Cytomegalovirus shedding in seropositive healthy women of reproductive age in Tianjin, China

Abstract

Cytomegalovirus (CMV) enters latency after primary infection and can reactivate periodically with virus excreted in body fluids which can be called shedding. CMV shedding during the early stage of pregnancy is associated with adverse pregnancy outcome. The shedding pattern in healthy seropositive women who plan to have babies has not been well characterised. Vaginal swabs, urine and blood were collected from 1262 CMV IgG-positive women who intended to have babies and tested for CMV DNA by fluorogenic quantitative PCR method. Serum IgM was also detected. The association between sociodemographic characteristics and CMV shedding prevalence was analysed. Among 1262 seropositive women, 12.8% (161/1262) were detected CMV DNA positive in at least one body fluid. CMV DNA was more frequently detected in vaginal secretion (10.5%) than in urine (3.2%) and blood (0.6%) also with higher viral loads (P < 0.00). CMV shedding was more likely detected in IgM-positive women than IgM-negative women (29.5% (13/44) vs. 12.2% (148/1218); OR 3.03, 95% CI 1.55–5.93; P = 0.001). CMV shedding in vaginal secretion was highly correlated with shedding in urine, the immune state of IgM, the adverse pregnant history and younger age. CMV shedding was more commonly detected in vaginal secretion than in urine or blood with higher viral loads among healthy seropositive women of reproductive age. Further studies are needed to figure out whether the shedding is occasional or continuous and whether it is associated with adverse pregnancy outcomes.

Detecting human cytomegalovirus in urine, vagina and saliva: Impact of biological fluids and storage durations and temperatures on CMV DNA recovery

“…For CMV vaccine trials, the detection of CMV shedding in bodily fluids could potentially be used as virological endpoints to inform the efficacy of vaccine candidates. As the validity of these studies rely on an accurate and reliable detection of CMV shedding, which often is at low viral load, it is imperative to ensure optimal sampling and preanalytical handling of biological samples for CMV DNA detection 12–14 . We found CMV DNA recovery is dependent on fluid type, the use of nucleic acid preservation media, and the duration and temperature of storage.…”

“…Detecting CMV DNA shedding in biological fluids of women of reproductive age is essential not only to advance the current understanding of the epidemiology of primary and nonprimary CMV infection, but also to support the investigations into the possible relationship between maternal CMV infection and CMV‐related adverse outcomes or cCMV 5–18 . For CMV vaccine trials, the detection of CMV shedding in bodily fluids could potentially be used as virological endpoints to inform the efficacy of vaccine candidates.…”

“…CMV infection, but also to support the investigations into the possible relationship between maternal CMV infection and CMVrelated adverse outcomes or cCMV. [5][6][7][8][9][10][11][12][13][14][15][16][17][18] For CMV vaccine trials, the detection of CMV shedding in bodily fluids could potentially be used as virological endpoints to inform the efficacy of vaccine candidates.…”

“…To improve the understanding of the natural history of primary, non‐primary and cCMV infection, several groups have investigated CMV shedding by polymerase chain reaction (PCR) in urine, cervicovaginal secretions, saliva and breast milk of pregnant, nonpregnant and postpartum women 5–16 . These studies have provided crucial insights into not only the prevalence and kinetics of CMV shedding, which are essential to inform the development of potential preventative and therapeutic interventions, but also the possible association between CMV shedding and adverse pregnancy outcomes or cCMV.…”

Minimal adverse outcomes of postnatal cytomegalovirus infection in term or moderate and late preterm infants

“…However, it is unknown to what extent breastfeeding can increase the postnatal CMV infection in infants. Additionally, CMV may shed in vaginal secretion (6,7), but the difference in postnatal CMV infection rates in infants delivered spontaneously or by cesarean section is less studied.…”