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Nonprimary Maternal Cytomegalovirus Infection After Viral Shedding in Infants
Isabelle Boucoiran1, Bryan T Mayer2, Elizabeth M Krantz2
1Department of Pediatrics, University of British Columbia, BC Children's Hospital, Vancouver, British Columbia, Canada.
The Pediatric Infectious Disease Journal
|June 12, 2018
Summary
Maternal nonprimary Cytomegalovirus (CMV) infection is common after infant CMV infection, suggesting "ping-pong" transmission within households. This highlights the need to understand CMV transmission dynamics between children and mothers.
Area of Science:
- Virology
- Infectious Diseases
- Pediatrics
Background:
- Congenital Cytomegalovirus (CMV) infection in infants often results from maternal nonprimary infection (reinfection or reactivation).
- Infant-to-mother CMV transmission is known, but the frequency and scale of maternal nonprimary infection following household exposure to shedding children remain uncharacterized.
Purpose of the Study:
- To investigate the frequency and risk factors for nonprimary Cytomegalovirus (CMV) infection in mothers exposed to viral shedding from their infants.
- To characterize the magnitude and duration of CMV shedding in mothers with nonprimary infection.
Main Methods:
- A cohort study in Uganda involving weekly quantitative polymerase chain reaction testing of infant and maternal oral swabs for CMV.
- Defining infant primary and maternal nonprimary infection by persistent high-level oral CMV shedding.
- Utilizing strain-specific antibody testing and Cox regression models to analyze risk factors for maternal nonprimary infection.
Main Results:
- Nonprimary CMV infection occurred in 15 of 30 mothers, typically within 6 weeks of their infants' primary infection.
- Maternal oral shedding lasted a median of 18 weeks, with a median viral load of 4.69 log copies/mL.
- Infant CMV shedding levels strongly predicted maternal nonprimary infection (HR: 2.32 per log10 DNA copies/swab increase).
Conclusions:
- Nonprimary CMV infection is frequent in mothers following infant primary infection, indicating significant infant-to-mother transmission.
- The findings suggest a potential
- ping-pong
- transmission cycle of CMV between infants and mothers.
- Further research is required to elucidate the specific CMV strains transmitted within these mother-infant dyads.
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