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Atyeo N, Maldonado J, Warner B, Chiorini J. Salivary Glands and Viral Pathogenesis. J Dent Res 2024; 103:227-234. [PMID: 38344753 PMCID: PMC10985391 DOI: 10.1177/00220345231222871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2024] Open
Abstract
The oral cavity is an epidemiologically relevant route of viral transmission due to the shedding of viruses in saliva. With advancements in salivary diagnostics, an increasing number of viruses have been detected. However, the anatomic source of virus in saliva is still largely unknown. Some viruses have a well-established tropism for the salivary glands (SGs), and recent studies have emphasized the importance of the glands as potential reservoirs for infectious viruses. Viral infections of the SGs have been linked to acute and chronic SG pathology and may be associated with SG dysfunction, with phenotypes similar to those seen in SjÖgren's disease (SjD), an autoimmune condition that affects the salivary and lacrimal glands. Understanding the breadth of viruses that infect the SG and the conserved or distinct host responses to these infections may provide insights into the pathogenesis of virus-mediated SG diseases. There is a need for further research to fully understand the molecular mechanisms by which viruses enter and replicate in the glands, their physiologic impact on SG function, and whether the SGs can serve as a long-term reservoir for infectious viral particles. The purpose of this review is to highlight a group of viruses that infect the salivary gland: hepatitis C virus, hepatitis D virus, severe acute respiratory syndrome coronavirus 2, enteric viruses, human T-cell leukemia virus type I, human immunodeficiency virus, human cytomegalovirus, and BK polyomavirus. We focus on the effects of viral infection on salivary gland (SG) inflammation, function, and its association with SjD.
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Affiliation(s)
- N. Atyeo
- National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD, USA
| | - J.O. Maldonado
- National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD, USA
- Center for Oral Health Integration, HealthPartners Institute, Bloomington, MN, USA
- Department of Diagnostic and Biological Sciences, School of Dentistry, University of Minnesota, Minneapolis, MN, USA
| | - B.M. Warner
- National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD, USA
| | - J.A. Chiorini
- National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD, USA
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2
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Barry PA, Iyer SS, Gibson L. Re-Evaluating Human Cytomegalovirus Vaccine Design: Prediction of T Cell Epitopes. Vaccines (Basel) 2023; 11:1629. [PMID: 38005961 PMCID: PMC10674879 DOI: 10.3390/vaccines11111629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 10/05/2023] [Accepted: 10/09/2023] [Indexed: 11/26/2023] Open
Abstract
HCMV vaccine development has traditionally focused on viral antigens identified as key targets of neutralizing antibody (NAb) and/or T cell responses in healthy adults with chronic HCMV infection, such as glycoprotein B (gB), the glycoprotein H-anchored pentamer complex (PC), and the unique long 83 (UL83)-encoded phosphoprotein 65 (pp65). However, the protracted absence of a licensed HCMV vaccine that reduces the risk of infection in pregnancy regardless of serostatus warrants a systematic reassessment of assumptions informing vaccine design. To illustrate this imperative, we considered the hypothesis that HCMV proteins infrequently detected as targets of T cell responses may contain important vaccine antigens. Using an extant dataset from a T cell profiling study, we tested whether HCMV proteins recognized by only a small minority of participants encompass any T cell epitopes. Our analyses demonstrate a prominent skewing of T cell responses away from most viral proteins-although they contain robust predicted CD8 T cell epitopes-in favor of a more restricted set of proteins. Our findings raise the possibility that HCMV may benefit from evading the T cell recognition of certain key proteins and that, contrary to current vaccine design approaches, including them as vaccine antigens could effectively take advantage of this vulnerability.
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Affiliation(s)
- Peter A. Barry
- Department of Pathology and Laboratory Medicine, Center for Immunology and Infectious Diseases, University of California Davis School of Medicine, Sacramento, CA 95817, USA;
- California National Primate Research Center, University of California, Davis, CA 95616, USA
| | - Smita S. Iyer
- Department of Pathology, University of Pittsburgh, Pittsburgh, PA 15261, USA;
| | - Laura Gibson
- Departments of Medicine and of Pediatrics, Infectious Diseases and Immunology, University of Massachusetts Chan Medical School, Worcester, MA 01655, USA
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3
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d'Angelo P, Zelini P, Zavaglio F, Piccini S, Cirasola D, Arossa A, Spinillo A, Lilleri D, Baldanti F. Correlates of postnatal human cytomegalovirus transmission in term babies in the first year. J Med Virol 2023; 95:e29105. [PMID: 37728300 DOI: 10.1002/jmv.29105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 09/04/2023] [Accepted: 09/05/2023] [Indexed: 09/21/2023]
Abstract
Postnatal human cytomegalovirus (HCMV) infection in newborns is well characterized for preterm infants but less so for term infants. We sought to analyze the rates and routes of HCMV transmission in full-term infants during the first year of life. A cohort of 120 HCMV seropositive mothers and their 122 newborns were tested after delivery for HCMV-DNA shedding in different bodily fluids. Postnatal HCMV infection was defined as the detection of >2.5 × 102 HCMV-DNA copies/mL in infants' saliva swabs. Maternal neutralizing antibody serum titer, HCMV-specific T-cell response, and HCMV glycoprotein B immunoglobulin G on breastmilk were analyzed. HCMV shedding was detected in 67 of 120 mothers (55.8%), and 20 of 122 infants (16.4%) developed HCMV infection within the first 3 months of life. Six additional infants were infected during the first year, for a postnatal infection rate of 21.3%. Viral shedding was more frequent in breastmilk than saliva, urine, and vaginal secretions, and the mothers of infected infants showed higher levels of HCMV-DNA in milk. No association was found between the antibody levels in serum or milk and maternal viral shedding, whereas a slightly lower frequency of HCMV-specific CD4+ T-cells with long-term memory phenotype was observed in women with HCM-DNA-positive milk. About one out of five infants develop HCMV infection within the first year of life. Breastmilk appears the major route of transmission of the infection, maternal saliva has a minor role whereas the role of vaginal secretions is negligible.
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Affiliation(s)
- Piera d'Angelo
- Molecular Virology Unit, Microbiology and Virology Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Paola Zelini
- Molecular Virology Unit, Microbiology and Virology Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Federica Zavaglio
- Molecular Virology Unit, Microbiology and Virology Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Stefania Piccini
- Department of Obstetric and Gynecology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Daniela Cirasola
- Microbiology and Virology Analysis Laboratory, Humanitas Research Hospital, Milano, Italy
| | - Alessia Arossa
- Department of Obstetric and Gynecology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Arsenio Spinillo
- Department of Obstetric and Gynecology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Department of Clinical, Surgical, Diagnostics and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Daniele Lilleri
- Molecular Virology Unit, Microbiology and Virology Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Fausto Baldanti
- Molecular Virology Unit, Microbiology and Virology Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Department of Clinical, Surgical, Diagnostics and Pediatric Sciences, University of Pavia, Pavia, Italy
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4
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Fowler K, Mucha J, Neumann M, Lewandowski W, Kaczanowska M, Grys M, Schmidt E, Natenshon A, Talarico C, Buck PO, Diaz-Decaro J. A systematic literature review of the global seroprevalence of cytomegalovirus: possible implications for treatment, screening, and vaccine development. BMC Public Health 2022; 22:1659. [PMID: 36050659 PMCID: PMC9435408 DOI: 10.1186/s12889-022-13971-7] [Citation(s) in RCA: 49] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 08/08/2022] [Indexed: 11/15/2022] Open
Abstract
Background Cytomegalovirus (CMV) is a common pathogen that affects individuals of all ages and establishes lifelong latency. Although CMV is typically asymptomatic in healthy individuals, infection during pregnancy or in immunocompromised individuals can cause severe disease. Currently, treatments are limited, with no prophylactic vaccine available. Knowledge of the current epidemiologic burden of CMV is necessary to understand the need for treatment and prevention. A systematic literature review (SLR) was conducted to describe the most recent epidemiologic burden of CMV globally. Methods Medline, Embase, and LILACS were searched to identify data on CMV prevalence, seroprevalence, shedding, and transmission rates. The SLR covered the time period of 2010–2020 and focused geographically on Australia, Europe, Israel, Japan, Latin America (LATAM), and North America. Studies were excluded if they were systematic or narrative reviews, abstracts, case series, letters, or correspondence. Studies with sample sizes < 100 were excluded to focus on studies with higher quality of data. Results Twenty-nine studies were included. Among adult men, CMV immunoglobulin G (IgG) seroprevalence ranged from 39.3% (France) to 48.0% (United States). Among women of reproductive age in Europe, Japan, LATAM, and North America, CMV IgG seroprevalence was 45.6-95.7%, 60.2%, 58.3-94.5%, and 24.6-81.0%, respectively. Seroprevalence increased with age and was lower in developed than developing countries, but data were limited. No studies of CMV immunoglobulin M (IgM) seroprevalence among men were identified. Among women of reproductive age, CMV IgM seroprevalence was heterogenous across Europe (1.0-4.6%), North America (2.3-4.5%), Japan (0.8%), and LATAM (0-0.7%). CMV seroprevalence correlated with race, ethnicity, socioeconomic status, and education level. CMV shedding ranged between 0% and 70.2% depending on age group. No findings on CMV transmission rates were identified. Conclusions Certain populations and regions are at a substantially higher risk of CMV infection. The extensive epidemiologic burden of CMV calls for increased efforts in the research and development of vaccines and treatments. Trial registration N/A. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13971-7.
