Congenital CMV infection in Zambia – further population-based studies needed

High rates of congenital cytomegalovirus (CMV) infections linked with maternal HIV infection among neonatal admissions at a large referral centre in sub-Saharan Africa.

Mwaanza N, Chilukutu L, Tembo J, Kabwe M, Musonda K, Kapasa M, Chabala C, Sinyangwe S, Mwaba P, Zumla A, Bates M. Clin Infect Dis. 2013 Nov 21. [Epub ahead of print]

Congenital cytomegalovirus (CMV) infection is the major infectious cause of birth defects and hearing loss globally. There is a growing recognition of the potential clinical impact of congenital CMV infections in high seroprevalence settings.

Methods: A cross-sectional study of neonatal admissions at a large referral centre in sub-Saharan Africa to determine the prevalence of both symptomatic and asymptomatic congenital CMV infection. Real Time PCR was used to screen DNA-extracted from sera, urine and saliva, and an ELISA assay was used to screen sera for anti-CMV IgM. Multivariate binary logistic regression was used to identify risk factors associated with increased odds of congenital CMV infection.

Results: Congenital CMV was detected in 3.8% (15/395) of neonates. Among these cases 40% (6/15) presented with jaundice, one of which also had petechiae. Congenital CMV infection was detected in 11.4% (9/79) [6.1-20.3%] of neonates born to HIV-infected mothers and both maternal HIV (OR 6.661 [2.126-20.876], p=0.001) and jaundice (OR 5.701 [1.776-18.306], p=0.003) were independently linked with significantly increased odds of congenital CMV infection.

Conclusion: Congenital and early infant CMV infections may have important consequences for child health in sub-Saharan Africa and other high HIV and CMV seroprevalence populations globally.

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Editor’s notes: Congenital cytomegalovirus (CMV) can lead to hearing impairment and neurodevelopmental delay, but few studies have estimated the prevalence of congenital CMV infection in Sub-Saharan Africa. This may be because it has been assumed that clinical impact of congenital CMV is likely to be low, resulting primarily from maternal re-infections or reactivations of CMV. This study recruited from an inpatient neonatal population in Lusaka, Zambia, and found a high prevalence of congenital CMV (3.8%) in this population and a strong association with maternal HIV infection.  The number of cases was small but a substantial minority (40%) were symptomatic. Limitations of the study include selection biases due to the recruitment process, and lack of information on antiretroviral status of the mother. Despite these, the study highlights the need for further, population-based studies in high HIV prevalence settings to assess the prevalence and risk factors for congenital CMV more widely, including the role of ART and maternal viral shedding on risk of transmission. 

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