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Lantos PM, Gantt S, Janko M, Dionne F, Permar SR, Fowler K. A Geographically Weighted Cost-effectiveness Analysis of Newborn Cytomegalovirus Screening. Open Forum Infect Dis 2024; 11:ofae311. [PMID: 38933739 PMCID: PMC11200186 DOI: 10.1093/ofid/ofae311] [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: 04/05/2024] [Accepted: 06/05/2024] [Indexed: 06/28/2024] Open
Abstract
Background Early identification of newborns with congenital cytomegalovirus (CMV) is necessary to provide antiviral therapy and other interventions that can improve outcomes. Prior research demonstrates that universal newborn CMV screening would be the most cost-effective approach to identifying newborns who are infected. CMV is not uniformly prevalent, and it is uncertain whether universal screening would remain cost-effective in lower-prevalence neighborhoods. Our aim was to identify geographic heterogeneity in the cost-effectiveness of universal newborn CMV screening by combining a geospatial analysis with a preexisting cost-effectiveness analysis. Methods This study used the CMV testing results and zip code location data of 96 785 newborns in 7 metropolitan areas who had been tested for CMV as part of the CMV and Hearing Multicenter Screening study. A hierarchical bayesian generalized additive model was constructed to evaluate geographic variability in the odds of CMV. The zip code-level odds of CMV were then used to weight the results of a previously published model evaluating universal CMV screening vs symptom-targeted screening. Results The odds of CMV were heterogeneous over large geographic scales, with the highest odds in the southeastern United States. Universal screening was more cost-effective and afforded more averted cases of severe hearing loss than targeted testing. Universal screening remained the most cost-effective option even in areas with the lowest CMV prevalence. Conclusions Universal newborn CMV screening is cost-effective regardless of underlying CMV prevalence and is the preferred strategy to reduce morbidity from congenital CMV.
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Affiliation(s)
- Paul M Lantos
- Divisions of Pediatric Infectious Diseases, General Internal Medicine, and Occupational and Environmental Medicine, School of Medicine, Duke University, Durham, North Carolina, USA
- Duke Global Health Institute, Durham, North Carolina, USA
| | - Soren Gantt
- Departments of Microbiology, Infectious Diseases & Immunology and Pediatrics, Université de Montréal, Montreal, Quebec, Canada
| | - Mark Janko
- Duke Global Health Institute, Durham, North Carolina, USA
| | - Francois Dionne
- Centre for Clinical Epidemiology and Evaluation, Vancouver, British Columbia, Canada
| | - Sallie R Permar
- Department of Pediatrics, Weill Cornell Medicine, New York, New York, USA
| | - Karen Fowler
- Department of Pediatrics, University of Alabama, Birmingham, Alabama, USA
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Dana Flanders W, Lally C, Dilley A, Diaz-Decaro J. Estimated cytomegalovirus seroprevalence in the general population of the United States and Canada. J Med Virol 2024; 96:e29525. [PMID: 38529529 DOI: 10.1002/jmv.29525] [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: 12/22/2023] [Revised: 02/20/2024] [Accepted: 02/29/2024] [Indexed: 03/27/2024]
Abstract
Seroprevalence data for cytomegalovirus (CMV), a widespread virus causing lifelong infection, vary widely, and contemporary data from the United States (US) and Canada are limited. Utilizing a modeling approach based on a literature review (conducted August, 2022) of data published since 2005, we determine age-, sex-, and country-specific CMV seroprevalence in the general US and Canadian populations. Sex-specific data were extracted by age categories, and a random-effects meta-regression model was used to fit the reported data (incorporating splines for the US). Seven studies reported US CMV seroprevalence (both sexes, aged 1‒89 years); all used National Health and Nutrition Examination Survey data. Due to limited population-based studies, Canadian estimates were modeled using other limited country data. In both countries, modeled seroprevalence estimates increased with age and were higher in females versus males (US: 49.0% vs. 41.6% at 18‒19 years; 61.5% vs. 50.0% at 38‒39 years; Canada: 23.7% vs. 13.7% at 18‒19 years; 32.6% vs. 22.6% at 38‒39 years). Notably, by young adulthood, one-half of US and one-quarter of Canadian females have acquired CMV. The observed differences in CMV seroprevalence in the US and Canada may partially reflect variations in general population characteristics.
