Epidemiologic characteristics of cytomegalovirus infection in mothers and their infants

Yow, Martha D.; Williamson, Dominic J.; Leeds, Leroy J.; Thompson, Peter; Woodward, Rell M.; Walmus, Bethann F.; Lester, Jerry W.; Six, Howard R.; Griffiths, Paul

doi:10.1016/0002-9378(88)90252-9

Cited by 190 publications

(107 citation statements)

References 19 publications

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“…However, an increased risk of cytomegalovirus infection is well established among the children of nursery workers and of certain other child-linked groups (Stagno et al, 1982(Stagno et al, , 1984Adler, 1988;Yow et al, 1988;Murph et al, 1991). Epidemics of paralytic poliomyelitis have occasioned similar observations about the children of teachers and of men in other high contact occupations (McFarlan et al, 1946;Cowan, 1950;Logan, 1953).…”

Section: Discussionmentioning

confidence: 99%

A case–control study of childhood leukaemia and paternal occupational contact level in rural Sweden

2002

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In a national case -control study in Sweden, we investigated whether in rural areas (where susceptible individuals are more prevalent than in urban areas) leukaemia risk was higher among the young children of fathers with many work contacts, as the infective hypothesis has predicted. A total of 1935 cases diagnosed in 1958 -1998 together with 7736 age-matched (within 1 year) population controls (of whom 970 and 3880 respectively were aged 0 -4) were linked to paternal occupational details as recorded in the census closest to the year of birth. Applying the two classifications of occupational contact level used in a study of rural Scotland, the odds ratios for children aged 0 -4 years in the highest contact category (which includes teachers) in the most rural Swedish counties were 3.47 (95% CI 1.54, 7.85) and 1.59 (1.07, 2.38) respectively, relative to the medium and low (reference) category; no such excess was found in urban or intermediate counties. There was also a significant positive trend at ages 0 -4 in the rural counties across the three levels of increasing occupational contact (P for trend 0.02 and 0.03, respectively), but again not in the urban or intermediate counties. No such effect or trend was found at ages 5 -14 in any of the three county groupings. The findings confirm those of a recent study in rural Scotland, and also suggest that unusual population mixing (as occurred in Scotland as a result of the North Sea oil industry) is not a necessary requirement for the effect, since comparable mixing has not been a feature of rural Sweden.

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Section: Discussionmentioning

confidence: 99%

A case–control study of childhood leukaemia and paternal occupational contact level in rural Sweden

2002

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“…The notion of an increased risk of infection among the children of people in certain occupations is less familiar. In cytomegalovirus infection, however, an increased risk is well established among the children of both nursery workers and fathers with occupations, or leisure activities, involving much contact with children (Stagno et al, 1982(Stagno et al, , 1984Adler, 1988;Yow et al, 1988;Murph et al, 1991). Certain epidemics of paralytic poliomyelitis also occasioned similar observations (Cowan, 1950;Logan, 1953;McFarlan et al, 1946), while a study of poliovirus antibody levels in relation to social factors found that a higher than average level for an individual's social class was often associated with a high-contact occupation (Backett, 1957).…”

Section: Discussionmentioning

confidence: 99%

Paternal occupational contact level and childhood leukaemia in rural Scotland: a case–control study

Kinlen

Bramald

2001

Br J Cancer

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Significant increases of childhood leukaemia have repeatedly been recorded in situations of marked rural-urban population mixing, confirming the hypothesis that this disease has an underlying infective basis. For the increase in population density implicit in such mixing would increase the level of contacts between susceptible (more prevalent in rural areas) and infected individuals, thereby promoting an epidemic of the relevant infection. The infective agent in question is unknown, but the absence of marked space-time clustering of childhood leukaemia in the general population indicates that it must, as in known infection-based malignancies, be an uncommon response i.e. that the infection itself is largely immunizing. Adults as well as children appear to be involved in its transmission (Kinlen et al, 1993a;Kinlen, 1995).In the case of young (largely pre-school) children aged 0-4 years, an important contribution to their overall level of direct and indirect contacts will be made by fathers' contacts at work. 'High contact' occupations have already been associated with an increased incidence of childhood cytomegalovirus infection and paralytic poliomyelitis. Furthermore, in situations of extreme rural population mixing which had produced excesses of childhood leukaemia, risk was greater among the young children of those whose work involved many community contacts (Kinlen, 1997). No such increases have been found in mortality studies of the question in the (largely urban) general population of England and Wales (Kinlen, 1997;Fear et al, 1999). As an urban population would be expected to have the raised levels of immunity to infective agents often associated with high population density, we have considered the question still open as to whether high levels of paternal occupational contacts have effects on the incidence of childhood leukaemia in young children in a very rural area, where the prevalence of susceptible individuals would be unusually high.We have therefore investigated paternal occupational contact level in relation to childhood leukaemia in a national case-control study in Scotland in the period 1950-89, with particular reference to rural areas and the possible role of population mixing. METHODS Cases and controlsEligible cases consisted of children (aged 0-14) diagnosed in Scotland with leukaemia and non-Hodgkin's lymphoma (NHL) in the years 1950-89. For each child for whom a birth certificate was traced in Scotland that showed a parental occupation, 3 controls of the same age and sex were randomly chosen from the birth registers of the same county. A high proportion of the cases and controls had been included in an earlier investigation of paternal preconceptional occupational exposure to radiation (Kinlen et al, 1993b which gives further details of control selection). Young children (aged 0-4 years) were the main focus of our study, since in the case of older children, a change of paternal occupation is more likely between birth and diagnosis; nevertheless, older children were also investigated. So ...

