Cytomegalovirus Infections in Ugandan Infants: Newborns, Neonates with Sepsis and Infants with Hydrocephalus
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Date
2019Author
Hehnly, Christine
Ssentongo, Paddy
Bebell, Lisa M.
Burgoine, Kathy
Bazira, Joel
Fronterre, Claudio
Kumbakumba, Elias
Mulondo, Ronald
Mbabazi-Kabachelor, Edith
Morton, Sarah U.
Ngonzi, Joseph
Ochora, Moses
Olupot-Olupot, Peter
Onen, Justin
Roberts, Drucilla J.
Sheldon, Kathryn
Sinnar, Shamim A.
Smith, Jasmine
Ssenyonga, Peter
Paulson, Joseph N.
Meier, Frederick A.
Ericson, Jessica E.
Broach, James R.
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Background: Congenital and postnatal cytomegalovirus (CMV) infections in Uganda is prevalent and may compromise the health of Ugandan children. The objective of this study is to
estimate the prevalence of CMV infections in newborns, neonates with sepsis, and infants with
hydrocephalus in Uganda.
Methods: Three populations: (1) newborn-mother pairs, (2) neonates with sepsis, and (3) infants
(≤ 3 months) with non-postinfectious (NPIH) or postinfectious (PIH) hydrocephalus, were
evaluated over four years (2016-2019) for CMV infection at three medical centers – two in the
Eastern (Mbale) and one in Western (Mbarara) Uganda. To characterize the prevalence of CMV
we used quantitative PCR (qPCR) analysis. In newborn-mother pairs maternal blood (n=99) and
a subset of matching cord blood (n=92), placental tissue (n=99), and vaginal specimens (n=99)
were tested for CMV. In neonates and infants aged 3 months or less, peripheral blood (751 with
sepsis, 399 with hydrocephalus) and cerebrospinal fluid samples (560 with sepsis, 399 with
hydrocephalus (205 PIH, 194 NPIH) were also tested for CMV.
Findings: The overall CMV prevalence across all groups was 9%. In newborn-mother pairs, a
3% (n=3/92; 95% CI, 1-9%) prevalence of cord blood positivity and 33% (n=33/99; 95% CI, 24-
44%) prevalence of maternal vaginal shedding of CMV was estimated. In neonates with clinical
sepsis, a 2% (n=17/751; 95% CI, 1-4%) CMV prevalence was estimated. Maternal HIV
seropositivity (adjusted odds ratio [aOR], 21.09; 95% CI, 4-109; p= 0.0002), residence in
Eastern Uganda (aOR, 11.10; 95% CI, 3-77; p=0 .003), maternal age < 25 years (aOR, 4.91; 95%
CI, 2-20; p=0.012), and older neonatal age (9 days vs. 5 days; p= 0.006) were associated with
CMV in neonates with clinical sepsis. In infants with PIH, the prevalence in blood was 24%
(n=50/205; 95% CI, 19-31%) and in infants with NPIH it was 20% (n=39/194; 95% CI, 15-26%; p=0.34). CMV was present in the CSF of 13% (n=26/205; 95% CI, 8-18%) of infants with PIH
compared to 0.5% of infants with NPIH (n=1/194; 95% CI, 0-3%, p<0.0001).
Interpretation: Our findings highlight that congenital and postnatal CMV prevalence is high in
this African setting and the associated complications may be significant. Universal testing and
longitudinal studies are critical to understand the burden infant CMV has in sub-Saharan African
countries.
Funding: U.S. National Institutes of Health (N.I.H) Director’s Pioneer Award 5DP1HD086071
and NIH Director’s Transformative Award 1R01AI145057.
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