The Epidemiological Research Of Congenital Cytomegalovirus Infection

Background Human Cytomegalovirus(HCMV)infection is one of the most common congenital infections in the whole world.It is also the leading cause of the sensorineural hearing loss(SNHL)and the nerve growth retardation and the second common serious deformity ranked only lower to the cerebral palsy.HCMV infection occurs mainly in infants and young children.Due to reactivation of latent virus,reinfection with a new cytomegalovirus strain,or both,people infected with HCMV could periodically shed the virus in saliva,urine or other bodily secretions,especially in HIV-infected individuals and the pregnant women.China is the high seroprevalence country,with 95%positive found in serum samples of women of reproductive age.Recently,a number of studies showed that the risk of congenital CMV(cCMV)infection was similar in the low seroprevalence settings and the high seroprevalence settings,with 1?2%of newborns with cCMV infection homed in seropositive women.However,there are few reaearches focused on epidemiological investigation of cCMV infection in China,and on the relationship between the level of anti-CMV IgG antibody of pregnant women and cCMV infection of neonates.Objectives The aims of the prespective cohort study was:1)to assess the rate of cCMV infection in China;2)to investigate the risk factors associated with cCMV infection;3)to explore the relationship between the fluctuation of anti-CMV IgG antibody in pregnancy and the risk of neonatal cCMV infection;4)to observe the clinical outcome of neonatal cCMV infection.Methods From June 2015 to January 2017,we enrolled women in early pregnancy(less than 20 estational weeks)at the Maternal and Child Health Hospital of Xinmi,Zhongmou and Jiaxian,Henan,China.At enrollment,we collected the data of the sociademographic variables and the reproductive history.Blood samples of pregnant women were collected and tested for anti-CMV pp150-IgG antibody by ELISA at three time points during pregnancy(less than 20,24-28,and 38-42 gestational weeks).Samples of saliva and urine of newborns were collected and tested for CMV DNA by PCR within 3 days after birth.Newborns infected CMV DNA by test would be recalled and collected the samples of saliva and urine to have the second test to confirm the cCMV infection within 21 days after birth.Comparision of the distribution of variables by using the chi-square test and the Fisher exact test.Logistic regression analysis and Poisson regression analysis were used to analyze the risk factors associated with cCMV infection.Results Totally,3068 pregnant women were enrolled,and samples were collected from 2455(80.01%)women and their newborns(2475).The seropositive of pregnant women was 98.14%(95%Cl:97.92-98.91).The rate of active CMV infection was 1.18%among women during pregnancy.The prevalence of cCMV infection was 1.54%(95%CI:1.05-2.02).In multivariate analysis,cCMV infection in neonates were associated with the baseline antibody levels of the pregnant women(compared with equal to or beyond 5.00 IU/mL,OR = 2.60(95%CI:1.37-4.95)for lower than 5 lU/mL)and fetus numbers(compared with singleton pregnancy,OR = 10.40(95%CI:3.83-28.21)for the twin pregancy).Pregnant women's age,residence,previous pregnancy history,complications during pregnancy,HBV infection,mode of delivery and neonatal body weight,length were showed no significant effects on the cCMV infection.Most of the cCMV infection were no clinical symptoms at birth,and only 5.26%(2/38,95%CI:1.46-17.28)showed congenital heart disease and neonatal infection.There was no significant difference on clinical manifestation between cCMV infection and uninfected newbborns.Conclusions The cCMV infection was common in high seroprevalence areas.The presence of meternal antibody,therefore,appeared no protection for the intrauterine infection.Women with the lower baseline antibody level(<5.00IU/mL)and the twin pregnancy had the higher risk for their newborns with cCMV infection.Testing of baseline antibody levels of pregnant women may be an effective screening method.In addition,more attention should be paid for the twin pregnancy.