Congenital Cytomegalovirus Infection Burden and Epidemiologic Risk Factors in Countries With Universal Screening: A Systematic Review and Meta-analysis.
Congenital Cytomegalovirus Infection Burden and Epidemiologic Risk Factors in Countries With Universal Screening: A Systematic Review and Meta-analysis.
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DOI：
10.1001/jamanetworkopen.2021.20736
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发表时间：
2021-08-02
影响因子：
13.8
通讯作者：
Schiff SJ
中科院分区：
文献类型：
--
作者：
Ssentongo P;Hehnly C;Birungi P;Roach MA;Spady J;Fronterre C;Wang M;Murray-Kolb LE;Al-Shaar L;Chinchilli VM;Broach JR;Ericson JE;Schiff SJ
高收入和中低收入国家先天性巨细胞病毒感染的合并患病率以及与患病率相关的因素是什么？在这项系统性综述和荟萃分析中，包括来自36个国家的77项研究，包括515646名3周以下的婴儿，先天性巨细胞病毒的汇总总患病率为0.67%。低收入和中等收入国家的感染负担是高收入国家的3倍。与尿液或唾液相比，使用血液进行筛查的比率较低。这项研究的结果表明，低收入和中等收入国家的先天性巨细胞病毒感染负担最大;需要在全球努力解决流行率最高的地区的先天性巨细胞病毒，以降低疾病的发病率和发病率。先天性巨细胞病毒（cCMV）感染是最常见的先天性感染，也是发育障碍和感音神经性耳聋的主要后天原因，但缺乏对感染负担的可靠评估。估计低收入和中等收入国家（LMIC）和高收入国家（HIC）的cCMV出生患病率，通过筛查方法描述患病率，并描述感染的相关风险因素。检索了MEDLINE/PubMed、Scopus和科克伦系统评价数据库，检索时间为1960年1月1日至2021年3月1日，共识别出1322项研究。纳入了提供来自3周以下婴儿普遍筛查的cCMV患病率数据的研究。排除了针对性筛选研究。遵循系统性综述和荟萃分析的首选报告项目指南。由3名审查员独立进行浸提。使用Newcastle-Ottawa量表对队列研究进行质量评估。进行了随机效应荟萃分析。进行荟萃回归分析，以评估社会人口学特征，孕产妇血清阳性率，人群水平的HIV感染率，筛查方法与cCMV的患病率的关联。通过对小于3周的婴儿进行尿液、唾液或血液样本中CMV的普遍筛查，确定cCMV的出生患病率。77项研究包括515646名婴儿，符合世界银行每个收入水平代表国家的纳入标准。cCMV的估计汇总总患病率为0.67%（95% CI，0.54%-0.83%）。LMIC（1.42%; 95% CI，0.97%-2.08%; n = 23项研究）中cCMV的合并出生患病率是HIC（0.48%; 95% CI，0.40%-0.59%，n = 54项研究）的3倍。使用血液样本的筛查方法显示cCMV的检出率低于尿液或唾液样本（比值比[OR]，0.38; 95%CI，0.23-0.66）。母体CMV血清阳性率较高（OR，1.19; 95% CI，1.11-1.28），人群水平的HIV感染率较高（OR，1.22; 95% CI，1.05-1.40），社会经济地位较低（OR，3.03; 95% CI，2.05-4.47）和较年轻的平均母亲年龄（OR，0.85; 95% CI，0.78-0.92，年龄较大与较低的发生率相关）与较高的cCMV发生率相关。在这项荟萃分析中，LMIC似乎引起了最显著的感染负担。仅使用血液或血清作为筛查方法的研究报告了较低的cCMV发生率。本系统性综述和荟萃分析按国家经济状况以及促成诊断和患病率的因素检查了婴幼儿先天性巨细胞病毒（cCMV）的患病率。
What are the pooled prevalence of congenital cytomegalovirus infection and factors associated with the rates in high-income and low- and middle-income countries? In this systematic review and meta-analysis including 77 studies from 36 countries comprising 515 646 infants younger than 3 weeks, the pooled overall prevalence of congenital cytomegalovirus was 0.67%. The infection burden was 3-fold greater in low- and middle-income countries than in high-income countries. Lower rates were reported in screening methods using blood compared with urine or saliva. The findings of this study suggest that low- and middle-income countries incur the greatest infection burden of congenital cytomegalovirus; a global effort to address congenital cytomegalovirus in regions with the greatest prevalence is needed to reduce disease incidence and morbidity. Congenital cytomegalovirus (cCMV) infection is the most common congenital infection and the leading acquired cause of developmental disabilities and sensorineural deafness, yet a reliable assessment of the infection burden is lacking. To estimate