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Affiliation(s)
- Karen Fowler
- University of Alabama at Birmingham, Birmingham, AL, USA
| | | | | | | | | | | | | | | | - Carla Talarico
- Moderna, Inc., 200 Technology Square, Cambridge, MA, 02139, USA
| | - Philip O Buck
- Moderna, Inc., 200 Technology Square, Cambridge, MA, 02139, USA
| | - John Diaz-Decaro
- Moderna, Inc., 200 Technology Square, Cambridge, MA, 02139, USA.
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5
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Human cytomegalovirus (HCMV) long-term shedding and HCMV-specific immune response in pregnant women with primary HCMV infection. Med Microbiol Immunol 2022; 211:249-260. [PMID: 35960328 DOI: 10.1007/s00430-022-00747-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 07/21/2022] [Indexed: 10/15/2022]
Abstract
Human cytomegalovirus (HCMV) shedding has been extensively investigated in newborns and in young children, however, much less is known about it in immunocompetent adults. Shedding of HCMV was investigated in saliva, vaginal secretions and urine of pregnant women experiencing primary infection along with the development of the HCMV-specific immune response. Thirty-three pregnant women shed HCMV DNA in peripheral biological fluids at least until one year after onset of infection, while in blood HCMV DNA was cleared earlier. Significantly higher levels of viral load were found in vaginal secretions compared to saliva and urine. All subjects examined two years after the onset of infection showed a high avidity index, with IgM persisting in 36% of women. Viral load in blood was directly correlated with levels of HCMV-specific IgM and inversely correlated with levels of IgG specific for the pentameric complex gH/gL/pUL128L; in addition, viral load in blood was inversely correlated with percentage of HCMV-specific CD4+ and CD8+ expressing IL-7R (long-term memory, LTM) while viral load in biological fluids was inversely correlated with percentage of HCMV-specific CD4+ and CD8+ effector memory RA+(TEMRA). In conclusion, viral shedding during primary infection in pregnancy persists in peripheral biological fluids for at least one year and the development of both antibodies (including those directed toward the pentameric complex) and memory T cells are associated with viral clearance.
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6
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Li J, Wellnitz S, Chi XS, Yue Y, Schmidt KA, Nguyen N, Chen W, Yurgelonis I, Rojas E, Liu Y, Loschko J, Pollozi E, Matsuka YV, Needle E, Vidunas E, Donald RGK, Moran J, Jansen KU, Dormitzer PR, Barry PA, Yang X. Horizontal transmission of cytomegalovirus in a rhesus model despite high-level, vaccine-elicited neutralizing antibody and T cell responses. J Infect Dis 2022; 226:585-594. [PMID: 35413121 PMCID: PMC10147388 DOI: 10.1093/infdis/jiac129] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 04/07/2022] [Indexed: 11/14/2022] Open
Abstract
The development of a vaccine to prevent congenital human cytomegalovirus (HCMV) disease is a public health priority. We tested rhesus CMV (RhCMV) prototypes of HCMV vaccine candidates in a seronegative macaque oral challenge model. Immunogens included a recombinant pentameric complex (PC; gH/gL/pUL128/pUL130/pUL131A), a postfusion gB ectodomain, and a DNA plasmid that encodes pp65-2. Immunization with QS21-adjuvanted PC alone or with the other immunogens elicited neutralizing titers comparable to those elicited by RhCMV infection. Similarly, immunization with all three immunogens elicited pp65-specific cytotoxic T cell responses comparable to those elicited by RhCMV infection. RhCMV readily infected immunized animals and was detected in saliva, blood and urine after challenge in quantities similar to those in placebo-immunized animals. If HCMV evades vaccine-elicited immunity in humans as RhCMV evaded immunity in macaques, a HCMV vaccine must elicit immunity superior to, or different from, that elicited by the prototype RhCMV vaccine to block horizontal transmission.
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Affiliation(s)
- Julia Li
- Vaccine Research and Development, Pfizer Inc., Pearl River, New York 10965, USA
| | - Sabine Wellnitz
- Vaccine Research and Development, Pfizer Inc., Pearl River, New York 10965, USA
| | - Xiaoyuan S Chi
- Vaccine Research and Development, Pfizer Inc., Pearl River, New York 10965, USA
| | - Yujuan Yue
- Center for Comparative Medicine, University of California, Davis, Davis, CA 95616, USA
| | - Kimberli A Schmidt
- Center for Comparative Medicine, University of California, Davis, Davis, CA 95616, USA
| | - Nancy Nguyen
- Center for Comparative Medicine, University of California, Davis, Davis, CA 95616, USA
| | - Wei Chen
- Vaccine Research and Development, Pfizer Inc., Pearl River, New York 10965, USA
| | - Irina Yurgelonis
- Vaccine Research and Development, Pfizer Inc., Pearl River, New York 10965, USA
| | - Eduardo Rojas
- Vaccine Research and Development, Pfizer Inc., Pearl River, New York 10965, USA
| | - Yuhang Liu
- Groton Center for Chemistry, Pfizer Inc., Groton, CT 06340, USA
| | - Jakob Loschko
- Vaccine Research and Development, Pfizer Inc., Pearl River, New York 10965, USA
| | - Eneida Pollozi
- Vaccine Research and Development, Pfizer Inc., Pearl River, New York 10965, USA
| | - Yury V Matsuka
- Vaccine Research and Development, Pfizer Inc., Pearl River, New York 10965, USA
| | - Elie Needle
- Vaccine Research and Development, Pfizer Inc., Pearl River, New York 10965, USA
| | - Eugene Vidunas
- Vaccine Research and Development, Pfizer Inc., Pearl River, New York 10965, USA
| | - Robert G K Donald
- Vaccine Research and Development, Pfizer Inc., Pearl River, New York 10965, USA
| | - Justin Moran
- Vaccine Research and Development, Pfizer Inc., Pearl River, New York 10965, USA
| | - Kathrin U Jansen
- Vaccine Research and Development, Pfizer Inc., Pearl River, New York 10965, USA
| | - Philip R Dormitzer
- Vaccine Research and Development, Pfizer Inc., Pearl River, New York 10965, USA
| | - Peter A Barry
- Center for Comparative Medicine, University of California, Davis, Davis, CA 95616, USA.,Department of Pathology and Laboratory Medicine, University of California, Davis, Davis, CA 95616, USA.,California National Primate Research Center, University of California, Davis, Davis, CA 95616, USA
| | - Xinzhen Yang
- Vaccine Research and Development, Pfizer Inc., Pearl River, New York 10965, USA
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7
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Geris JM, Spector LG, Roesler M, Hernandez-Alvarado N, Blackstad M, Nelson HH, Schleiss MR. High prevalence of asymptomatic CMV shedding in healthy children attending the minnesota state fair. J Clin Virol 2022; 148:105102. [PMID: 35158280 PMCID: PMC8918022 DOI: 10.1016/j.jcv.2022.105102] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 02/01/2022] [Accepted: 02/05/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Young children in the household are a known risk factor for maternal CMV infection and consequently, congenital infection in infants. However, little is known about viral shedding in pre-school aged children. OBJECTIVES To estimate the prevalence of CMV DNA shedding and CMV antibodies among healthy children and their mothers. STUDY DESIGN A study of children ages 0 through 5 years was undertaken at the 2019 Minnesota State Fair. Children and their mothers were assessed for CMV shedding by procurement of a saliva swab for CMV PCR testing. An optional finger-stick for capillary blood was used to assess CMV antibodies. RESULTS A total of 109 children and 85 mothers were enrolled. The prevalence of CMV saliva shedding among children (mean age 3.1 years, SE=0.16) and their mothers was 12/109 (11.0%) and 1/85 (1.2%), respectively. The prevalence of CMV DNA among children peaked at 3 years of age (26%) while the mean viral load was greatest at one year of age (236,693 IU/mL). CMV IgG antibodies among those who agreed to a finger-stick were detected in 16/35 mothers (45.7%) and 0/7 children (0%). Mothers of children aged 5 years or greater had the highest seroprevalence (61.5%). CONCLUSIONS The prevalence of CMV salivary shedding in this unselected sample of young children was approximately 11.0%. The overall maternal seroprevalence in our sample was <50%, suggesting these women are at risk for acquisition of a primary CMV infection in subsequent pregnancies.