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“…The high prevalence of cytomegalovirus infection among young children in nurseries is now well established as constituting a risk to their care-workers, who may then infect their own children (Stagno et al, 1982(Stagno et al, , 1984Preece et al, 1984;Pass et al, 1986Pass et al, , 1987Alder, 1988;Yow, 1988;Murph et al, 1991). An increased risk of cytomegalovirus infection has also been found among the children of fathers with occupations, or other activities, that involve much contact with children (Stagno et al, 1984).…”

Section: Parental Occupation and Childhood Infectionmentioning

confidence: 99%

High-contact paternal occupations, infection and childhood leukaemia: five studies of unusual population-mixing of adults

Kinlen

1997

Br J Cancer

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Summary The hypothesis has been tested that, among excesses of childhood leukaemia associated with extreme population-mixing, the incidence is higher for the children of men in occupations involving contact with many individuals (particularly children), as noted in certain childhood infections. Data on childhood leukaemia were examined from five previous studies of the author in which significant excesses had been found associated with population-mixing involving adults. Occupational titles were categorized according to the estimated level of work contacts as medium, high, very high or indeterminate. Occupations involving frequent contact with children were categorized as having a very high contact level given the high frequency of exposure to the infection postulated as underlying childhood leukaemia. There was a significant positive trend (P < 0.001) in childhood leukaemia risk at ages 0-14 years across the occupational contact categories from the reference group (comprising the medium and low plus indeterminate categories) through high to very high (i.e. high-child) contact categories in the combined data from the author's five studies of adult population-mixing; this significant trend also applied at ages 0-4 (P < 0.001) and 5-14 (P < 0.01) years. The excess in the high category was mainly because of paternal occupations connected with the construction industry and transport, suggesting a broader definition of the 'very high' contact category. No sign of these excesses was found in a limited examination of the question outside areas of population-mixing using mortality data for childhood leukaemia in the general population of England and Wales. The findings represent the first individual-based support for infection underlying childhood leukaemia that is promoted by population-mixing, as well as further support for the role of adults in transmission of the infection. Keywords: childhood leukaemia; infection; paternal occupationThe hypothesis of an infective basis in childhood leukaemia is strongly supported by the findings in studies of areas (mainly rural) affected by unusual population-mixing. Such situations would be conducive to mini-epidemics of an underlying infection to which leukaemia is an uncommon response and, in a large series of examples studied, significant excesses of childhood leukaemia have been found (Kinlen, 1988;Kinlen et al, 1990Kinlen et al, , 1993aKinlen et al, , 1995Langford, 1991;Kinlen and John, 1994;Petridou et al, 1996;Stiller and Boyle, 1996;Alexander et al, 1997). These community-based findings make a persuasive case for an infective basis for childhood leukaemia. In the absence of the demonstration of evidence of different exposures to the causative agent (here impossible), other case-control differences would be valuable as additional support, although it may be noted that such evidence is often lacking in illnesses that are known to be uncommon responses to infections. The design of the population-mixing studies necessarily means that data amenable to case-control comparisons ...

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Epidemiologic characteristics of cytomegalovirus infection in mothers and their infants

Cited by 190 publications

References 19 publications

A case–control study of childhood leukaemia and paternal occupational contact level in rural Sweden

A case–control study of childhood leukaemia and paternal occupational contact level in rural Sweden

Paternal occupational contact level and childhood leukaemia in rural Scotland: a case–control study

High-contact paternal occupations, infection and childhood leukaemia: five studies of unusual population-mixing of adults

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