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Affiliation(s)
- W Dana Flanders
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Epidemiologic Research & Methods, LLC, Southport, NC, USA
| | - Cathy Lally
- Epidemiologic Research & Methods, LLC, Southport, NC, USA
| | - Anne Dilley
- Epidemiologic Research & Methods, LLC, Southport, NC, USA
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Treatment of Cytomegalovirus Anterior Uveitis at a North American Tertiary Center With Oral Valganciclovir. Cornea 2020; 39:584-589. [PMID: 32068609 DOI: 10.1097/ico.0000000000002251] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
PURPOSE Cytomegalovirus is an increasingly recognized cause of anterior uveitis. We present clinical features of cytomegalovirus anterior uveitis (CMVAU) and outcomes of oral valganciclovir treatment at a tertiary referral center in North America. METHODS This is a retrospective case series review (2002-2014) of immunocompetent patients with CMVAU treated with valganciclovir 900 mg BID and subsequent maintenance dosing of ≤450 mg BID. Most patients were prescribed topical corticosteroids concurrently. Diagnostic evaluations and clinical features at baseline and follow-up were reviewed. Resolution time, maintenance of quiescence, and adverse events were assessed. RESULTS Eighteen eyes of 16 patients were included. The mean age of diagnosis was 41 years. At diagnosis, mean best-corrected visual acuity was 0.30 LogMAR and mean intraocular pressure (IOP) was 18.4 mm Hg; 14 eyes (78%) had an active anterior chamber (AC) cell, 8 (44%) had circinate keratic precipitates, and 6 (33%) had iris atrophy. The mean follow-up duration was 48 months. Fourteen eyes of 12 patients were available for the 12-month follow-up; patients demonstrated improvement in best-corrected visual acuity (difference: -0.21 LogMAR, 95% CI -0.33 to -0.09; P = 0.003), AC cell (OR = 0.10, 95% CI 0.02-0.41; P = 0.002), and IOP (difference: -4.21 mm Hg, 95% CI -7.98 to -0.44; P = 0.03) compared with baseline. One patient experienced a serious adverse event likely due to valganciclovir. Thirteen eyes experienced recurrence of inflammation: 7 (54%) on prophylactic dose of valganciclovir and 6 (46%) after stopping. CONCLUSIONS Valganciclovir appears effective and safe for treating CMVAU in this retrospective case series. Long-term antiviral prophylaxis does not abolish recurrences, although it may possibly reduce their frequency when compared with no prophylaxis.
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Jahromi BN, Yaghobi R, Matlub N, Fazelzadeh A, Ramzi A, Anvar Z, Zare N, Salarian L, Fallahi J. Prevalence of Cytomegalovirus in Semen of Male Partners of Infertile Couples and the Virus Impact on Sperm Parameters. J Reprod Infertil 2020; 21:124-129. [PMID: 32500015 PMCID: PMC7253934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Genital tract infection is one of the causes of male infertility. Several studies have shown a role for human cytomegalovirus (CMV) in this context. In the present study, the prevalence of CMV in a population of male partners of infertile couples was estimated and the impact of CMV on sperm parameters was determined. METHODS In this cross sectional study, CMV DNA and virus copy number were examined in the semen of 150 participants including 80 with normal semen analysis (SA) and 70 with abnormal SA, by quantitative Real-Time PCR. Sperm parameters were compared between CMV positive and negative groups. Comparisons with p- values under 0.05 were considered significant. Logistic regression was performed to control the effect of some variables with p<0.25 on sperm parameters. RESULTS CMV DNA was detected in the semen of 28 (18.6%) individuals. 21 men (30%) with abnormal SA and 7 (8.8%) with normal SA were positive for CMV DNA (p=0.001). The mean virus copy number was 883.1±4662.01 for the men with abnormal SA and 2525.7±12680.9 for those with normal SA (p=0.001). Sperm count was (32.1±23.5) ×106 in CMV positive and (44.2±24.1) ×106 in CMV negative groups (p=0.022). Normal sperm morphology was 2.73±2.83% and 5.99±5.44% in CMV positive and negative groups, respectively (p<0.001). After controlling some variables, the sperm morphology remains the only statistically significant sperm parameter that was reduced by CMV. CONCLUSION The higher CMV prevalence in the semen of males with abnormal SA compared to normal SA and significant reduction of sperm morphology in the presence of CMV, are in favor of the negative impact of CMV on male fertility.