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Affiliation(s)
- Jennifer M Geris
- Division of Epidemiology & Clinical Research, Department of Pediatrics, University of Minnesota, Minneapolis MN, USA; Institute for Molecular Virology, University of Minnesota, Minneapolis MN, USA.
| | - Logan G Spector
- Division of Epidemiology & Clinical Research, Department of Pediatrics, University of Minnesota, Minneapolis MN, USA
| | - Michelle Roesler
- Division of Epidemiology & Clinical Research, Department of Pediatrics, University of Minnesota, Minneapolis MN, USA
| | - Nelmary Hernandez-Alvarado
- Division of Pediatric Infectious Diseases and Immunology, Department of Pediatrics, University of Minnesota, Minneapolis MN, USA
| | - Mark Blackstad
- Division of Pediatric Infectious Diseases and Immunology, Department of Pediatrics, University of Minnesota, Minneapolis MN, USA
| | - Heather H Nelson
- Division of Epidemiology & Community Health, University of Minnesota School of Public Health, Minneapolis MN, USA
| | - Mark R Schleiss
- Institute for Molecular Virology, University of Minnesota, Minneapolis MN, USA; Division of Pediatric Infectious Diseases and Immunology, Department of Pediatrics, University of Minnesota, Minneapolis MN, USA
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8
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Tan NK, Pope CF, Carrington D. Screening for cytomegalovirus shedding in vagina and saliva: Significant differences between biological fluids, swab types and storage durations in DNA recovery. J Clin Virol 2022; 146:105055. [DOI: 10.1016/j.jcv.2021.105055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 12/06/2021] [Accepted: 12/11/2021] [Indexed: 10/19/2022]
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9
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Pathogenesis of wild-type-like rhesus cytomegalovirus strains following oral exposure of immune-competent rhesus macaques. J Virol 2021; 96:e0165321. [PMID: 34788083 DOI: 10.1128/jvi.01653-21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Rhesus cytomegalovirus (RhCMV) infection of rhesus macaques (Macaca mulatta) is a valuable nonhuman primate model of human CMV (HCMV) persistence and pathogenesis. In vivo studies predominantly use tissue culture-adapted variants of RhCMV that contain multiple genetic mutations compared to wild-type (WT) RhCMV. In many studies, animals have been inoculated by non-natural routes (e.g., subcutaneous, intravenous) that do not recapitulate disease progression via the normative route of mucosal exposure. Accordingly, the natural history of RhCMV would be more accurately reproduced by infecting macaques with strains of RhCMV that reflect the WT genome using natural routes of mucosal transmission. Herein, we tested two WT-like RhCMV strains, UCD52 and UCD59, and demonstrated that systemic infection and frequent, high-titer viral shedding in bodily fluids occurred following oral inoculation. RhCMV disseminated to a broad range of tissues, including the central nervous system and reproductive organs. Commonly infected tissues included the thymus, spleen, lymph nodes, kidneys, bladder, and salivary glands. Histological examination revealed prominent nodular hyperplasia in spleens and variable levels of lymphoid lymphofollicular hyperplasia in lymph nodes. One of six inoculated animals had limited viral dissemination and shedding, with commensurately weak antibody responses to RhCMV antigens. These data suggest that long-term RhCMV infection parameters might be restricted by local innate factors and/or de novo host immune responses in a minority of primary infections. Together, we have established an oral RhCMV infection model that mimics natural HCMV infection. The virological and immunological parameters characterized in this study will greatly inform HCMV vaccine designs for human immunization. IMPORTANCE Human cytomegalovirus (HCMV) is globally ubiquitous with high seroprevalence rates in all communities. HCMV infections can occur vertically following mother-to-fetus transmission across the placenta and horizontally following shedding of virus in bodily fluids in HCMV infected hosts and subsequent exposure of susceptible individuals to virus-laden fluids. Intrauterine HCMV has long been recognized as an infectious threat to fetal growth and development. Since vertical HCMV infections occur following horizontal HCMV transmission to the pregnant mother, the nonhuman primate model of HCMV pathogenesis was used to characterize the virological and immunological parameters of infection following primary mucosal exposures to rhesus cytomegalovirus.
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Blostein F, Foote S, Salzman E, McNeil DW, Marazita ML, Martin ET, Foxman B. Associations Between Salivary Bacteriome Diversity and Salivary Human Herpesvirus Detection in Early Childhood: A Prospective Cohort Study. J Pediatric Infect Dis Soc 2021; 10:856-863. [PMID: 34173666 PMCID: PMC8459089 DOI: 10.1093/jpids/piab044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 05/26/2021] [Indexed: 11/13/2022]
Abstract
BACKGROUND The bacteriome is associated with susceptibility to some eukaryotic viruses, but no study has examined associations between the salivary bacteriome and human herpesviruses (HHVs). We provide new prevalence and incidence estimates for salivary herpesviruses detection and estimate associations with bacteriome diversity in young children. METHODS Salivary samples collected at ages ~2, 8, 12, and 24 months from 153 children participating in the Center for Oral Health Research in Appalachia cohort 2 (COHRA2) were screened for HHVs using the Fast-Track Neuro9 multiplex PCR assay, and for the bacteriome using 16S rRNA amplicon sequencing. We used Cox proportional hazard models to test for associations between the salivary bacteriome and hazards of cytomegalovirus (CMV) and human herpesvirus-6 (HHV6). RESULTS CMV, HHV6, and Epstein-Barr virus (EBV) were detected at all visits. Human herpesvirus-7 (HHV7) was first detected at the 8-month visit and herpes simplex virus 1 (HSV1) was only detected at the 12-month visit. Varicella-zoster virus, herpes simplex virus 2, and human herpesvirus-8 were never detected. HHV6 (24-month cumulative incidence: 73.8%) and CMV (24-month cumulative incidence: 32.3%) were detected most frequently. Increasing salivary bacteriome diversity was associated with longer survival to first detection of CMV (hazard ratio [95% CI]: 0.24 [0.12, 0.49]) and HHV6 (hazard ratio [95% CI]: 0.24 [0.13, 0.44]). CONCLUSION CMV, HHV6, EBV, HHV7, and HSV1 were detected in the saliva during the first 2 years of life. Time to first detection of CMV and HHV6 was associated with salivary bacteriome diversity, suggesting a possible interaction between HHVs and the salivary bacteriome.
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Affiliation(s)
- Freida Blostein
- Department of Epidemiology, Center for Molecular and Clinical Epidemiology of Infectious Diseases, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Sydney Foote
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Elizabeth Salzman
- Department of Epidemiology, Center for Molecular and Clinical Epidemiology of Infectious Diseases, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Daniel W McNeil
- Department of Clinical Psychology, West Virginia University, Morgantown, West Virginia, USA
| | - Mary L Marazita
- Department of Oral and Craniofacial Sciences, Center for Craniofacial and Dental Genetics, School of Dental Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA,Department of Human Genetics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA,Clinical and Translational Sciences Institute, and Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Emily T Martin
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Betsy Foxman
- Department of Epidemiology, Center for Molecular and Clinical Epidemiology of Infectious Diseases, University of Michigan School of Public Health, Ann Arbor, Michigan, USA,Corresponding Author: Betsy Foxman, PhD, Department of Epidemiology, University of Michigan School of Public Health, M5108 SPH II, 1415 Washington Heights, Ann Arbor, MI 48109-2029. E-mail:
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11
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Alain S, Garnier-Geoffroy F, Labrunie A, Montané A, Marin B, Gatet M, Grosjean J, Dufour V, Saugeras M, Postil D, Hantz S. Cytomegalovirus (CMV) Shedding in French Day-Care Centers: A Nationwide Study of Epidemiology, Risk Factors, Centers' Practices, and Parents' Awareness of CMV. J Pediatric Infect Dis Soc 2020; 9:686-694. [PMID: 32068854 DOI: 10.1093/jpids/piz097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 02/12/2020] [Indexed: 11/12/2022]
Abstract
BACKGROUND Congenital cytomegalovirus (CMV) remains an important healthcare burden, resulting from primary or secondary infection in pregnant women. Exposure to young children's saliva is a major risk factor, as prevalence of CMV shedding can reach 34%. METHODS This cross-sectional, multicenter, nationwide study was conducted in randomly selected day care centers (DCCs), and complemented with a survey among parents and DCCs. All children aged >3 months were eligible. The study measured the CMV shedding prevalence in children's saliva and described CMV genotypes epidemiology. The risk factors for CMV shedding and high viral load were evaluated using multivariable models. RESULTS A total of 93 DCCs participated. Among the 1770 enrolled children with evaluable samples, the CMV shedding prevalence was 40% (713/1770, 95% confidence interval, 34.6-46.1), independently associated with children aged between 12 and 18 months, history of CMV infection in ≥1 parents, a mid-level income. Prevalence increased with DCC staff workload and attending children number. Viral load was ≥5 log-copies CMV/mL in 48% (342/713). Risk factors for higher viral load included children aged between 12 and 18 months, and still being breastfed. The most frequent genotype combinations were gB1-gN4c-gH2 (6.9%), gB1-gN2-gH2 (6.3%), gB4a-gN3a-gH1 (6.3%), and gB1-gN3b-gH2 (5,7%). CMV awareness was low in parents: their serological status was unknown by 72% of mothers and 82% of fathers. Only 41% knew something about CMV. CONCLUSIONS CMV shedding was independently associated with risk factors related to the children, family and DCC. Some of these risk factors may influence prevention strategies, including through an improved information provided to parents. CLINICAL TRIALS REGISTRATION NCT01704222.
