Rate of congenital CMV threefold higher in low- and middle-income countries
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Researchers identified elevated rates of congenital cytomegalovirus infection in lower income countries and advised that a “global effort” is needed to address the disease in these areas.
A systematic review and meta-analysis by scientists at the Pennsylvania State University and Lancaster University in the United Kingdom found that the pooled birth prevalence of congenital cytomegalovirus (cCMV) was threefold higher in low- and middle-income countries compared with high-income countries.
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According to the CDC, about one in every 200 infants is born with cCMV infection. Although most people with CMV do not show symptoms, about one in five babies born with cCMV will develop long-term health problems, with the most common post-childhood issues being hearing loss, vision loss, delays in developmental and motor skills, seizures and microcephaly.
Paddy Ssentongo, MD, PhD, MPH, an assistant research professor of engineering science and mechanics at Penn State, said in an interview with Healio that the idea for the study came from his work 8 years ago in Uganda, examining and treating infants with hydrocephalus, where cerebral spinal fluid accumulates in the brain and begins increasing the size of the head.
“I was so perturbed when I was working on this,” Ssentongo said. “I was like, why don't we go back to this source, all these brain effects and look for the source of the cause of the brain infection?”
Years later, Ssentongo was one of numerous doctors who contributed to a 2020 study identifying bacterial causes of encephalitis, specifically paenibacillus. Most of the children studied, he said, also had cCMV.
“We know it’s among the top causes of hearing loss in the world,” Ssentongo said. “And we know it’s the number one congenital infection ... After we identified [cCMV] being in the background of this bacteria that causes brain infection and hydrocephalus, that's what prompted us to look for the distribution, and [examine] what are the causes and the risk factors of cytomegalovirus in the entire world.”
Ssentongo and colleagues scoured over 60 years’ worth of peer-reviewed publications for studies examining birth prevalence of cCMV. Also noted were the studies’ screening methods, including whether they identified the disease through a sample of urine, blood or saliva.
The review and analysis included 77 studies from 36 countries with a total study population of more than 515,000 infants. According to the findings, the pooled overall prevalence of cCMV was 0.67% (95% CI, 0.54%-0.83%). The prevalence was 1.42% in low- and middle-income countries (95% CI, 0.97%-2.08%) and 0.48% (95% CI, 0.40%-0.59%) in high-income countries.
The researchers also identified HIV prevalence in a country’s population and low socioeconomic status as risk factors for cCMV, as well as the tendency for mothers to have CMV.
“If the population has so many mothers or women who have been infected with the fate of CMV, that population is more likely to pass on the virus for their children,” Ssentongo said.
Although the results mostly reflect those of lower income countries, American providers, Ssentongo said, should initiate a discussion about cCMV with their pregnant patients before a baby’s birth, and that it should be added to the regular test panel for infants.
“When the babies are born in the United States, it's not our common vision right now to test them or children for cCMV,” Ssentongo said. “But we would recommend that this be added to the panel of tests done in the U.S. The outcomes are not good for the development of children, so it is important to discuss right away.”
References:
CDC. Cytomegalovirus (CMV) and congenital CMV infection. https://www.cdc.gov/cmv/index.html. Accessed August 25, 2021.
Paulson JN, et al. Sci Transl Med. 2020;doi:10.1126/scitranslmed.aba0565.
Ssentongo P, et al. JAMA Netw Open. 2021;doi:10.1001/jamanetworkopen.2021.20736.
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