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Affiliation(s)
- Bahia Namavar Jahromi
- Infertility Research Center, Shiraz University of Medical Sciences, Shiraz, Iran, Department of Obstetrics and Gynecology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran, Maternal-Fetal Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran,Corresponding Authors: Bahia Namavar Jahromi, Zahra Anvar, Department Of OB-GYN, Shahid Faghihi Hospital, Shiraz, Iran, E-mail:,
| | - Ramin Yaghobi
- Shiraz Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Najmeh Matlub
- IVF Section, Ghadir Mother and Child Hospital of Shiraz, Shiraz, Iran
| | - Arezou Fazelzadeh
- Department of Obstetrics and Gynecology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Abolfazl Ramzi
- Shiraz Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Anvar
- Infertility Research Center, Shiraz University of Medical Sciences, Shiraz, Iran, Department of Obstetrics and Gynecology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran,Corresponding Authors: Bahia Namavar Jahromi, Zahra Anvar, Department Of OB-GYN, Shahid Faghihi Hospital, Shiraz, Iran, E-mail:,
| | - Najaf Zare
- Infertility Research Center, Shiraz University of Medical Sciences, Shiraz, Iran, Department of Biostatistics, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Leila Salarian
- Department of Pediatrics, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Jafar Fallahi
- Molecular Medicine Department, School of Advanced Medical Sciences and Technologies, Shiraz University of Medical Sciences, Shiraz, Iran
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Al Mana H, Yassine HM, Younes NN, Al-Mohannadi A, Al-Sadeq DW, Alhababi D, Nasser EA, Nasrallah GK. The Current Status of Cytomegalovirus (CMV) Prevalence in the MENA Region: A Systematic Review. Pathogens 2019; 8:pathogens8040213. [PMID: 31683687 PMCID: PMC6963600 DOI: 10.3390/pathogens8040213] [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: 09/29/2019] [Revised: 10/19/2019] [Accepted: 10/21/2019] [Indexed: 12/16/2022] Open
Abstract
Human cytomegalovirus (CMV) is a highly prevalent herpesvirus worldwide. According to the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO), CMV infects people of all ages, and by the age of five, approximately one-third of children in the United States are infected. Although the infection is generally asymptomatic, it can cause severe disease in immunocompromised patients, transplant and transfusion recipients, as well as newborn neonates. The objective of this study is to systematically review published literature on CMV in the MENA region to estimate its incidence in the region and describe its epidemiological and clinical significance. The literature was searched through four scientific databases: PubMed, Scopus, Science Direct, and Web of Science. A total of 72 studies from 11 countries satisfied the inclusion criteria, covering a period from 1988-2019. The CMV IgG seroprevalence ranged from 8.7%-99.2% (SD = 38.95%). CMV incidence in these countries ranged between 1.22% and 77% in transplant and transfusion recipients, with an increase in incidence with advanced age. However, the incidence rate was unclear for congenital CMV due to the variability of the reporting. This review highlights the need for more robust and well-designed studies to better estimate CMV incidence in the MENA region, standardize diagnostic criteria, and consider prophylactic and pre-emptive treatments to limit the morbidity and mortality of the disease.
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Affiliation(s)
- Hassan Al Mana
- Department of Biomedical Science, College of Health Sciences, QU Health, Qatar University, Doha, PO Box 2713, Qatar.
- Biomedical Research Center, Qatar University, Doha, PO Box 2713, Qatar.
| | - Hadi M Yassine
- Department of Biomedical Science, College of Health Sciences, QU Health, Qatar University, Doha, PO Box 2713, Qatar.
- Biomedical Research Center, Qatar University, Doha, PO Box 2713, Qatar.
| | - Nadin N Younes
- Department of Biomedical Science, College of Health Sciences, QU Health, Qatar University, Doha, PO Box 2713, Qatar.
| | - Anjud Al-Mohannadi
- Department of Biomedical Science, College of Health Sciences, QU Health, Qatar University, Doha, PO Box 2713, Qatar.
| | - Duaa W Al-Sadeq
- Department of Biomedical Science, College of Health Sciences, QU Health, Qatar University, Doha, PO Box 2713, Qatar.
- Biomedical Research Center, Qatar University, Doha, PO Box 2713, Qatar.
| | - Dalal Alhababi
- Department of Biomedical Science, College of Health Sciences, QU Health, Qatar University, Doha, PO Box 2713, Qatar.
| | - Elham A Nasser
- Department of Biomedical Science, College of Health Sciences, QU Health, Qatar University, Doha, PO Box 2713, Qatar.
| | - Gheyath K Nasrallah
- Department of Biomedical Science, College of Health Sciences, QU Health, Qatar University, Doha, PO Box 2713, Qatar.
- Biomedical Research Center, Qatar University, Doha, PO Box 2713, Qatar.
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Lantos PM, Hoffman K, Permar SR, Jackson P, Hughes BL, Kind A, Swamy G. Neighborhood Disadvantage is Associated with High Cytomegalovirus Seroprevalence in Pregnancy. J Racial Ethn Health Disparities 2018; 5:782-786. [PMID: 28840519 PMCID: PMC5826762 DOI: 10.1007/s40615-017-0423-4] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 07/26/2017] [Accepted: 08/03/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Cytomegalovirus (CMV) is the most common infectious cause of fetal malformations and childhood hearing loss. CMV is more common among socially disadvantaged groups, and geographically clusters in poor communities. The Area Deprivation Index (ADI) is a neighborhood-level index derived from census data that reflects material disadvantage. METHODS We performed a geospatial analysis to determine if ADI predicts the local odds of CMV seropositivity. We analyzed a dataset of 3527 women who had been tested for CMV antibodies during pregnancy. We used generalized additive models to analyze the spatial distribution of CMV seropositivity. Adjusted models included individual-level age and race and neighborhood-level ADI. RESULTS Our dataset included 1955 CMV seropositive women, 1549 who were seronegative, and 23 with recent CMV infection based on low avidity CMV antibodies. High ADI percentiles, representing greater neighborhood poverty, were significantly associated with the nonwhite race (48 vs. 22, p < 0.001) and CMV seropositivity (39 vs. 28, p < 0.001). Our unadjusted spatial models identified clustering of high CMV odds in poor, urban neighborhoods and clustering of low CMV odds in more affluent suburbs (local odds ratio 0.41 to 1.90). Adjustment for both individual race and neighborhood ADI largely eliminated this spatial variability. ADI remained a significant predictor of local CMV seroprevalence even after adjusting for individual race. CONCLUSIONS Neighborhood-level poverty as measured by the ADI is a race-independent predictor of local CMV seroprevalence among pregnant women.
