Cytomegalovirus Infections in Ugandan Infants : Newborn-Mother Pairs, Neonates with Sepsis, and Infants with Hydrocephalus

Hehnly, Christine and Ssentongo, Paddy and Bebell, Lisa M. and Burgoine, Kathy and Bazira, Joel and Fronterre, Claudio and Kumbakumba, Elias and Mulondo, Ronald and Mbabazi-Kabachelor, Edith and Morton, Sarah U. and Ngonzi, Joseph and Ochora, Moses and Olupot-Olupot, Peter and Onen, Justin and Roberts, Drucilla J. and Sheldon, Kathryn and Sinnar, Shamim A. and Smith, Jasmine and Ssenyonga, Peter and Paulson, Joseph N. and Meier, Frederick A. and Ericson, Jessica E. and Broach, James R. and Schiff, Steven J. (2022) Cytomegalovirus Infections in Ugandan Infants : Newborn-Mother Pairs, Neonates with Sepsis, and Infants with Hydrocephalus. International Journal of Infectious Diseases, 118. pp. 24-33. ISSN 1201-9712

Abstract

Objective To estimate the prevalence of cytomegalovirus (CMV) infections in newborn-mother pairs, neonates with sepsis, and infants with hydrocephalus in Uganda. Design and 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 for CMV infection at three medical centers in Uganda. Quantitative PCR (qPCR) was used to characterize the prevalence of CMV. Results The overall CMV prevalence in 2498 samples in duplicate across all groups was 9%. In newborn-mother pairs, there was a 3% prevalence of cord blood CMV positivity and 33% prevalence of maternal vaginal shedding. In neonates with clinical sepsis there was a 2% CMV prevalence. Maternal HIV seropositivity (aOR, 25.20; 95% CI, 4.43-134.26; p= 0.0001), residence in Eastern Uganda (aOR, 11.06; 95% CI, 2.30-76.18; p=0.003), maternal age < 25 years (aOR, 4.54; 95% CI, 1.40-19.29; p=0.02), and increasing neonatal age (aOR, 1.08 for each day older; 95% CI, 1.00-1.16; p= 0.05), were associated risk factors for CMV in neonates with clinical sepsis. We found a two-fold higher maternal vaginal shedding in Eastern (45%) vs Western (22%) Uganda during parturition (n=22/49 vs. 11/50, Fisher's exact test, p=0.02). In infants with PIH, the prevalence in blood was 24% and in infants with NPIH it was 20%. CMV was present in the CSF of 13% of infants with PIH compared to 0.5% of infants with NPIH (n=26/205 vs. 1/194, p<0.0001). Conclusion Our findings highlight that congenital and postnatal CMV prevalence is substantial in this African setting and the long-term consequences are uncharacterized.