Hamprecht K, Maschmann J, Vochem M, Dietz K, Speer C P, Jahn G
Institute of Medical Virology and Epidemiology of Viral Diseases, University Hospital of Tübingen, Germany.
Lancet. 2001 Feb 17;357(9255):513-8. doi: 10.1016/S0140-6736(00)04043-5.
Breastfeeding practices strongly influence the epidemiology of human cytomegalovirus infection. By contrast with term neonates, few data are available on transmission of infection from mothers to preterm infants during breastfeeding.
151 mothers and their 176 preterm infants (gestational age at birth <32 weeks or birthweight <1500 g) were prospectively screened for cytomegalovirus infection by serology, virus culture, and PCR. The roles of cell-free and cell-associated cytomegalovirus excretion during lactation were analysed longitudinally in relation to transmission, by maximum-likelihood estimates.
Of the 69 seronegative breastfeeding control mothers, none had detectable cytomegalovirus DNA in breastmilk and none of their 80 infants shed the virus in urine. The proportion of cytomegalovirus reactivation in seropositive breastfeeding mothers was 96% (73 of 76). The early appearance of viral DNA in milk whey (median 3.5 days post partum in transmitters; 8 days in non-transmitters; p=0.025) and infectious virus in milk whey (10 days and 16 days, respectively; p=0.005) were risk factors for transmission. The cumulative rate of transmission was 37% (27 of 73 mothers; 33 infants). The infection of the neonates had a mean incubation time of 42 days (95% CI 28-69). About 50% of the infected infants had no symptoms, but four had sepsis-like symptoms.
The proportion of cytomegalovirus reactivation during lactation almost equals maternal seroprevalence. Breastfeeding as a source of postnatal cytomegalovirus infection in preterm infants has been underestimated and may be associated with a symptomatic infection.
母乳喂养方式对人巨细胞病毒感染的流行病学有重大影响。与足月儿相比，关于母乳喂养期间母亲将感染传播给早产儿的数据较少。
对151名母亲及其176名早产儿（出生时胎龄<32周或出生体重<1500克）进行前瞻性血清学、病毒培养和PCR检测，以筛查巨细胞病毒感染。通过最大似然估计，纵向分析哺乳期无细胞和细胞相关巨细胞病毒排泄与传播的关系。
69名血清阴性的母乳喂养对照母亲中，母乳中均未检测到巨细胞病毒DNA，其80名婴儿尿液中也均未排出病毒。血清阳性的母乳喂养母亲中巨细胞病毒再激活的比例为96%（76名中的73名）。乳清中病毒DNA的早期出现（传播者产后中位数3.5天；非传播者8天；p=0.025）和乳清中感染性病毒的出现（分别为10天和16天；p=0.005）是传播的危险因素。传播的累积发生率为37%（73名母亲中的27名；33名婴儿）。新生儿感染的平均潜伏期为42天（95%CI 28-69）。约50%的感染婴儿无症状，但有4名出现类似败血症的症状。
哺乳期巨细胞病毒再激活的比例几乎与母亲血清阳性率相等。母乳喂养作为早产儿出生后巨细胞病毒感染的一个来源一直被低估，并且可能与有症状感染有关。