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Affiliation(s)
- Sophie Alain
- National Reference Center for Herpesviruses, Limoges, France.,Inserm U1092 University Limoges, Limoges, France.,Bacteriology, Virology, Hygiene Department, CHU Limoges, Limoges, France
| | - Françoise Garnier-Geoffroy
- National Reference Center for Herpesviruses, Limoges, France.,Inserm U1092 University Limoges, Limoges, France.,Bacteriology, Virology, Hygiene Department, CHU Limoges, Limoges, France
| | - Anaïs Labrunie
- Centre for Methodology and Data Management (Cebimer Department), CHU Limoges, Limoges, France
| | | | - Benoit Marin
- Centre for Methodology and Data Management (Cebimer Department), CHU Limoges, Limoges, France.,General Directorate for Health, Paris, France
| | | | - Jérôme Grosjean
- National Reference Center for Herpesviruses, Limoges, France.,Bacteriology, Virology, Hygiene Department, CHU Limoges, Limoges, France.,Biology Department, Chambery Hospital, Chambery, France
| | - Véronique Dufour
- Families and Early Childhood Directorate, Infantile Maternal Protection Department, Paris, France
| | - Mathilde Saugeras
- Center of Clinical Investigation Department, CHU Limoges, Limoges, France
| | - Deborah Postil
- Centre for Methodology and Data Management (Cebimer Department), CHU Limoges, Limoges, France
| | - Sébastien Hantz
- National Reference Center for Herpesviruses, Limoges, France.,Inserm U1092 University Limoges, Limoges, France.,Bacteriology, Virology, Hygiene Department, CHU Limoges, Limoges, France
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12
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Nelson CS, Baraniak I, Lilleri D, Reeves MB, Griffiths PD, Permar SR. Immune Correlates of Protection Against Human Cytomegalovirus Acquisition, Replication, and Disease. J Infect Dis 2020; 221:S45-S59. [PMID: 32134477 PMCID: PMC7057792 DOI: 10.1093/infdis/jiz428] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Human cytomegalovirus (HCMV) is the most common infectious cause of infant birth defects and an etiology of significant morbidity and mortality in solid organ and hematopoietic stem cell transplant recipients. There is tremendous interest in developing a vaccine or immunotherapeutic to reduce the burden of HCMV-associated disease, yet after nearly a half-century of research and development in this field we remain without such an intervention. Defining immune correlates of protection is a process that enables targeted vaccine/immunotherapeutic discovery and informed evaluation of clinical performance. Outcomes in the HCMV field have previously been measured against a variety of clinical end points, including virus acquisition, systemic replication, and progression to disease. Herein we review immune correlates of protection against each of these end points in turn, showing that control of HCMV likely depends on a combination of innate immune factors, antibodies, and T-cell responses. Furthermore, protective immune responses are heterogeneous, with no single immune parameter predicting protection against all clinical outcomes and stages of HCMV infection. A detailed understanding of protective immune responses for a given clinical end point will inform immunogen selection and guide preclinical and clinical evaluation of vaccines or immunotherapeutics to prevent HCMV-mediated congenital and transplant disease.
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Affiliation(s)
- Cody S Nelson
- Human Vaccine Institute, Duke University Medical Center, Durham, North Carolina,Correspondence: Cody S. Nelson, Human Vaccine Institute, Duke University Medical Center, 2 Genome Ct, Durham, NC 27710 ()
| | - Ilona Baraniak
- Institute for Immunity and Transplantation, University College London, London, United Kingdom
| | - Daniele Lilleri
- Laboratory of Genetics, Transplantation, and Cardiovascular Diseases, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Matthew B Reeves
- Institute for Immunity and Transplantation, University College London, London, United Kingdom
| | - Paul D Griffiths
- Institute for Immunity and Transplantation, University College London, London, United Kingdom
| | - Sallie R Permar
- Human Vaccine Institute, Duke University Medical Center, Durham, North Carolina
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13
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Non-invasive detection of IgG antibodies from common pathogenic viruses using oral flocked swabs. Diagn Microbiol Infect Dis 2020; 97:115038. [PMID: 32444155 DOI: 10.1016/j.diagmicrobio.2020.115038] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 03/10/2020] [Accepted: 03/10/2020] [Indexed: 01/03/2023]
Abstract
Salivary antibodies are useful in surveillance and vaccination studies. However, low antibody levels and degradation by endonucleases are problematic. Oral flocked swabs are a potential non-invasive alternative for detecting viral antibodies. Seroprevalence for Cytomegalovirus (CMV), Varicella-Zoster virus (VZV), Epstein-Barr virus (EBV), Measles and Mumps IgG antibodies were determined from 50 matched serum, saliva and swabs samples from healthy volunteers using commercial ELISAs. CMV IgG, VZV IgG, and EBV EBNA-1 IgG, VCA IgG, and Measles IgG swab versus serum sensitivities were 95.8%, 96.0%, 92.1%, 95.5%, 84.5%, respectively, and swabs correlated well with saliva. Sensitivity of Mumps IgG in swabs and saliva was poor at 60.5%, and 68.2%, respectively. Specificities for IgG antibodies were 100% for CMV, EBV and Mumps, but could not be determined for VZV and Measles due to exclusively seropositive volunteers. Except for Mumps IgG, swabs correlate well with serum, are easy to self-collect and are stable at room temperature.
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14
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Amin MM, Bialek SR, Dollard SC, Wang C. Urinary Cytomegalovirus Shedding in the United States: The National Health and Nutrition Examination Surveys, 1999-2004. Clin Infect Dis 2019; 67:587-592. [PMID: 29471326 DOI: 10.1093/cid/ciy143] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 02/14/2018] [Indexed: 12/23/2022] Open
Abstract
Background There are no data on the prevalence of cytomegalovirus (CMV) shedding from a representative sample of the US population. This information is critical for understanding and preventing CMV. Methods We tested urine specimens from CMV immunoglobulin (Ig) G-positive participants aged 6-49 years in 3 racial/ethnic groups from the National Health and Nutrition Examination Surveys 1999-2004 for the presence of CMV DNA using real-time polymerase chain reaction assay. We examined the association of sociodemographic characteristics with shedding prevalence and viral loads. Results Among 6828 CMV IgG-positive participants tested, 537 had CMV DNA detected in urine-a shedding prevalence of 9.70%. Among persons aged 6-49 years, shedding prevalence was 3.83%. The prevalence of urinary shedding was inversely associated with increasing age (26.60%, 6.50%, and 3.45% in CMV IgG-positive participants aged 6-11, 12-19, and 20-49 years, respectively; P < .001 for trend test and pairwise comparisons). Urinary viral load also decreased significantly with age (mean, 2.97, 2.69, and 2.43 log10 copies/mL in those age groups, respectively; P < .001 for trend test and pairwise comparisons). Conclusions Urinary CMV shedding and viral loads decreased dramatically with age, likely reflecting higher rates of primary CMV infection and longer duration of shedding in younger individuals. The findings demonstrate that children aged 6-11 years continue to shed CMV at higher rates and viral loads than adolescents and adults and thus may still be an important source for CMV transmission.
