Njeru D G, Mwanda W O, Kitonyi G W, Njagi E C
Haematology and Blood Transfusion Unit, Department of Human Pathology, School of Medicine, University of Nairobi, P.O. Box 19676-00202, Nairobi, Kenya.
East Afr Med J. 2009 Dec;86(12 Suppl):S58-61. doi: 10.4314/eamj.v86i12.62903.
Cytomegalovirus (CMV) infection in susceptible patients is associated with serious morbidity and a high mortality. Transmission of cytomegalovirus infection through blood transfusion is markedly reduced by transfusion of CMV seronegative blood products, or by transfusion of leucodepleted blood products.
To determine the prevalence CMV IgG and IgM antibodies among blood donors at the National Blood Transfusion Services (NBTS), Nairobi.
Cross-sectional descriptive study.
Four hundred participants were recruited from blood donors at the NBTS and testing was done at the Kenyatta National Hospital (KNH) immunology laboratories and the NBTC.
Social demographic data and the CMV serologic status for the participants was determined and documented as being positive or negative for immunoglobulin G (IgG) and immunoglobulin M (IgM). The age, gender, marital status, education level and geographical area of residence of the participants were documented. Corresponding results of HIV, hepatitis B antigen, hepatitis C antibody from the patients were obtained from the NBTS.
Majority of the blood donors recruited were male at 57.9%. Most blood donors were aged 16-20 years (42.5%) and only 17.2% were above 30 years of age. Unmarried blood donors, those with secondary school education and an income between Kshs 5000 (US $67) and KShs 50,000 (US$ 667) monthly were the majority at 78.5%, 54.8% and 66.1% respectively. Sexually active blood donors constituted 60.5% of the donors recruited. Positivity for transfusion transmissible infections (TTI) tested was 1.3%, 0.3%, 2.3% and 1.0% for human immunodeficiency virus (HIV), syphilis, hepatitis B and hepatitis C respectively. Anti- CMV IgG and IgM positivity was 97.0%, (95% CI 96.45-97.53%), and 3.6% (95% CI 1.7-5.2%), respectively. There was no statistical difference between different ages, marital status, salary, individual's sexuality in the prevalence of CMV antibodies. However females had a higher prevalence of CMV antibodies.
There is a very high prevalence of cytomegalovirus antibodies among blood donors at the NBTS, with virtually all blood donors having been exposed to the virus. Since the CMV remains latent within leucocytes after infection inspite of the prescence of antibodies in seropositive individuals, leucoreduction of blood products is recommended before transfusion to seronegative susceptible patients. In Kenya, susceptible groups of patients include very low birthweight babies, patients with acquired immune deficiency syndrome (AIDS) due to human immunodeficiency virus infections (HIV) patients, patients on myelosuppressive cancer therapy and recipients of kidney transplants. Further studies are recomended to determine the prevalence of CMV antibodies in these patients in order to establish the magnitude of the demand for CMV safe blood.
易感患者的巨细胞病毒（CMV）感染与严重发病和高死亡率相关。通过输注CMV血清阴性血液制品或白细胞滤除血液制品，可显著降低CMV感染通过输血传播的风险。
确定内罗毕国家输血服务中心（NBTS）献血者中CMV IgG和IgM抗体的流行率。
横断面描述性研究。
从NBTS的献血者中招募了400名参与者，并在肯雅塔国家医院（KNH）免疫实验室和NBTC进行检测。
确定并记录参与者的社会人口统计学数据以及CMV血清学状态，记录其免疫球蛋白G（IgG）和免疫球蛋白M（IgM）呈阳性或阴性。记录参与者的年龄、性别、婚姻状况、教育水平和居住地理区域。从NBTS获取患者相应的HIV、乙肝抗原、丙肝抗体检测结果。
招募的献血者中大多数为男性，占57.9%。大多数献血者年龄在16 - 20岁之间（42.5%），只有17.2%的献血者年龄在30岁以上。未婚献血者、接受过中学教育且月收入在5000肯尼亚先令（67美元）至50000肯尼亚先令（667美元）之间的献血者分别占多数，比例分别为78.5%、54.8%和66.1%。有性活动的献血者占招募献血者的60.5%。检测的输血传播感染（TTI）阳性率分别为：人类免疫缺陷病毒（HIV）1.3%、梅毒0.3%、乙肝2.3%、丙肝1.0%。抗CMV IgG和IgM阳性率分别为97.0%（95%可信区间96.45 - 97.53%）和3.6%（95%可信区间1.7 - 5.2%）。不同年龄、婚姻状况、薪资、个人性行为在CMV抗体流行率方面无统计学差异。然而，女性CMV抗体流行率较高。
NBTS献血者中巨细胞病毒抗体流行率非常高，几乎所有献血者都曾接触过该病毒。由于尽管血清阳性个体中有抗体，但CMV感染后仍潜伏在白细胞内，因此建议对血清阴性的易感患者输血前对血液制品进行白细胞滤除。在肯尼亚，易感患者群体包括极低出生体重儿、因人类免疫缺陷病毒（HIV）感染导致获得性免疫缺陷综合征（AIDS）的患者、接受骨髓抑制性癌症治疗的患者以及肾移植受者。建议进一步研究以确定这些患者中CMV抗体的流行率，从而确定对CMV安全血液的需求量。