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Affiliation(s)
- Paul M Lantos
- Department of Medicine, Duke University, DUMC 100800, Durham, NC, 27710, USA.
- Department of Pediatrics, Duke University, Durham, NC, USA.
- Global Health Institute, Duke University, Durham, NC, USA.
| | - Kate Hoffman
- Nicholas School of the Environment, Duke University, Durham, NC, USA
| | - Sallie R Permar
- Department of Pediatrics, Duke University, Durham, NC, USA
- Human Vaccine Institute, Duke University, Durham, NC, USA
| | - Pearce Jackson
- Department of Obstetrics and Gynecology, Duke University, Durham, NC, USA
| | - Brenna L Hughes
- Department of Obstetrics and Gynecology, Duke University, Durham, NC, USA
| | - Amy Kind
- Department of Medicine, University of Wisconsin, Madison, WI, USA
| | - Geeta Swamy
- Department of Obstetrics and Gynecology, Duke University, Durham, NC, USA
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Cobelens F, Nagelkerke N, Fletcher H. The convergent epidemiology of tuberculosis and human cytomegalovirus infection. F1000Res 2018; 7:280. [PMID: 29780582 PMCID: PMC5934687 DOI: 10.12688/f1000research.14184.2] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/23/2018] [Indexed: 12/28/2022] Open
Abstract
Although several factors are known to increase the risk of tuberculosis, the occurrence of tuberculosis disease in an infected individual is difficult to predict. We hypothesize that active human cytomegalovirus infection due to recent infection, reinfection or reactivation plays an epidemiologically relevant role in the aetiology of tuberculosis by precipitating the progression from latent tuberculosis infection to disease. The most compelling support for this hypothesis comes from the striking similarity in age-sex distribution between the two infections, important because the age-sex pattern of tuberculosis disease progression has not been convincingly explained. Cytomegalovirus infection and tuberculosis have other overlapping risk factors, including poor socio-economic status, solid organ transplantation and, possibly, sexual contact and whole blood transfusion. Although each of these overlaps could be explained by shared underlying risk factors, none of the epidemiological observations refute the hypothesis. If this interaction would play an epidemiologically important role, important opportunities would arise for novel approaches to controlling tuberculosis.
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Affiliation(s)
- Frank Cobelens
- Department of Global Health and Amsterdam Institute for Global Health and Development, Academic Medical Center, Meibergdreef 9, AZ, Amsterdam, 1105, Netherlands
| | - Nico Nagelkerke
- Department of Medical Microbiology, University of Manitoba, Basic Medical Sciences Building, 745 Bannatyne Avenue, Winnipeg, MB , R3E 0J9, Canada
| | - Helen Fletcher
- TB Centre, London School of Hygiene & Tropical Medicine, Keppel Street , London , WC1E 7HT, UK
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Cobelens F, Nagelkerke N, Fletcher H. The convergent epidemiology of tuberculosis and human cytomegalovirus infection. F1000Res 2018; 7:280. [PMID: 29780582 PMCID: PMC5934687 DOI: 10.12688/f1000research.14184.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/01/2018] [Indexed: 03/25/2024] Open
Abstract
Although several factors are known to increase the risk of tuberculosis, the occurrence of tuberculosis disease in an infected individual is difficult to predict. We hypothesize that active human cytomegalovirus infection due to recent infection, reinfection or reactivation plays an epidemiologically relevant role in the aetiology of tuberculosis by precipitating the progression from latent tuberculosis infection to disease. The most compelling support for this hypothesis comes from the striking similarity in age-sex distribution between the two infections, important because the age-sex pattern of tuberculosis disease progression has not been convincingly explained. Cytomegalovirus infection and tuberculosis have other overlapping risk factors, including poor socio-economic status, sexual contact, whole blood transfusion and solid organ transplantation. Although each of these overlaps could be explained by shared underlying risk factors, none of the epidemiological observations refute the hypothesis. If this interaction would play an epidemiologically important role, important opportunities would arise for novel approaches to controlling tuberculosis.
