Repeated measures study of weekly and daily cytomegalovirus shedding patterns in saliva and urine of healthy cytomegalovirus-seropositive children
Repeated measures study of weekly and daily cytomegalovirus shedding patterns in saliva and urine of healthy cytomegalovirus-seropositive children
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DOI：
10.1186/s12879-014-0569-1
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发表时间：
2014-11-13
影响因子：
3.7
通讯作者：
Dollard, Sheila C.
中科院分区：
文献类型：
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作者：
Cannon, Michael J.;Stowell, Jennifer D.;Dollard, Sheila C.
背景：为了更好地了解接触儿童体液的潜在传播风险，我们监测了健康CMV血清阳性儿童随着时间的推移巨细胞病毒的存在和数量。方法：通过筛查，我们从佐治亚州亚特兰大地区确定了36名CMV血清阳性的儿童，其中23人在筛查时正在脱落CMV。每个孩子每周接受12次家访，现场工作人员收集唾液和尿液。结果：筛查时脱落的儿童84%(455/543)和28%(151/539)的随访唾液标本中含有CMV DNA，未脱落的患儿在16%(47/303)和5%(16/305)的随访尿液标本中检出CMVDNA。在阳性样本中，我们发现唾液和尿液中病毒载量的中位数分别为82,900拷贝/毫升和34,730拷贝/毫升(P=0.01)，而第75百分位数唾液中的病毒载量接近150万拷贝/毫升，而尿液中的病毒载量为86,800拷贝/毫升。年龄越小，病毒载量越高，尤其是唾液病毒载量越高(P<；0.001)。随着时间的推移，脱落率和病毒载量相对稳定。所有在筛查中脱落的儿童在11周和12周内仍有至少一段时间的脱落，中位数和平均病毒载量随着时间的推移没有实质性变化。结论：健康的CMV血清阳性儿童可以在较高的相对稳定的水平上脱落数月。这些数据表明，行为预防信息需要解决通过唾液和尿液传播的问题，但也需要了解唾液和接触年幼儿童可能带来的更高风险。
Background: To better understand potential transmission risks from contact with the body fluids of children, we monitored the presence and amount of CMV shedding over time in healthy CMV-seropositive children.Methods: Through screening we identified 36 children from the Atlanta, Georgia area who were CMV-seropositive, including 23 who were shedding CMV at the time of screening. Each child received 12 weekly in-home visits at which field workers collected saliva and urine. During the final two weeks, parents also collected saliva and urine daily.Results: Prevalence of shedding was highly correlated with initial shedding status: children shedding at the screening visit had CMV DNA in 84% of follow-up saliva specimens (455/543) and 28% of follow-up urine specimens (151/539); those not shedding at the screening visit had CMV DNA in 16% of follow-up saliva specimens (47/303) and 5% of follow-up urine specimens (16/305). Among positive specimens we found median viral loads of 82,900 copies/mL in saliva and 34,730 copies/mL in urine (P = 0.01), while the viral load for the 75th percentile was nearly 1.5 million copies/mL for saliva compared to 86,800 copies/mL for urine. Younger age was significantly associated with higher viral loads, especially for saliva (P < 0.001). Shedding prevalence and viral loads were relatively stable over time. All children who were shedding at the screening visit were still shedding at least some days during weeks 11 and 12, and median and mean viral loads did not change substantially over time.Conclusions: Healthy CMV-seropositive children can shed CMV for months at high, relatively stable levels. These data suggest that behavioral prevention messages need to address transmission via both saliva and urine, but also need to be informed by the potentially higher risks posed by saliva and by exposures to younger children.