the birth prevalence of cCMV in low- and middle-income countries (LMICs) and high-income countries (HICs), characterize the rate by screening methods, and delineate associated risk factors of the infection. MEDLINE/PubMed, Scopus, and Cochrane Database of Systematic Reviews databases were searched from January 1, 1960, to March 1, 2021, and a total of 1322 studies were identified. Studies that provided data on the prevalence of cCMV derived from universal screening of infants younger than 3 weeks were included. Targeted screening studies were excluded. Preferred Reporting Items for Systematic Reviews and Meta-analyses guideline was followed. Extraction was performed independently by 3 reviewers. Quality was assessed using the Newcastle-Ottawa Scale for cohort studies. Random-effects meta-analysis was undertaken. Metaregression was conducted to evaluate the association of sociodemographic characteristics, maternal seroprevalence, population-level HIV prevalence, and screening methods with the prevalence of cCMV. Birth prevalence of cCMV ascertained through universal screening of infants younger than 3 weeks for CMV from urine, saliva, or blood samples. Seventy-seven studies comprising 515 646 infants met the inclusion criteria from countries representative of each World Bank income level. The estimated pooled overall prevalence of cCMV was 0.67% (95% CI, 0.54%-0.83%). The pooled birth prevalence of cCMV was 3-fold greater in LMICs (1.42%; 95% CI, 0.97%-2.08%; n = 23 studies) than in HICs (0.48%; 95% CI, 0.40%-0.59%, n = 54 studies). Screening methods with blood samples demonstrated lower rates of cCMV than urine or saliva samples (odds ratio [OR], 0.38; 95% CI, 0.23-0.66). Higher maternal CMV seroprevalence (OR, 1.19; 95% CI, 1.11-1.28), higher population-level HIV prevalence (OR, 1.22; 95% CI, 1.05-1.40), lower socioeconomic status (OR, 3.03; 95% CI, 2.05-4.47), and younger mean maternal age (OR, 0.85; 95% CI, 0.78-0.92, older age was associated with lower rates) were associated with higher rates of cCMV. In this meta-analysis, LMICs appeared to incur the most significant infection burden. Lower rates of cCMV were reported by studies using only blood or serum as a screening method. This systematic review and meta-analysis examines the prevalence of congenital cytomegalovirus (cCMV) in young infants by economic status of countries as well as factors contributing to the diagnosis and prevalence.
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影响因子：
26.1
作者：
Dollard SC;Dreon M;Hernandez-Alvarado N;Amin MM;Wong P;Lanzieri TM;Osterholm EA;Sidebottom A;Rosendahl S;McCann MT;Schleiss MR
通讯作者：
Schleiss MR
影响因子：
120.7
作者：
Boppana, Suresh B.;Ross, Shannon A.;Fowler, Karen B.
通讯作者：
Fowler, Karen B.
影响因子：
5.1
作者：
Adler, SP;Finney, JW;Best, AM
通讯作者：
Best, AM
影响因子：
1.9
作者：
Duval, S;Tweedie, R
通讯作者：
Tweedie, R
影响因子：
3.7
作者：
Cannon, Michael J.;Stowell, Jennifer D.;Dollard, Sheila C.
通讯作者：
Dollard, Sheila C.