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Affiliation(s)
- Minal M Amin
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Stephanie R Bialek
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sheila C Dollard
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Chengbin Wang
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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15
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Barbosa NG, Yamamoto AY, Duarte G, Aragon DC, Fowler KB, Boppana S, Britt WJ, Mussi-Pinhata MM. Cytomegalovirus Shedding in Seropositive Pregnant Women From a High-Seroprevalence Population: The Brazilian Cytomegalovirus Hearing and Maternal Secondary Infection Study. Clin Infect Dis 2019; 67:743-750. [PMID: 29490030 DOI: 10.1093/cid/ciy166] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 02/26/2018] [Indexed: 01/01/2023] Open
Abstract
Background Most congenital cytomegalovirus (CMV) infections in highly seropositive populations occur in infants born to women with preexisting CMV seroimmunity. Although essential for developing prevention strategies, CMV shedding patterns in pregnant women with nonprimary infections have not been characterized. We investigated correlates of CMV shedding in a cohort of seropositive pregnant women. Methods In a prospective study, saliva, urine, vaginal swabs, and blood were collected from 120 CMV-seropositive women in the first, second, and third trimesters and 1 month postpartum. Specimens were tested for CMV DNA by polymerase chain reaction. We analyzed the contribution of the specific maternal characteristics to viral shedding. Results CMV shedding was detected at least once in 42 (35%) women. Mothers living with or providing daily care to young children (3-6 years) were twice as likely to shed CMV at least once compared to women with less exposure to young children (58% vs 26%; adjusted relative risk [aRR], 2.21; 95% confidence interval [CI], 1.37-3.56). Living in crowded households (≥2 people per room) was associated with viral shedding (64% vs 31%; aRR, 1.99; 95% CI, 1.26-3.13). Sexual activity as indicated by the number of sexual partners per year or condom use was not found to be a correlate of viral shedding. Conclusions CMV shedding is relatively frequent in seropositive pregnant women. The association between virus shedding and caring for young children as well as crowded living conditions may provide opportunities for increased exposures that could lead to CMV reinfections in seropositive women.
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Affiliation(s)
- Nayara G Barbosa
- Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, Brazil
| | - Aparecida Y Yamamoto
- Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, Brazil
| | - Geraldo Duarte
- Department of Gynecology and Obstetrics, Ribeirão Preto Medical School, University of São Paulo, Brazil
| | - Davi C Aragon
- Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, Brazil
| | - Karen B Fowler
- Department of Pediatrics, University of Alabama at Birmingham
| | - Suresh Boppana
- Department of Pediatrics, University of Alabama at Birmingham
| | - William J Britt
- Department of Pediatrics, University of Alabama at Birmingham
| | - Marisa M Mussi-Pinhata
- Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, Brazil
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16
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White JL, Patel EU, Abraham AG, Grabowski MK, Arav-Boger R, Avery RK, Quinn TC, Tobian AAR. Prevalence, Magnitude, and Genotype Distribution of Urinary Cytomegalovirus (CMV) Shedding Among CMV-Seropositive Children and Adolescents in the United States. Open Forum Infect Dis 2019; 6:ofz272. [PMID: 31281866 PMCID: PMC6602884 DOI: 10.1093/ofid/ofz272] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 06/04/2019] [Indexed: 11/12/2022] Open
Abstract
Background There are limited nationally representative data on correlates of cytomegalovirus (CMV) shedding among children and adolescents. In addition, the genotype distribution of CMV infections has not been well characterized among general populations in the United States. Methods This study characterized urinary CMV shedding among CMV immunoglobulin G-positive 6- to 19-year-olds in the US household population using data from the 1999-2004 National Health and Nutrition Examination Survey (NHANES). Multivariable Poisson regression was used to estimate adjusted prevalence ratios (aPR) and corresponding 95% confidence intervals (CIs). Analyses were weighted and multiple imputation was performed to handle missing data (with the exception of CMV genotypes). Results Prevalence of urinary CMV shedding was significantly lower among 9- to 11-year-olds (20.6%; aPR = 0.61; 95% CI, 0.44-0.83) and 12- to 19-year-olds (7.0%; aPR = 0.21; 95% CI, 0.14-0.30) compared with 6- to 8-year-olds (34.4%). Among CMV shedders, the youngest age group also had the highest urinary CMV viral loads. The prevalence of urinary CMV shedding among obese individuals was significantly lower compared with lean individuals (aPR = 0.68; 95% CI, 0.47-0.99). Among CMV shedders, glycoprotein B (gB)1 (51%) was the most prevalent gB variant, followed by gB2 (29%), gB3 (21%), and gB4 (13%); glycoprotein H (gH)2 (60%) was more prevalent than gH1 (48%). Multiple (≥2) gB (14%) and multiple gH (7%) infections were detected among CMV shedders. Conclusions This study underscores the importance of young children even above the age of 5 years as a potential source of CMV transmission. The detection of multiple CMV strains among CMV shedders may have implications for the transmission of viral diversity as well as vaccine development.
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Affiliation(s)
- Jodie L White
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Eshan U Patel
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Alison G Abraham
- Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Mary Kate Grabowski
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ravit Arav-Boger
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee
| | - Robin K Avery
- Department Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Thomas C Quinn
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, Baltimore, Maryland
| | - Aaron A R Tobian
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
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17
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Willis EL, Stevens TL, White GL, Mcfarlane D. Characterization of Baboon Cytomegalovirus Infection in Healthy Adult Baboons ( Papio anubis). Comp Med 2019; 69:55-62. [PMID: 30704552 DOI: 10.30802/aalas-cm-18-000050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Cytomegalovirus (CMV) is a common chronic herpesvirus found in humans and numerous other mammalian species. In people, chronic viruses like CMV can alter overall health and immunity and pose a serious risk for those with an inadequate immune system. In addition, CMV plays an important role in animal health, and could affect the health of vulnerable populations, like endangered species. Previous studies found a high rate of CMV seropositivity among adult baboons (Papio anubis), and results from our laboratory revealed that baboon CMV (BaCMV) seropositivity was correlated with altered immune cell populations. In the current study, we further characterized BaCMV infection in normal, adult baboons. Analysis of blood samples from baboons (age, 6 to 26 y) revealed a low overall prevalence of detectable of BaCMV DNA, with a higher detection rate in aged baboons (older than 15 y). Furthermore, data suggest that individual baboons maintain similar rates of recurrence and levels of BaCMV shedding in saliva over time. Finally, we evaluated multiple commercially available assays for antihuman CMV IgG and IgM for use with baboon sera. Results of this study will improve our understanding of BaCMV and may be directly relevant to other closely related species.
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Affiliation(s)
- Erin L Willis
- Department of Physiological Sciences, Center for Veterinary Health Sciences, Oklahoma State University, Stillwater, Oklahoma
| | - Taylor L Stevens
- Department of Comparative Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Gary L White
- Department of Comparative Medicine, Primate Consulting, Edmond, Oklahoma
| | - Dianne Mcfarlane
- Department of Physiological Sciences, Center for Veterinary Health Sciences, Oklahoma State University, Stillwater, Oklahoma;,
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18
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Azenkot T, Zaniello B, Green ML, Selke S, Huang ML, Magaret A, Wald A, Johnston C. Cytomegalovirus shedding from breastmilk and mucosal sites in healthy postpartum women: A pilot study. J Med Virol 2019; 91:894-898. [PMID: 30578684 DOI: 10.1002/jmv.25386] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 12/20/2018] [Indexed: 11/09/2022]
Abstract
Mother-to-child cytomegalovirus (CMV) breastmilk transmission can occur in the postnatal period. In a pilot study, we measured daily CMV detection by polymerase chain reaction in breastmilk, vaginal, and saliva samples from nine healthy CMV-seropositive postpartum women for 28 days. CMV was found in seven of nine women and 171 of 253 breastmilk samples (67.6%). In four women, all breastmilk samples were positive. CMV was less frequently detected in the vagina (39 of 258, 15.1%) and saliva (53 of 258, 20.5%). Daily breastmilk, oral, and genital collection is feasible and demonstrates high variability between women. Further study of the dynamics of CMV in distinct anatomic compartments is warranted.