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Affiliation(s)
- Frank Cobelens
- Department of Global Health and Amsterdam Institute for Global Health and Development, Academic Medical Center, Meibergdreef 9, AZ, Amsterdam, 1105, Netherlands
| | - Nico Nagelkerke
- Department of Medical Microbiology, University of Manitoba, Basic Medical Sciences Building, 745 Bannatyne Avenue, Winnipeg, MB , R3E 0J9, Canada
| | - Helen Fletcher
- TB Centre, London School of Hygiene & Tropical Medicine, Keppel Street , London , WC1E 7HT, UK
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Surendran A, Chisthi MM. Breast Cancer Association with Cytomegalo Virus-A Tertiary Center Case-Control Study. J INVEST SURG 2017; 32:172-177. [PMID: 29252032 DOI: 10.1080/08941939.2017.1397827] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE Cytomegalo virus is a ubiquitous virus often associated with congenital infections. Some studied have claimed an association between infection with this virus and development of breast cancer. The aim of this prospective research was to study the difference in Cytomegalo virus sero-positivity among patients with breast cancer and benign breast diseases, and thereby to prove any association. MATERIALS AND METHODS This was a hospital based Case-Control study conducted at the General Surgery wards of our hospital, a tertiary level public sector health care institution. This study was done on 130 patients with breast swellings who underwent surgical excision of their lumps over a 1-year period. Patients with histologically proven malignancies were selected as cases while proven benign cases were deemed to be the controls. IgG and IgM antibodies to Cytomegalo virus were checked in the patients from both groups. RESULTS All of the studied patients turned out to be positive for Immunoglobulin G against Cytomegalo virus while all the patients were found to be negative for Immunoglobulin M. There was no difference in the antibody titers among the benign and malignant cases in the study. Logistic regression calculation was also carried out including the study parameters and other known risk factors. CONCLUSIONS We conclude that there is no association between Cytomegalo virus sero-positivity and breast cancer. Another conclusion is that the studied adult population has been exposed to Cytomegalo virus in some point of their lives. Further studies of a larger magnitude are essential to confirm our results.
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Affiliation(s)
- Anilkumar Surendran
- a Department of General Surgery , Government Medical College , Trivandrum , Kerala , India
| | - Meer M Chisthi
- a Department of General Surgery , Government Medical College , Trivandrum , Kerala , India
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Lantos PM, Hoffman K, Permar SR, Jackson P, Hughes BL, Swamy GK. Geographic Disparities in Cytomegalovirus Infection During Pregnancy. J Pediatric Infect Dis Soc 2017; 6:e55-e61. [PMID: 28201739 PMCID: PMC5907865 DOI: 10.1093/jpids/piw088] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Accepted: 12/03/2016] [Indexed: 01/08/2023]
Abstract
BACKGROUND Cytomegalovirus (CMV) is the most common infectious cause of fetal malformations and childhood hearing loss. CMV is more common among socially disadvantaged groups, and it clusters geographically in poor communities. We conducted a geospatial analysis of chronic and primary CMV infection among pregnant women around Durham, NC. METHODS We performed a geospatial analysis of subjects from an ongoing study of CMV infection among pregnant women using geographic information systems and spatial statistics. Subjects were categorized on the basis of results of their CMV immunoglobulin G avidity testing as seronegative, seropositive, or primary infection. We used generalized additive models to analyze the spatial distributions of individuals who fell into each category and to control for confounders such as race and age. We used a generalized estimating equation to correlate community-level variables with CMV status. RESULTS Of 3527 pregnant women aged 15 to 59 years, 93.4% were either white or black. CMV seropositivity was significantly more common among non-Hispanic white subjects than among minority subjects (odds ratio, 3.76 [95% confidence interval, 3.25-4.34]). We identified a cluster in which women had elevated odds of CMV seropositivity in the urban neighborhoods of Durham. Cases of primary CMV infection were more common in areas with higher-than-average CMV seroprevalence. Neighborhood median family income was associated inversely with the prevalence of chronic CMV. CONCLUSIONS We found a high prevalence of CMV seropositivity in urban low-income neighborhoods among pregnant women, particularly among racial and ethnic minorities. Seronegative pregnant women from these communities might be at heightened risk for primary CMV infection.
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Affiliation(s)
- Paul M Lantos
- Department of Pediatrics, Duke University, Durham, North Carolina,Department of Internal Medicine, Duke University, Durham, North Carolina,Correspondence: P. M. Lantos, MD, DUMC 100800, Durham, NC 27710 ()
| | - Kate Hoffman
- Nicholas School of the Environment, Duke University, Durham, North Carolina
| | - Sallie R Permar
- Department of Pediatrics, Duke University, Durham, North Carolina,Human Vaccine Institute, Duke University, Durham, North Carolina
| | - Pearce Jackson
- Department of Obstetrics and Gynecology, Duke University, Durham, North Carolina
| | - Brenna L Hughes
- Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Geeta K Swamy
- Department of Obstetrics and Gynecology, Duke University, Durham, North Carolina
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Wizman S, Lamarre V, Coic L, Kakkar F, Le Meur JB, Rousseau C, Boucher M, Tapiero B. Awareness of cytomegalovirus and risk factors for susceptibility among pregnant women, in Montreal, Canada. BMC Pregnancy Childbirth 2016; 16:54. [PMID: 26979058 PMCID: PMC4793542 DOI: 10.1186/s12884-016-0844-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 03/11/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Advances in diagnostic and therapeutic modalities for congenital cytomegalovirus (CMV) infection have generated a mounting interest in identifying mothers susceptible to CMV. The objectives of this study were to evaluate the prevalence and socio-demographic determinants of CMV susceptibility and CMV awareness, among pregnant women, in Montreal, Quebec. METHODS Between April and December 2012, women delivering at Centre Hospitalier Universitaire Sainte Justine were recruited for the study. Stored serum from the first trimester of pregnancy was tested for CMV IgG. Knowledge about CMV and socio-demographic characteristics were collected via standardized questionnaire. RESULTS Four hundred and ninety one women were enrolled in the study. Overall, 225 mothers (46%) were seronegative for CMV, and 85% (n = 415) were unaware of CMV or the associated risks in pregnancy. Significant risk factors for CMV seronegative status included Canadian vs. foreign born (aOR 6.88, 95% CI 4.33-10.94), and high vs. low family income (aOR 4.68, 95% CI 2.09-10.48). Maternal employment status was the only significant predictor of CMV unawareness, with unemployed mothers at the highest risk (aOR 85.6, 95% CI 17.3-421.3). CONCLUSIONS Nearly half of pregnant women studied were at risk of primary infection, and yet, the majority was unaware of potential risks associated with CMV. Canadian born mothers and those with a high socioeconomic status were more likely to be CMV seronegative. Increased education about CMV infection, through public health interventions and obstetrician/pediatric counseling, is needed for all pregnant women.
