affiliation(s)
- Suresh B Boppana
- Departments of Pediatrics, The University of Alabama at Birmingham, Birmingham, AL, USA.,Departments of Microbiology, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - William J Britt
- Departments of Pediatrics, The University of Alabama at Birmingham, Birmingham, AL, USA. .,Departments of Microbiology, The University of Alabama at Birmingham, Birmingham, AL, USA. .,Departments of Neurobiology, The University of Alabama at Birmingham, Birmingham, AL, USA.
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