Congenital CMV Infection and Hearing Loss in Rural Indian Population

描述（由申请人提供）：先天性巨细胞病毒感染是儿童听力损失和脑部疾病的主要原因，医学研究所已将巨细胞病毒作为疫苗开发的目标。先前的研究表明，怀孕期间母体的原发性感染是破坏性先天性感染的最重要危险因素。然而，最近的研究，包括我们之前在Ballabgarh的MCHDR研究，显示先天性巨细胞病毒感染在几乎普遍巨细胞病毒血清免疫的孕产妇人群中发生率更高（1%至2%）。这些研究还表明，巨细胞病毒相关的感音神经性听力损失（SNHL）发生在巨细胞病毒血清阳性率高的人群中，其发生率与美国和北欧相似，因此，先天性巨细胞病毒感染在发展中国家人群中的公共卫生影响可能是显著的。我们建议检验先天性巨细胞病毒感染在印度SNHL中占很大比例的假设。这一假设将在两个具体目标中得到解决：(1)通过筛查新生儿巨细胞病毒和听力损失来确定在印度巴拉巴格尔的综合农村卫生服务项目（CRHSP）中出生的婴儿中巨细胞病毒相关SNHL的贡献，以及(2)评估更新，快速，简单和简单的基于pcr的方法适用于资源贫乏环境中的新生儿巨细胞病毒筛查。CRHSP和Ballabgarh拥有良好的基础设施，可以随时进入CRHSP服务的研究人群，UAB和AIIMS的研究人员之间的持续合作关系为拟议的研究提供了显著的优势。此外，我们期望对农村人口出生时SNHL进行初步估计，并在社区一级测试新生儿听力筛查计划的可行性。拟议的研究将提供关于出生时听力损失的总体患病率和cmv相关SNHL在人群中的贡献的重要信息，早期识别SNHL风险增加的儿童，以及制定SNHL儿童的干预策略。拟议的研究计划还包括并强调培训和技术转让的组成部分。

DESCRIPTION (provided by applicant): Congenital CMV infection is a leading cause of hearing loss and brain disease in children and the Institute of Medicine has targeted CMV for vaccine development. Previous studies have suggested that primary maternal infection during pregnancy was the most significant risk factor for damaging congenital infections. However, more recent studies including our previous MCHDR study at Ballabgarh have shown congenital CMV infection occurs at higher rate (1% to 2%) in maternal populations with near universal CMV seroimmunity. These studies have also suggested that CMV-related sensorineural hearing loss (SNHL) occurs in populations with high CMV seroprevalence at a rate similar to that observed in the U.S. and Northern Europe thus, the public health impact of congenital CMV infection in populations of developing countries could be significant. We propose to test the hypothesis that congenital CMV infection contributes to a significant proportion of SNHL in India. This hypothesis will be addressed in two specific aims: (1) To determine the contribution of CMV- related SNHL in infants born at the Comprehensive Rural Health Services Project (CRHSP) in Ballabgarh, India by screening newborns for CMV and hearing loss, and (2) To evaluate the utility of newer, rapid, simple and simple PCR-based methods suitable for newborn CMV screening in resource-poor settings. The presence of an excellent infrastructure at CRHSP, Ballabgarh providing ready access to the study population served by the CRHSP and the ongoing collaborative relationship between the investigators at UAB and at AIIMS provides significant advantage to the proposed studies. In addition, we expect to develop preliminary estimates of SNHL at birth in the rural population and to test the feasibility of newborn hearing screening program at the community level. The proposed studies will provide crucial information about the overall prevalence of hearing loss at birth and the contribution of CMV-related SNHL in the population, an early identification of children at increased risk for SNHL, and the development of intervention strategies for children with SNHL. The proposed research plan also incorporates and emphasizes the training and technology transfer components. PUBLIC HEALTH RELEVANCE: We propose to test the hypothesis that a significant proportion of SNHL at birth or neonatal period in India is secondary to congenital CMV infection. The proposed study will also examine the feasibility of screening newborns for hearing function at the primary health center setting in a rural community. It is expected that the results of this study to provide a reliable estimate of SNHL prevalence at birth in a low-income semi-urban population near New Delhi, India. In addition, we will evaluate simple and reliable methods that can be used in resource-poor settings to screen infants for congenital CMV infection.