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Affiliation(s)
- Tali Azenkot
- University of California, Davis, UC Davis School of Medicine, Davis, CA
| | | | - Margaret L Green
- Departments of Medicine and Laboratory Medicine, University of Washington, Seattle, WA.,Fred Hutchinson Cancer Research Center, Vaccine and Infectious Diseases Division, Seattle, WA
| | - Stacy Selke
- Departments of Medicine and Laboratory Medicine, University of Washington, Seattle, WA
| | - Meei-Li Huang
- Departments of Medicine and Laboratory Medicine, University of Washington, Seattle, WA
| | - Amalia Magaret
- Departments of Medicine and Laboratory Medicine, University of Washington, Seattle, WA.,Fred Hutchinson Cancer Research Center, Vaccine and Infectious Diseases Division, Seattle, WA
| | - Anna Wald
- Departments of Medicine and Laboratory Medicine, University of Washington, Seattle, WA.,Fred Hutchinson Cancer Research Center, Vaccine and Infectious Diseases Division, Seattle, WA
| | - Christine Johnston
- Departments of Medicine and Laboratory Medicine, University of Washington, Seattle, WA.,Fred Hutchinson Cancer Research Center, Vaccine and Infectious Diseases Division, Seattle, WA
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19
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Amin MM, Stowell JD, Hendley W, Garcia P, Schmid DS, Cannon MJ, Dollard SC. CMV on surfaces in homes with young children: results of PCR and viral culture testing. BMC Infect Dis 2018; 18:391. [PMID: 30103693 PMCID: PMC6088405 DOI: 10.1186/s12879-018-3318-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 08/07/2018] [Indexed: 11/23/2022] Open
Abstract
Background Caring for young children is a known risk factor for cytomegalovirus (CMV) infection mainly through exposure to their saliva and urine. In a previous study, 36 CMV-seropositive children 2 mo. to 4 years old were categorized as CMV shedders (n = 23) or non-shedders (n = 13) based on detection of CMV DNA in their saliva and urine. The current study evaluated the presence of CMV on surfaces in homes of the children. Methods Study staff made 4 visits to homes of the 36 enrolled children over 100 days. Saliva was collected by swabbing the mouth and urine was collected on filter paper inserted into diapers. In addition, five surface specimens were collected: three in contact with children’s saliva (spoon, child’s cheek, washcloth) and two in contact with children’s urine (diaper changing table, mother’s hand). Samples were tested by PCR and viral culture to quantify the presence of CMV DNA and viable virus. Results A total of 654 surface samples from 36 homes were tested; 136 were CMV DNA positive, 122 of which (90%) were in homes of the children shedding CMV (p < 0.001). Saliva–associated samples were more often CMV positive with higher viral loads than urine-associated samples. The higher the CMV viral load of the child in the home, the more home surfaces that were PCR positive (p = 0.01) and viral culture positive (p = 0.05). Conclusions The main source for CMV on surfaces in homes was saliva from the child in the home. Higher CMV viral loads shed by children correlated with more viable virus on surfaces which could potentially contribute to viral transmission.
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Affiliation(s)
- Minal M Amin
- Centers for Disease Control and Prevention (CDC), 1600 Clifton Road NE, Atlanta, GA, 30329, USA
| | | | - William Hendley
- Centers for Disease Control and Prevention (CDC), 1600 Clifton Road NE, Atlanta, GA, 30329, USA
| | - Philip Garcia
- Centers for Disease Control and Prevention (CDC), 1600 Clifton Road NE, Atlanta, GA, 30329, USA
| | - D Scott Schmid
- Centers for Disease Control and Prevention (CDC), 1600 Clifton Road NE, Atlanta, GA, 30329, USA
| | - Michael J Cannon
- Centers for Disease Control and Prevention (CDC), 1600 Clifton Road NE, Atlanta, GA, 30329, USA
| | - Sheila C Dollard
- Centers for Disease Control and Prevention (CDC), 1600 Clifton Road NE, Atlanta, GA, 30329, USA.
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20
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Burton CE, Dragan T, Mabilangan CA, O'Brien SF, Fearon M, Scalia V, Preiksaitis JK. Assignment of cytomegalovirus infection status in infants awaiting solid organ transplant: Viral detection methods as adjuncts to serology. Pediatr Transplant 2018; 22:e13229. [PMID: 29797796 DOI: 10.1111/petr.13229] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/18/2018] [Indexed: 12/31/2022]
Abstract
Assignment of CMV infection status in infants awaiting SOT is challenging as passive maternal antibody can lead to false-positive serology. Since 2000, our protocol has recommended sending throat and urine samples for CMV viral detection, culture, or NAAT, for CMV-seropositive infants <18 months awaiting SOT. We reviewed pretransplant CMV serology for 152 infants and, for CMV seropositives, examined relationships between CMV IgG OD values, age, and CMV viral detection to explore time to clearance of maternal CMV IgG and evaluate viral detection in assignment of pretransplant CMV infection status. The proportion of CMV-seropositive infants decreased from 52% in infants 0-6 months of age to 28% in those 12-18 months. Among CMV-seropositive infants, median OD was significantly higher in the 6- to 12- and 12- to 18-month groups compared to the 0- to 6-month group. Distribution of OD by age group suggested that maternal antibody cleared before 12 months. Of 59 eligible CMV-seropositive infants, 49 (83%) had CMV viral detection studies and 18 of 49 (36.7%) had detectable CMV: 9 of 30 (30.0%) infants 0-6 months, 7 of 15 (46.7%) infants 6-12 months, and 2 of 4 (50.0%) infants 12-18 months. CMV viral detection studies are useful to confirm positive CMV infection status in CMV-seropositive infants awaiting SOT. Maternal CMV IgG likely clears before 12 months.
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Affiliation(s)
| | | | | | - Sheila F O'Brien
- Canadian Blood Services, Ottawa, ON, Canada.,School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Margaret Fearon
- Canadian Blood Services, Toronto, ON, Canada.,Department of Pathology & Laboratory Medicine, University of Toronto, Toronto, ON, Canada
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21
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Boucoiran I, Mayer BT, Krantz EM, Marchant A, Pati S, Boppana S, Wald A, Corey L, Casper C, Schiffer JT, Gantt S. Nonprimary Maternal Cytomegalovirus Infection After Viral Shedding in Infants. Pediatr Infect Dis J 2018; 37:627-631. [PMID: 29889809 PMCID: PMC6016842 DOI: 10.1097/inf.0000000000001877] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Most infants with congenital Cytomegalovirus (CMV) infection are born to seropositive women as a result of maternal CMV nonprimary infection (reinfection or reactivation). Although infected children are known to transmit CMV to their seronegative mothers, the frequency and magnitude of nonprimary maternal CMV infection after exposure to viral shedding by children in their household have not been characterized. METHODS A cohort of Ugandan newborns and their mothers were tested weekly for CMV by quantitative polymerase chain reaction of oral swabs. Infant primary infection and maternal nonprimary infection were defined by the onset of persistent high-level oral CMV shedding. Strain-specific antibody testing was used to assess maternal reinfection. Cox regression models with time-dependent covariates were used to evaluate risk factors for nonprimary maternal infection. RESULTS Nonprimary CMV infection occurred in 15 of 30 mothers, all after primary infection of their infants by a median of 6 weeks (range: 1-10) in contrast to none of the mothers of uninfected infants. The median duration of maternal oral shedding lasted 18 weeks (range: 4-42) reaching a median maximum viral load of 4.69 log copies/mL (range: 3.22-5.64). Previous-week infant CMV oral quantities strongly predicted maternal nonprimary infection (hazard ratio: 2.32 per log10 DNA copies/swab increase; 95% confidence interval: 1.63-3.31). Maternal nonprimary infections were not associated with changes in strain-specific antibody responses. CONCLUSIONS Nonprimary CMV infection was common in mothers after primary infection in their infants, consistent with infant-to-mother transmission. Because infants frequently acquire CMV from their mothers, for example, through breast milk, this suggests the possibility of "ping-pong" infections. Additional research is needed to characterize the antigenic and genotypic strains transmitted among children and their mothers.
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Affiliation(s)
- Isabelle Boucoiran
- Department of Pediatrics, University of British Columbia, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Bryan T Mayer
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| | | | - Arnaud Marchant
- Institute for Medical Immunology, Institute for Medical Immunology, Université libre de Bruxelles, Charleroi, Belgium
| | - Sunil Pati
- Department of Pediatrics, University of Alabama Hospital, Birmingham, United Kingdom
| | - Suresh Boppana
- Department of Pediatrics, University of Alabama Hospital, Birmingham, United Kingdom
| | - Anna Wald
- Fred Hutchinson Cancer Research Center, Seattle, Washington
- Department of Medicine, University of Washington
| | - Larry Corey
- Fred Hutchinson Cancer Research Center, Seattle, Washington
- Department of Medicine, University of Washington
| | - Corey Casper
- Fred Hutchinson Cancer Research Center, Seattle, Washington
- Department of Medicine, University of Washington
- Infectious Disease Research Institute, Seattle, Washington
| | - Joshua T Schiffer
- Fred Hutchinson Cancer Research Center, Seattle, Washington
- Department of Medicine, University of Washington
| | - Soren Gantt
- Fred Hutchinson Cancer Research Center, Seattle, Washington
- Department of Pediatrics, University of British Columbia, BC Children's Hospital, Vancouver, British Columbia, Canada
- Department of Pediatrics, University of British Columbia, BC Children's Hospital, Vancouver, British Columbia, Canada
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22
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Alyazidi R, Murthy S, Slyker JA, Gantt S. The Potential Harm of Cytomegalovirus Infection in Immunocompetent Critically Ill Children. Front Pediatr 2018; 6:96. [PMID: 29692984 PMCID: PMC5902572 DOI: 10.3389/fped.2018.00096] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 03/26/2018] [Indexed: 12/17/2022] Open
Abstract
Cytomegalovirus (CMV) is a ubiquitous infection that causes disease in congenitally infected children and immunocompromised patients. Although nearly all CMV infections remain latent and asymptomatic in immunologically normal individuals, numerous studies have found that systemic viral reactivation is common in immunocompetent critically ill adults, as measured by detection of CMV in the blood (viremia). Furthermore, CMV viremia is strongly correlated with adverse outcomes in the adult intensive care unit (ICU), including prolonged stay, duration of mechanical ventilation, and death. Increasing evidence, including from a randomized clinical trial of antiviral treatment, suggests that these effects of CMV may be causal. Therefore, interventions targeting CMV might improve outcomes in adult ICU patients. CMV may have an even greater impact on critically ill children, particularly in low and middle income countries (LMIC), where CMV is regularly acquired in early childhood, and where inpatient morbidity and mortality are inordinately high. However, to date, there are few data regarding the clinical relevance of CMV infection or viremia in immunocompetent critically ill children. We propose that CMV infection should be studied as a potential modifiable cause of disease in critically ill children, and that these studies be conducted in LMIC. Below, we briefly review the role of CMV in immunologically normal critically ill adults and children, outline age-dependent differences in CMV infection that may influence ICU outcomes, and describe an agenda for future research.