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Affiliation(s)
- Sarah Wizman
- Infectious Disease Division, Department of Paediatrics, CHU Sainte Justine, Université de Montréal, 3175 Ch. de la Cote-Sainte-Catherine (bureau 7412), Montréal, H3T1C5, , QC, Canada. .,, 5632 Irving Layton, Montréal, H4W0A2, , QC, Canada.
| | - Valérie Lamarre
- Infectious Disease Division, Department of Paediatrics, CHU Sainte Justine, Université de Montréal, 3175 Ch. de la Cote-Sainte-Catherine (bureau 7412), Montréal, H3T1C5, , QC, Canada
| | - Lena Coic
- Infectious Disease Division, Department of Paediatrics, CHU Sainte Justine, Université de Montréal, 3175 Ch. de la Cote-Sainte-Catherine (bureau 7412), Montréal, H3T1C5, , QC, Canada
| | - Fatima Kakkar
- Infectious Disease Division, Department of Paediatrics, CHU Sainte Justine, Université de Montréal, 3175 Ch. de la Cote-Sainte-Catherine (bureau 7412), Montréal, H3T1C5, , QC, Canada
| | - Jean-Baptiste Le Meur
- Department of Social and Preventive Medicine, Faculty of Medicine, Laval University, Pavillon Ferdinand-Vandry (bureau 4633), 1050 Av de la Medicine, Québec, G1V0A6, QC, Canada
| | - Céline Rousseau
- Infectious Disease Division, Department of Paediatrics, CHU Sainte Justine, Université de Montréal, 3175 Ch. de la Cote-Sainte-Catherine (bureau 7412), Montréal, H3T1C5, , QC, Canada.,Department of Microbiology, CHU Sainte-Justine, Université de Montréal, 3175 Ch. de la Cote-Sainte-Catherine (bureau 2901), Montréal, H3T1C5, , QC, Canada
| | - Marc Boucher
- Obstetric and Gynecology Department, CHU Sainte Justine, Université de Montréal, 3175 Ch. de la Cote-Sainte-Catherine (bureau 4822), Montréal, H3T1C5, , QC, Canada
| | - Bruce Tapiero
- Infectious Disease Division, Department of Paediatrics, CHU Sainte Justine, Université de Montréal, 3175 Ch. de la Cote-Sainte-Catherine (bureau 7412), Montréal, H3T1C5, , QC, Canada
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Abstract
PURPOSE OF REVIEW Cytomegalovirus (CMV) is the most common cause of congenital infection in the world. Symptomatic infants are at increased risk of developing permanent sequelae, including sensorineural hearing loss and neurodevelopmental delay. Advances in the treatment and prevention of congenital CMV infection are a high priority nationally and globally. RECENT FINDINGS In symptomatic infants, antiviral therapy with 6 months of oral valganciclovir improves hearing and neurodevelopmental outcomes. Strategies to prevent congenital or maternal CMV infections, including the use of CMV hyperimmune globulin and development of a maternal vaccine, have yet to yield positive results. SUMMARY The clinical significance of congenital CMV infection, developments in antiviral therapy, and efforts to prevent congenital disease are herein reviewed.
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Voigt S, Schaffrath Rosario A, Mankertz A. Cytomegalovirus Seroprevalence Among Children and Adolescents in Germany: Data From the German Health Interview and Examination Survey for Children and Adolescents (KiGGS), 2003-2006. Open Forum Infect Dis 2015; 3:ofv193. [PMID: 26817022 PMCID: PMC4724754 DOI: 10.1093/ofid/ofv193] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Accepted: 12/01/2015] [Indexed: 11/13/2022] Open
Abstract
CMV seroprevalence increases with age and is significantly associated with migration background, country of origin, and place of birth. We identified the birth order of siblings, breastfeeding, early day care attendance and living in East Germany as further risk factors. Background. Congenital cytomegalovirus (CMV) infection can cause severe birth defects. The majority of children with congenital CMV are born to CMV-seropositive women; however, transmission from mother to fetus and resulting defects are more likely to occur when mothers experience seroconversion during pregnancy. The objective of this study was to provide a population-based estimate of CMV seropositivity and to identify factors that correlate with the detection of CMV-immunoglobulin (Ig)G antibodies. Methods. Cytomegalovirus-specific IgG antibodies were determined by enzyme-linked immunosorbent assay in 13 876 serum samples from children and adolescents (aged 1–17 years). Cytomegalovirus seroprevalence was correlated with children's age, gender, migration background, country of origin, place of birth, socioeconomic status, breast feeding, daycare attendance, order and number of siblings, and residence in East versus West Germany. Results. Age-adjusted seroprevalence was 27.4% (95% confidence interval, 25.8–29.0). Cytomegalovirus seroprevalence increased with age (21.5% at ages 1–2; 32.0% at ages 14–17). Cytomegalovirus seropositivity was significantly associated with migration background, country of origin and place of birth, and (among migrants only) with low socioeconomic status. Risk factors for CMV acquisition included the birth order of siblings, breastfeeding, early daycare attendance, and living in East Germany. Conclusions. In Germany, CMV seroprevalence increases with age, irrespective of gender. These data highlight risk factors associated with seroprevalence and help to identify a target age for the application of a CMV vaccine.
