Department of Medical Microbiology, Leiden University Medical Center, Leiden, The Netherlands.
Rev Med Virol. 2013 Jul;23(4):241-9. doi: 10.1002/rmv.1744. Epub 2013 Apr 5.
Because maternal seropositivity for CMV is associated with substantial protection against congenital CMV infection, prevention measures have focused mainly on seronegative pregnant women for decades. However, population-wide insight in the contribution of nonprimary infection (reactivation and/or re-infection with a different strain) on the most common sequela, hearing loss, is missing. A population-based prediction model was developed to estimate the proportion of congenital CMV-related hearing loss resulting from nonprimary maternal infection. Incorporated was a meta-analysis of the risk of hearing loss, calculating pooled proportions of children with hearing loss after nonprimary and primary infection. Subsequently, the model was applied for worldwide present population seroprevalences (range 30-95%). It was estimated that, for all population seroprevalences, nonprimary maternal infections are responsible for the majority of congenital CMV infections. This proportion increased with seroprevalence, ranging from 57% (95%CI 24-85%) to 96% (95% CI 88-99%) for seroprevalences of 30% to 95%. Our meta-analysis (six reports) showed that the risk of hearing loss after nonprimary infection was 11% (28/253 children, 95% CI 7-15%) versus 13% (50/385 children, 95% CI 10-16%) after primary infection. Incorporating this risk into our model, we estimated that nonprimary infections also accounted for the majority of CMV-related hearing loss. This proportion ranged from 53% (95% CI 13-86%) to 95% (95% CI 62-99%) for seroprevalences of 30% to 95%. Our data underline the worldwide contribution of nonprimary infections in causing CMV-related hearing loss. These results imply that prevention research such as vaccine and hygiene studies should not only be directed at seronegative but also seropositive pregnant women.
由于母体 CMV 血清阳性与先天性 CMV 感染有实质性保护作用，预防措施几十年来主要集中在血清阴性孕妇身上。然而，对于最常见的后遗症——听力损失，人群对非原发性感染（再激活和/或不同毒株的再感染）的贡献缺乏了解。建立了一个基于人群的预测模型，以估计非原发性母体感染引起的先天性 CMV 相关听力损失的比例。该模型纳入了对听力损失风险的荟萃分析，计算了非原发性和原发性感染后儿童听力损失的合并比例。随后，该模型被应用于全球目前的人群血清流行率（范围为 30-95%）。据估计，对于所有人群血清流行率，非原发性母体感染是先天性 CMV 感染的主要原因。随着血清流行率的增加，这一比例从 30%流行率的 57%（95%CI 24-85%）到 95%流行率的 96%（95%CI 88-99%）。我们的荟萃分析（六项报告）显示，非原发性感染后听力损失的风险为 11%（253 名儿童中的 28 名，95%CI 7-15%），而原发性感染后为 13%（385 名儿童中的 50 名，95%CI 10-16%）。将这一风险纳入我们的模型，我们估计非原发性感染也导致了大多数 CMV 相关的听力损失。在 30%至 95%的血清流行率范围内，这一比例从 53%（95%CI 13-86%）到 95%（95%CI 62-99%）不等。我们的数据强调了非原发性感染在导致 CMV 相关听力损失方面的全球贡献。这些结果意味着，预防研究，如疫苗和卫生研究，不仅应针对血清阴性孕妇，还应针对血清阳性孕妇。