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Affiliation(s)
- Raidan Alyazidi
- University of British Columbia and BC Children's Hospital, Vancouver, BC, Canada.,Department of Pediatrics, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Srinivas Murthy
- University of British Columbia and BC Children's Hospital, Vancouver, BC, Canada
| | | | - Soren Gantt
- University of British Columbia and BC Children's Hospital, Vancouver, BC, Canada
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Levis DM, Hillard CL, Price SM, Reed-Gross E, Bonilla E, Amin M, Stowell JD, Clark R, Johnson D, Mask K, Carpentieri C, Cannon MJ. Using theory-based messages to motivate U.S. pregnant women to prevent cytomegalovirus infection: results from formative research. BMC WOMENS HEALTH 2017; 17:131. [PMID: 29237429 PMCID: PMC5729419 DOI: 10.1186/s12905-017-0482-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 11/28/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND An estimated 1 in 150 infants is born each year with congenital cytomegalovirus (CMV); nearly 1 in 750 suffers permanent disabilities. Congenital CMV is the result of a pregnant woman becoming infected with CMV. Educating pregnant women about CMV is currently the best approach to prevention. Limited research is available on how to effectively communicate with women about CMV. We conducted formative research on fear appeals theory-based messages about CMV and prevention with U.S. women. Fear appeal theories suggest that message recipients will take action if they feel fear. METHODS First, we conducted in-depth interviews (N = 32) with women who had young children who tested positive for CMV. Second, we conducted eight focus groups (N = 70) in two phases and two cities (Phase 2: Atlanta, GA; Phase 3: San Diego, CA) with pregnant women and non-pregnant women who had young children. Few participants knew about CMV before the focus groups. Participants reviewed and gave feedback on messages created around fear appeals theory-based communication concepts. The following concepts were tested in one or more of the three phases of research: CMV is severe, CMV is common, CMV is preventable, CMV preventive strategies are similar to other behavior changes women make during pregnancy, CMV preventive strategies can be incorporated in moderation to reduce exposure, and CMV is severe but preventable. RESULTS Participants recommended communicating that CMV is common by using prevalence ratios (e.g., 1 in 150) or comparing CMV to other well-known disabilities. To convey the severity of CMV, participants preferred stories about CMV along with prevention strategies. Participants also welcomed prevention strategies when it included a message about risk reduction. In general, participants said messages were motivating, even if they felt that it could be difficult to make certain behavior changes. CONCLUSIONS Findings from this research can contribute to future efforts to educate pregnant women about CMV, especially regarding use of fear appeals-based messages. Pregnant women may face certain challenges to practicing prevention strategies but, overall, are motivated make changes to increase their chances of having a healthy baby.
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Affiliation(s)
- Denise M Levis
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention (CDC), 1600 Clifton Road, Mailstop E-86, Atlanta, GA, 30333, USA.
| | - Christina L Hillard
- Carter Consulting, Inc., 2310 Parklake Drive NE, Suite 535, Atlanta, GA, 30345, USA
| | - Simani M Price
- Westat, Inc., 1600 Research Blvd, Rockville, MD, 20850, USA
| | | | - Erika Bonilla
- Westat, Inc., 1600 Research Blvd, Rockville, MD, 20850, USA
| | - Minal Amin
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), 1600 Clifton Road, Mailstop G-18, Atlanta, GA, 30333, USA
| | - Jennifer D Stowell
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention (CDC), 1600 Clifton Road, Mailstop E-86, Atlanta, GA, 30333, USA
| | - Rebekah Clark
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention (CDC), 1600 Clifton Road, Mailstop E-86, Atlanta, GA, 30333, USA
| | - Delaney Johnson
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention (CDC), 1600 Clifton Road, Mailstop E-86, Atlanta, GA, 30333, USA
| | - Karen Mask
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention (CDC), 1600 Clifton Road, Mailstop E-86, Atlanta, GA, 30333, USA
| | - Cynthia Carpentieri
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention (CDC), 1600 Clifton Road, Mailstop E-86, Atlanta, GA, 30333, USA
| | - Michael J Cannon
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention (CDC), 1600 Clifton Road, Mailstop E-86, Atlanta, GA, 30333, USA
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Matrajt L, Gantt S, Mayer BT, Krantz EM, Orem J, Wald A, Corey L, Schiffer JT, Casper C. Virus and host-specific differences in oral human herpesvirus shedding kinetics among Ugandan women and children. Sci Rep 2017; 7:13105. [PMID: 29026166 PMCID: PMC5638921 DOI: 10.1038/s41598-017-12994-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 09/13/2017] [Indexed: 01/12/2023] Open
Abstract
Human herpesviruses (HHV) establish lifelong latent infection and are transmitted primarily via shedding at mucosal surfaces. Each HHV causes a unique spectrum of disease depending on the infected individual’s age and immunity. We collected weekly oral swabs from young children and mothers in 32 Ugandan households for a median of one year. We characterized kinetics of oral shedding during primary and chronic infection for each virus. Cytomegalovirus (CMV), Epstein-Barr virus (EBV), and HHV-6 were shed at high rates following primary infection. The rate of oral herpes simplex virus (HSV) shedding was lower overall, and children and mothers with chronic HSV infection had lower shedding rates than children with primary infection. CMV shedding rate and viral load were higher in children with primary infection compared to children with chronic infection, and even lower in mothers with chronic infection. HHV-6 shedding rate and viral load were similar between children with primary or chronic infection, but lower in mothers. EBV shedding rate and quantity decreased less dramatically in mothers versus children, with HIV-positive mothers shedding at a higher rate than HIV-negative mothers. Each HHV has a distinct pattern of oral shedding which depends partially on the age and immune status of the host.
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Affiliation(s)
- Laura Matrajt
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Soren Gantt
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA. .,Department of Pediatrics, Division of Infectious Diseases, University of British Columbia, Vancouver, BC, Canada.
| | - Bryan T Mayer
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | | | - Jackson Orem
- Uganda Cancer Institute, Makerere University, Kampala, Uganda.,College of Health Sciences, Makerere University, Kampala, Uganda
| | - Anna Wald
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Department of Medicine, University of Washington, 98195, Seattle, WA, USA.,Department of Epidemiology, University of Washington, Seattle, WA, USA.,Department of Laboratory Medicine, University of Washington, Seattle, WA, USA
| | - Lawrence Corey
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Department of Medicine, University of Washington, 98195, Seattle, WA, USA.,Department of Laboratory Medicine, University of Washington, Seattle, WA, USA.,Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Joshua T Schiffer
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Department of Medicine, University of Washington, 98195, Seattle, WA, USA.,Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Corey Casper
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Infectious Disease Research Institute, Seattle, WA, USA
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25
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Intrauterine therapy of cytomegalovirus infection with valganciclovir: review of the literature. Med Microbiol Immunol 2017; 206:347-354. [PMID: 28733760 DOI: 10.1007/s00430-017-0512-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 07/13/2017] [Indexed: 12/22/2022]
Abstract
Congenital cytomegalovirus (CMV) infection is the leading cause for sensorineural hearing loss and mental retardation in children without genetic diseases worldwide. There is little evidence guiding therapeutic strategies during pregnancy when intrauterine fetal CMV infection is confirmed. We provide a systematic review of the use of ganciclovir (GCV) or VGCV during pregnancy discussing safety of its use for mother and fetus and describe two cases of intrauterine therapy of fetal CMV infection with valganciclovir (VGCV). A PubMed database search was done up to November 16, 2016 without any restrictions of publication date or journal, using the following keywords: "valganciclovir" or "ganciclovir" and "pregnan*". Furthermore, citations were searched and expert references were obtained. Reported cases were considered if therapy was in humans and initiation of treatment of the CMV infection was during pregnancy. In total, seven case reports were retrieved which described GCV or VGCV use during pregnancy for fetal or maternal CMV infection. In the four cases of treatment for maternal CMV infection, no negative effects on the fetus were reported. Three cases of GCV administration to pregnant woman with the intention of fetal treatment after proven fetal infection were found. We additionally present two cases of VGCV treatment in pregnancy from our center of tertiary care. VGCV seems to be a safe treatment for congenital CMV infection for the mother and the fetus. Therapeutic concentrations can be achieved in the fetus by oral intake of the mother and CMV replication can be suppressed. Larger studies are needed to evaluate this therapeutic intervention and the long-term effects.
