Congenital cytomegalovirus, parvovirus and enterovirus infection in Mozambican newborns at birth: A cross-sectional survey

PLoS One. 2018 Mar 14;13(3):e0194186. doi: 10.1371/journal.pone.0194186. eCollection 2018.

Abstract

Background: Congenital cytomegalovirus (cCMV) infection is the most prevalent congenital infection acquired worldwide, with higher incidence in developing countries and among HIV-exposed children. Less is known regarding vertical transmission of parvovirus B19 (B19V) and enterovirus (EV). We aimed to assess the prevalence of CMV, B19V and EV vertical transmission and compare results of screening of congenital CMV obtained from two different specimens in a semirural Mozambican maternity.

Methods: A cross sectional study was conducted among pregnant mothers attending Manhiça District Hospital upon delivery. Information on maternal risk factors was ascertained. Dried umbilical cord (DUC) samples were collected in filter paper for CMV, B19V and EV detection by real-time polymerase chain reaction (RT-PCR), and nasopharyngeal aspirates (NPA) to test for CMV by RT-PCR. Maternal blood samples and placental biopsy samples were also obtained to investigate CMV maternal serology, HIV status and immunopathology.

Results: From September 2014 to January 2015, 118 mothers/newborn pairs were recruited. Prevalence of maternal HIV infection was 31.4% (37/118). CMV RT-PCR was positive in 3/115 (2.6%) of DUC samples and in 3/96 (6.3%) of NPA samples obtained from neonates. The concordance of the RT-PCR assay through DUC with their correspondent NPA sample was moderate (Kappa = 0.42 and p<0.001. No differences on cCMV prevalence were found among HIV-exposed and unexposed. All (100%) mothers were seropositive for CMV IgG. RT-PCR of EV and B19V in DUC were both negative in all screened cases. No histological specific findings were found in placental tissues. No risk factors associated to vertical transmission of these viral infections were found.

Conclusions: This study indicates the significant occurrence of vertical transmission of CMV in southern Mozambique. Larger studies are needed to evaluate the true burden, clinical relevance and consequences of congenital infections with such pathogens in resource-constrained settings.

Publication types

  • Clinical Trial
  • Multicenter Study
  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Cross-Sectional Studies
  • Cytomegalovirus Infections* / congenital
  • Cytomegalovirus Infections* / epidemiology
  • Cytomegalovirus Infections* / transmission
  • Enterovirus Infections* / blood
  • Enterovirus Infections* / congenital
  • Enterovirus Infections* / epidemiology
  • Enterovirus Infections* / transmission
  • Erythema Infectiosum* / blood
  • Erythema Infectiosum* / congenital
  • Erythema Infectiosum* / epidemiology
  • Erythema Infectiosum* / transmission
  • Female
  • Humans
  • Infant, Newborn
  • Infectious Disease Transmission, Vertical*
  • Male
  • Mozambique
  • Pilot Projects
  • RNA, Viral / blood
  • Reverse Transcriptase Polymerase Chain Reaction

Substances

  • RNA, Viral

Grants and funding

Quique Bassat had during the duration of the study a fellowship from the program Miguel Servet of the ISCIII (Plan Nacional de I+D+I 2008-2011, grant number: CP11/00269). Lola Madrid had a fellowship from the program Río Hortega of the ISCIII (CM13/00260). Rosauro Varo has a fellowship from the program Rio Hortega of the ISCIII (CD16/00024). CISM receives financial support from the Spanish Agency for International Cooperation. ISGlobal is a member of the CERCA Programme, Generalitat de Catalunya. SM, TN, CMA, EJC, CE, CC, MI, BV, VF, CLD and CM have nothing to declare. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.