Awareness of and attitudes toward congenital cytomegalovirus infection among pregnant women in Singapore
ABSTRACT To assess the level of awareness of congenital cytomegalovirus (CMV) infection and attitudes toward prenatal CMV serologic testing among pregnant women.
A questionnaire was distributed to pregnant women who attended a specialist outpatient clinic at Singapore General Hospital, Singapore, between September and December 2010.
Among 200 respondents, 40 (20.0%) were aware of CMV. Healthcare workers were more likely to be aware of CMV (odds ratio 6.91, confidence interval 2.14-22.30; P=0.001). Most respondents found it "very" or "somewhat" easy to adhere to standard guidelines for primary prevention of CMV. Among the respondents, 62.0% (124/200) would like to be given the option of prenatal CMV screening and 72.0% (144/200) were keen to be screened. On multivariate analysis, respondents who were keen to undergo serologic screening for CMV were not more likely to consider invasive testing or termination of pregnancy should the test results demonstrate primary maternal CMV infection.
Pregnant women who were keen to undergo CMV testing demonstrated attitudes toward invasive testing and termination of pregnancy that were not significantly different from those of women who would refuse testing. Patient choice and expectations should be considered in the implementation of preventive measures against congenital CMV.
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ABSTRACT: To reduce the incidence of infants with congenital infections, women should be aware of and know prevention measures against maternal infection with mother-to-child infections during pregnancy. Our objective was to assess the awareness of and knowledge about mother-to-child infections in Japanese pregnant women. A survey of 343 Japanese pregnant women was completed. Awareness of 13 pathogens capable of mother-to-child transmission was surveyed. Knowledge about the transmission route, the most susceptible time of infection that may cause severe fetal disease during pregnancy, and methods to prevent maternal infection were investigated for four major pathogens (cytomegalovirus, rubella virus, Toxoplasma gondii, and parvovirus B19) and results were compared between these pathogens. The proportion of women aware of pathogens concerning TORCH syndrome was the following: rubella virus 76%, Treponema pallidum 69%, Toxoplasma gondii 58%, parvovirus B19 28%, herpes simplex virus 27%, and cytomegalovirus 18%. Only 8% knew how cytomegalovirus is transmitted, and only 12% knew how parvovirus B19 is transmitted; both were significantly lower than those who knew transmission routes for rubella virus or Toxoplasma gondii. The proportion of women who knew the most susceptible time for severe fetal infection by maternal acquisition of cytomegalovirus, Toxoplasma gondii, or parvovirus B19 was significantly lower than that for rubella virus. The vast majority of surveyed women were not aware of methods to prevent maternal infection with cytomegalovirus or parvovirus B19. In conclusion, current awareness of and knowledge about cytomegalovirus and parvovirus B19 infection are low in Japanese pregnant women.Congenital Anomalies 02/2014; 54(1):35-40. DOI:10.1111/cga.12030
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ABSTRACT: Background Hand, foot, and mouth disease (HFMD) is generally considered a rare illness in adults. Classically, HFMD has been strongly associated with coxsackievirus strain A16 and enterovirus 71. The coxsackievirus A6 (CVA6) strain has been linked to severe worldwide outbreaks since 2008. CVA6 is associated with a more severe and profound course of disease, affecting both children and adults. Objectives To present a series of five adult patients diagnosed with HFMD due to CVA6. We investigate method of diagnosis and compare clinical presentation of adult cases to those in children. Study Design Each patient underwent a full-body skin exam as well as inspection of the oral cavity. Rapid plasma reagin (RPR) and serologic assays by complement fixation against coxsackievirus B (1-6) and A (2,4,7,9,10,16) were performed as indicated. As standard serological testing does not detect CVA6, real-time reverse transcription-polymerase chain reaction (qRT-PCR) of serum, buccal swabs, and skin scrapings were performed by the Centers for Disease Control and Prevention (CDC). Results: Each patient had clinical findings consistent with various stages of HFMD. One patient presented with delayed onychomadesis and desquamation of the palms and soles. RPR and serologic assays by complement fixation against CVB (1-6) and CVA (2,4,7,9,10,16) were mostly negative, although elevated in two patients due to cross-reactivity. qRT-PCR identified CVA6 genetic material in samples from all patients. Conclusion This series demonstrates that there is a wide array of disease presentation of CVA6 associated HFMD in adults.Journal of Clinical Virology 08/2014; 60(4). DOI:10.1016/j.jcv.2014.04.023 · 3.47 Impact Factor
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ABSTRACT: BackgroundCongenital cytomegalovirus (CMV) is the leading infectious cause of birth defects in the United States. To better understand factors that may influence CMV transmission risk, we compared viral and immunological factors in healthy children and their mothers.MethodsWe screened for CMV IgG antibodies in a convenience sample of 161 children aged 0 inverted question mark47 months from the Atlanta, Georgia metropolitan area, along with 32 mothers of children who screened CMV-seropositive. We assessed CMV shedding via PCR using saliva collected with oral swabs (children and mothers) and urine collected from diapers using filter paper inserts (children only).ResultsCMV IgG was present in 31% (50/161) of the children. Half (25/50) of seropositive children were shedding in at least one fluid. The proportion of seropositive children who shed in saliva was 100% (8/8) among the 4 inverted question mark12 month-olds, 64% (9/14) among 13 inverted question mark24 month-olds, and 40% (6/15) among 25 inverted question mark47 month-olds (P for trend inverted question mark= inverted question mark0.003). Seropositive mothers had a lower proportion of saliva shedding (21% [6/29]) than children (P inverted question mark< inverted question mark0.001). Among children who were shedding CMV, viral loads in saliva were significantly higher in younger children (P <0.001); on average, the saliva viral load of infants (i.e., <12 months) was approximately 300 times that of two year-olds (i.e., 24 inverted question mark35 months). Median CMV viral loads were similar in children inverted question marks saliva and urine but were 10 inverted question mark50 times higher (P inverted question mark< inverted question mark0.001) than the median viral load of the mothers inverted question mark saliva. However, very high viral loads (> one million copies/mL) were only found in children inverted question marks saliva (31% of those shedding); children inverted question marks urine and mothers inverted question mark saliva specimens all had fewer than 100,000 copies/mL. Low IgG avidity, a marker of primary infection, was associated with younger age (p inverted question mark= inverted question mark0.03), higher viral loads in saliva (p inverted question mark= inverted question mark0.02), and lower antibody titers (p inverted question mark= inverted question mark0.005).ConclusionsYoung CMV seropositive children, especially those less than one year-old may present high-risk CMV exposures to pregnant women, especially via saliva, though further research is needed to see if this finding can be generalized across racial or other demographic strata.BMC Infectious Diseases 11/2014; 14(1):568. DOI:10.1186/s12879-014-0568-2 · 2.56 Impact Factor