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Affiliation(s)
- Sebastian Voigt
- Departments of Infectious Diseases; Department of Pediatric Oncology/Hematology/SCT, Charité-Universitätsmedizin, Berlin, Germany
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14
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Delaney AS, Thomas W, Balfour HH. Coprevalence of Epstein-Barr Virus, Cytomegalovirus, and Herpes Simplex Virus Type-1 Antibodies Among United States Children and Factors Associated With Their Acquisition. J Pediatric Infect Dis Soc 2015; 4:323-9. [PMID: 26582871 DOI: 10.1093/jpids/piu076] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Accepted: 06/18/2014] [Indexed: 12/15/2022]
Abstract
BACKGROUND Epstein-Barr virus (EBV), cytomegalovirus (CMV), and herpes simplex virus type-1 (HSV-1) infections are common worldwide, but age-specific prevalence of primary infection varies by race or ethnicity and geographical location. Comparing demographic groups could identify factors influencing the rate of acquisition, age-specific antibody prevalence is relevant for determining when to administer prophylactic vaccines, and coprevalence suggests similar risk factors. METHODS Stored sera collected from the cross-sectional National Health and Nutrition Examination Surveys 2003-2004 cycle were tested for EBV, CMV, and HSV-1 antibody. Demographic information was obtained through self-reported questionnaires. Statistical analysis included logistic regression and multivariate analysis adjusting for the multistage cluster design. RESULTS Overall, 36% of children had antibody against 2 or more of the viruses. Coprevalence with EBV, CMV, and HSV-1 was higher in females, in non-Hispanic blacks, and Mexican Americans, compared with non-Hispanic whites, and in those without health insurance. Antibody prevalence was associated with (1) lower household income and education and (2) greater crowding. Nearly all children with CMV antibody or HSV-1 antibody had been infected with EBV. CONCLUSIONS There was a disproportionately high prevalence of EBV, CMV, and HSV-1 antibody among Mexican Americans and non-Hispanic blacks, groups with a lower poverty income ratio, and those with less household education. They might benefit from receiving prophylactic herpes vaccines when fairly young. The presence of EBV, CMV, or HSV-1 antibody increases the odds of having antibody against one of the other viruses and is a ripe area for future research.
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Affiliation(s)
| | - William Thomas
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis
| | - Henry H Balfour
- Department of Laboratory Medicine and Pathology Department of Pediatrics, University of Minnesota Medical School, Minneapolis
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15
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Lantos PM, Permar SR, Hoffman K, Swamy GK. The Excess Burden of Cytomegalovirus in African American Communities: A Geospatial Analysis. Open Forum Infect Dis 2015; 2:ofv180. [PMID: 26716106 PMCID: PMC4691661 DOI: 10.1093/ofid/ofv180] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 11/13/2015] [Indexed: 11/14/2022] Open
Abstract
CMV seroprevalence is much higher in African-Americans than Caucasians. CMV seropositivity is geographically clustered, largely due to racial segregation. African-American communities may suffer a disproportionate public health burden due to CMV Background. Cytomegalovirus (CMV) is a common cause of birth defects and hearing loss in infants and opportunistic infections in the immunocompromised. Previous studies have found higher CMV seroprevalence rates among minorities and among persons with lower socioeconomic status. No studies have investigated the geographic distribution of CMV and its relationship to age, race, and poverty in the community. Methods. We identified patients from 6 North Carolina counties who were tested in the Duke University Health System for CMV immunoglobulin G. We performed spatial statistical analyses to analyze the distributions of seropositive and seronegative individuals. Results. Of 1884 subjects, 90% were either white or African American. Cytomegalovirus seropositivity was significantly more common among African Americans (73% vs 42%; odds ratio, 3.31; 95% confidence interval, 2.7–4.1), and this disparity persisted across the life span. We identified clusters of high and low CMV odds, both of which were largely explained by race. Clusters of high CMV odds were found in communities with high proportions of African Americans. Conclusions. Cytomegalovirus seropositivity is geographically clustered, and its distribution is strongly determined by a community's racial composition. African American communities have high prevalence rates of CMV infection, and there may be a disparate burden of CMV-associated morbidity in these communities.
