Hamprecht Klaus, Maschmann Jens, Jahn Gerhard, Poets Christian F, Goelz Rangmar
Institute of Medical Virology and Epidemiology of Viral Diseases, University Hospital of Tübingen, Elfriede-Aulhorn-Str 6, 72076 Tübingen, Germany.
J Clin Virol. 2008 Mar;41(3):198-205. doi: 10.1016/j.jcv.2007.12.005.
Breastfeeding has a major impact on HCMV epidemiology. The incidence of postnatal HCMV reactivation during lactation equals the maternal seroprevalence. Infectious virus, viral DNA and RNA can be isolated easily from cell and fat-free milk whey. Early onset of viral DNAlactia and virolactia as well as high viral load in milk whey are maternal risk factors for virus transmission. The dynamics of HCMV reactivation can be described by unimodal kinetics with interindividual variation. Virus reactivation during lactation is a self-limiting local process in the absence of systemic HCMV infection. Preterm infants below 1000g birthweight and a gestational age below 30 weeks may be at high risk of acquiring a symptomatic HCMV infection. Several recent studies described low transmission rates and mostly asymptomatically infected neonates using frozen milk. Despite different freeze-storing procedures, HCMV transmissions occurred, and severe HCMV infections were observed. Few data exist on the long-term outcome of postnatally acquired HCMV infection via breast milk. To substantiate the international debate on the use of native or inactivated milk for feeding of preterm infants, additional data are necessary for better identification of mother-infant-pairs at risk for viral transmission and symptomatic infection early after birth.
母乳喂养对人巨细胞病毒（HCMV）流行病学有重大影响。哺乳期产后HCMV再激活的发生率与母亲的血清阳性率相当。传染性病毒、病毒DNA和RNA可轻易从无细胞和无脂肪的乳清中分离出来。乳汁中病毒DNA和病毒血症的早期出现以及乳清中高病毒载量是病毒传播的母亲风险因素。HCMV再激活的动态过程可用具有个体差异的单峰动力学来描述。在无全身性HCMV感染的情况下，哺乳期病毒再激活是一个自限性的局部过程。出生体重低于1000g且胎龄低于30周的早产儿可能有获得有症状HCMV感染的高风险。最近的几项研究描述了使用冷冻乳汁时的低传播率以及大多为无症状感染的新生儿。尽管有不同的冷冻储存程序，但仍发生了HCMV传播，并观察到了严重的HCMV感染。关于通过母乳产后获得HCMV感染的长期后果的数据很少。为了证实关于使用天然或灭活乳汁喂养早产儿的国际辩论，需要更多数据以更好地识别出生后早期有病毒传播和有症状感染风险的母婴对。