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Deuchler S, Ackermann H, Singh P, Kohnen T, Wagner C, Koch F. Key Factors to Improve the Outcome of Retinal Reattachment Surgery in Proliferative Vitreoretinopathy and Proliferative Diabetic Retinopathy. J Ophthalmol 2017; 2017:2323897. [PMID: 28770107 PMCID: PMC5523461 DOI: 10.1155/2017/2323897] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 05/07/2017] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION For management of complicated retinal detachments, a pars plana vitrectomy with temporary silicone oil (SO) fill is the method of choice. According to literature, the retinal redetachment rate varies between <10% and >70% with around 36% in our own group (retrospective data analysis, n = 119 eyes). METHODS The main goal was to reduce the retinal redetachment rate. Standard operating procedures (SOPs) and evaluation protocols (EVALPs) were developed to prospectively analyse risk factors. Lab analysis of SO was performed, and the role of surgical experience was evaluated and investigated with Eyesi®. RESULTS We achieved a significant reduction of the retinal redetachment rate (to 6.80%, n = 101, p = 0.002). After surgery with SO injection, neither further membrane peeling (in 16.5%) nor retinal laser coagulation (in 100%) during revision surgery had a significant effect on the reattachment rate (p = 0.167, p = 0.23), while extensive additional laser coagulation reduced visual acuity (p = 0.01). A 3-port approach had to be set up to complete SO removal. A difference in success rate depending on surgical experience was confirmed, and the performance in Eyesi correlated with that in the patients' eye. CONCLUSIONS A SOP- and EVALP-based management and new strategies to secure the surgical performance seem to be essential for successful surgery.
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Affiliation(s)
- Svenja Deuchler
- Vitreoretinal Unit, Department of Ophthalmology, Goethe University, Frankfurt am Main, Germany
| | - Hanns Ackermann
- Institute of Biostatistics and Mathematical Modelling, University Hospital, 60590 Frankfurt am Main, Hessen, Germany
| | - Pankaj Singh
- Vitreoretinal Unit, Department of Ophthalmology, Goethe University, Frankfurt am Main, Germany
| | - Thomas Kohnen
- Department of Ophthalmology, Goethe University, Frankfurt am Main, Germany
| | - Clemens Wagner
- VRmagic GmbH, 68167 Mannheim, Baden-Württemberg, Germany
| | - Frank Koch
- Vitreoretinal Unit, Department of Ophthalmology, Goethe University, Frankfurt am Main, Germany
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Freer G, Quaranta P, Pistello M. Evaluation of T Cell Immunity against Human Cytomegalovirus: Impact on Patient Management and Risk Assessment of Vertical Transmission. J Immunol Res 2016; 2016:9384813. [PMID: 28044143 PMCID: PMC5156801 DOI: 10.1155/2016/9384813] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 10/07/2016] [Accepted: 10/17/2016] [Indexed: 11/18/2022] Open
Abstract
Cytomegalovirus (CMV) is one of the most common infectious agents, infecting the general population at an early age without causing morbidity most of the time. However, on particular occasions, it may represent a serious risk, as active infection is associated with rejection and disease after solid organ transplantation or fetal transmission during pregnancy. Several methods for CMV diagnosis are available on the market, but because infection is so common, careful selection is needed to discriminate primary infection from reactivation. This review focuses on methods based on CMV-specific T cell reactivity to help monitor the consequences of CMV infection/reactivation in specific categories of patients. This review makes an attempt at discussing the pros and cons of the methods available.
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Affiliation(s)
- Giulia Freer
- Retrovirus Center, Department of Translational Research, University of Pisa, Via del Brennero 2, 56127 Pisa, Italy
| | - Paola Quaranta
- Retrovirus Center, Department of Translational Research, University of Pisa, Via del Brennero 2, 56127 Pisa, Italy
| | - Mauro Pistello
- Retrovirus Center, Department of Translational Research, University of Pisa, Via del Brennero 2, 56127 Pisa, Italy
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Mayer BT, Matrajt L, Casper C, Krantz EM, Corey L, Wald A, Gantt S, Schiffer JT. Dynamics of Persistent Oral Cytomegalovirus Shedding During Primary Infection in Ugandan Infants. J Infect Dis 2016; 214:1735-1743. [PMID: 27651417 DOI: 10.1093/infdis/jiw442] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 09/12/2016] [Indexed: 01/06/2023] Open
Abstract
Cytomegalovirus (CMV) infection occurs frequently in young children, who, when infected, are then a major source of transmission. Oral CMV shedding by 14 infants with primary infection was comprehensively characterized using quantitative polymerase chain reaction weekly for ≥9 months. Three phases of oral shedding were identified: expansion, transition, and clearance. Viral expansion occurred over a median of 7 weeks, with a median doubling time of 3 days. During the transition phase, expansion slowed over a median of 6 weeks before peak viral load was reached. Clearance was slow (22-day median half-life), and shedding did not resolve during observation for any infant. Mathematical modeling demonstrated that prolonged oral CMV expansion is explained by a low within-host reproduction number (median, 1.63) and a delayed immune response that only decreases the infected cell half-life by 44%. Thus, the prolonged oral CMV shedding observed during primary infection can be explained by slow viral expansion and inefficient immunologic control.
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Affiliation(s)
| | | | - Corey Casper
- Vaccine and Infectious Disease Division.,Clinical Research Division.,Public Health Science Division, Fred Hutchinson Cancer Research Center.,Department of Medicine.,Department of Epidemiology.,Department of Global Health
| | | | - Lawrence Corey
- Vaccine and Infectious Disease Division.,Clinical Research Division.,Department of Medicine.,Department of Laboratory Medicine, University of Washington, Seattle
| | - Anna Wald
- Vaccine and Infectious Disease Division.,Department of Medicine.,Department of Epidemiology.,Department of Laboratory Medicine, University of Washington, Seattle
| | - Soren Gantt
- Vaccine and Infectious Disease Division.,BC Children's Hospital, University of British Columbia, Vancouver, Canada
| | - Joshua T Schiffer
- Vaccine and Infectious Disease Division.,Clinical Research Division.,Department of Medicine
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Cytomegalovirus IgG Level and Avidity in Breastfeeding Infants of HIV-Infected Mothers in Malawi. CLINICAL AND VACCINE IMMUNOLOGY : CVI 2015; 22:1222-6. [PMID: 26424831 DOI: 10.1128/cvi.00460-15] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 09/27/2015] [Indexed: 12/27/2022]
Abstract
Cytomegalovirus (CMV) infection is common among infants of HIV-infected mothers in resource-limited settings. We examined the prevalence and timing of infant CMV infection during the first year of life using IgG antibody and avidity among HIV-exposed infants in Malawi and correlated the results with the presence of detectable CMV DNA in the blood. The Breastfeeding, Antiretrovirals and Nutrition (BAN) study randomized 2,369 mothers and their infants to maternal antiretrovirals, infant nevirapine, or neither for 28 weeks of breastfeeding, followed by weaning. Stored plasma specimens were tested for CMV IgG and antibody avidity from a random subset of infants who had been previously tested with blood CMV PCR and had available specimens at birth and at 24 and 48 weeks of age. Ninety-four of 127 infants (74.0%) tested at 24 weeks of age had CMV IgG of low or intermediate avidity, signifying primary CMV infections. An additional 22 infants (17.3%) had IgG of high avidity; 19 of them had CMV DNA detected in their blood, indicating infant infections. Taken together, these results show that the estimated prevalence of CMV infection at 24 weeks was 88.9%. By 48 weeks of age, 81.3% of infants had anti-CMV IgG; most of them (70.9%) had IgG of high avidity. The CMV serology and avidity testing, combined with the PCR results, confirmed a high rate of primary CMV infection by 6 months of life among breastfeeding infants of HIV-infected mothers. The CMV PCR in blood detected most, but not all, infant CMV infections.
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