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Affiliation(s)
- Paul M Lantos
- Divisions of Pediatric Infectious Diseases ; General Internal Medicine
| | | | - Kate Hoffman
- Nicholas School of the Environment , Duke University , Durham, North Carolina
| | - Geeta K Swamy
- Department of Obstetrics and Gynecology , Duke University School of Medicine
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Rupp C, Herpel E, Schnitzler P, Zawierucha A, Zwickel P, Klute L, Kadmon M, Stremmel W, Gauss A. Protracted primary cytomegalovirus infection presenting as ileoanal pouchitis in a non-immunosuppressed patient: a case report. J Med Case Rep 2014; 8:163. [PMID: 24885004 PMCID: PMC4061925 DOI: 10.1186/1752-1947-8-163] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Accepted: 01/27/2014] [Indexed: 12/02/2022] Open
Abstract
Introduction Pouchitis often occurs after proctocolectomy and ileal pouch-anal anastomosis for ulcerative colitis. It is usually deemed idiopathic and commonly responds to antibacterial therapy. To date, only a few cases of cytomegalovirus pouchitis have been documented, and only a single report describes pouchitis in a case of assumed primary cytomegalovirus infection. Case presentation A 26-year-old Caucasian woman underwent proctocolectomy and ileal pouch-anal anastomosis for refractory ulcerative colitis and adenocarcinoma. After 28 months she developed bloody diarrhoea, abdominal pain, fever, nausea and general malaise suggesting severe pouchitis. Antibiotic treatment reduced humoral inflammation, but failed to resolve her fever. A pouchoscopy revealed distinct pouchitis, and cytomegalovirus infection was diagnosed from pouch biopsies by polymerase chain reaction as well as conventional histology and immunohistochemistry. The infection was confirmed in her blood by polymerase chain reaction and pp65 antigen test, and was clearly defined as the ‘primary’ infection by serial serological tests. Intravenous treatment with ganciclovir (10mg/kg body weight/day) led to resolution of symptoms and negative cytomegalovirus deoxyribonucleic acid and pp65 within a few days. When symptoms and laboratory evidence of cytomegalovirus infection recurred a few days after completing 20 days of therapy with ganciclovir and valganciclovir, a second course of ganciclovir treatment was initiated. Conclusions Cytomegalovirus infection of the ileoanal pouch is an important differential diagnosis of pouchitis even in non-immunosuppressed patients and can be treated with ganciclovir.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Annika Gauss
- Department of Gastroenterology and Hepatology, University Hospital Heidelberg, INF 410, 69120 Heidelberg, Germany.
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17
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Foxworth MK, Wilms IR, Brookman RR, Crewe S, Adler SP. Prevalence of CMV infection among sexually active adolescents: a matched case-control study. ADOLESCENT HEALTH MEDICINE AND THERAPEUTICS 2014; 5:73-8. [PMID: 24808724 PMCID: PMC4010613 DOI: 10.2147/ahmt.s60103] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background We observed previously that African American adolescents in Richmond reporting infrequent sexual activity had cytomegalovirus (CMV) seroprevalence rates one half that of their adult mothers and caregivers. We therefore sought to determine if sexually active African American adolescents have higher rates of CMV infection than sexually inactive African American adolescents. Methods Cases (aged 13–18 years) sought care for a sexually transmitted infection (STI) or pregnancy. Controls were sexually inactive and matched to cases for age, race, and gender and enrolled at the same clinic as cases and sought medical treatment unrelated to an STI. Subjects completed a questionnaire, provided saliva for antibody testing, and were interviewed for determination of sexual activity. Results Two groups of sexually active cases were enrolled. The first group had a diagnosis of an STI. In this group, both cases and matched controls were seropositive at a rate of 32% (7/22 for cases and 7/22 for controls). In the second group, cases self-reported an STI but objective evidence was lacking. In this group, cases were seropositive at a rate of 38% (six of 16) compared with matched controls among whom 6.3% were seropositive (one in 16). The overall rate of seropositivity in all 38 cases was 34% compared with a rate of 21% for all controls (P=0.3, odds ratio 2.0, 95% confidence interval 0.6–7.5). Conclusion Our results confirm lower rates of CMV infection among the current generation of African American adolescents compared with African American adults in Richmond, and suggest that this is not associated with sexual activity.
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Affiliation(s)
- Michael K Foxworth
- Department of Pediatrics and Microbiology, Virginia Commonwealth University, Richmond, VA, USA
| | - Isca R Wilms
- Department of Pediatrics and Microbiology, Virginia Commonwealth University, Richmond, VA, USA
| | - Richard R Brookman
- Department of Pediatrics and Microbiology, Virginia Commonwealth University, Richmond, VA, USA
| | - Stephanie Crewe
- Department of Pediatrics and Microbiology, Virginia Commonwealth University, Richmond, VA, USA
| | - Stuart P Adler
- Department of Pediatrics and Microbiology, Virginia Commonwealth University, Richmond, VA, USA
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