SERO-CHARACTERIZATION OF HUMAN CYTOMEGALOVIRUS AMONG PREGNANT WOMEN IN THIKA. PUBLISHERS: Zakayo Maingi (corresponding author) Dr Anthony Kebira Prof Yixing Zhang

Background of study Cytomegalovirus (CMV) is the commonest among viral infections during perinatal period that cause congenital infections Seroprevalence in pregnant women ranges from 45% to 100%. Its clinical manifestations range from asymptomatic forms to severe foetal damage It is transmitted from person-to-person via close non-sexual contact, sexual activity, breastfeeding, blood transfusions, and organ transplantation.

Problem statement Studies of CMV during pregnancy have not been conducted in pregnant women in this region. Evidence of pregnancy complications and congenital malformations Caring for these children with congenital problems is a challenging task.

Justification of the study Significance and impact of CMV -serious complications. CMV infection during pregnancy poses a 30% to 40% risk of intrauterine transmission No surveillance framework done among pregnant women in Kenya negligence is part of the contributing factors to high intrauterine transmission leading to high recorded cases of irreversible sequeal and mental disorders in foetuses

hypothesis Cytomegalovirus infection is high among Pregnant women attending Thika Hospitals. Social demographic factors are not significant in CMV transmission and infection among pregnant women

objectives objectives To determine the prevalence of CMV among pregnant women To determine the number of acute and chronic CMV cases. To establish the level of active and protective CMV antibodies in the pregnant women. To determine the social demographic characteristics among study participants

methodology Research design This was a cross sectional study. serves a population from both urban and rural setting. signing a consent form filled the provided questionnaire then proceeded to the laboratory for sample collection.

Eligibility criteria Inclusion criteria: Pregnant women attending the ante natal clinic of Thika Hospitals. Pregnant women in their first or second trimester of pregnancy. Pregnant women in the age group of 16-45 years Exclusion criteria Pregnant women in their third trimester Pregnant women not sure of their gestational period.

Expected results and applications. The study was carried out to show the importance of CMV testing in pregnant women. Identify the groups at risk The study also recommended that infected pregnant women be put on antiviral therapy.

methodology Consenting pregnant women filled a questionnaire to obtain socio-demographic data A 5ml blood specimen was obtained for each subject. Quantitative analysis for CMV antibodies(IgG and IgM) was performed, and the assay result interpreted as IU/mL. Avidity testing was carried out on samples having both antibodies.

results serostatus f % both 54 20.8% IgG 158 60.8% IgM 10 3.8% none 38 14.6% total 260 100.0%

Results cont’d avidity index Participants(n) % <35% 11 20.37 >35% 43 79.63 Total 54 100.0

variable participants (%) IgM (%) IgG (%) total(%) p value Age group: 16-20 12 19.4 70.9 90.3 21-25 22 22.26 34.26   26-30 38 13.68 81.05 94.73 0.001* 31-35 25 3.7 85.19 88.89 36-40 9 22.22 55.56 77.78 41-45 6 10 90 100 marital status: single 24.39 13.6 57.6 71.2 married 64.61 7.2 82 89.2 divorced 10.39 96.3 parity: none 45 10.35 65.5 75.85 one to four 53.08 5.8 87.7 93.5 0.0006* >four 13.59 66.7 education 1.2 primary 4.6 20 86.7 secondary 30.4 11.4 73.4 84.8 0.014* tertiary 63.8 4.8 79.5 84.3

Active and protective abs variable active abs protective abs   age group: 16-20 2(28.6%) 10(58.8%) 21-25 2(100%) 32(76.2%) 26-30 3(60%) 61(79.2%) 31-35 1(50%) 38(82.6%) 36-40 2(50%) 9(90%) 41-45 0(0) 8(88.9%) marital status: single 4(30%) 33(86.8%) married 6(50%) 105(76.45%) divorced 20(76.86%) parity: none 7(58.3%) 56(73.67 %) one to four 3(37.5%) 108(89.2%) >four education primary 4(50%) secondary 5(55.56%) 43(74.1%) tertiary 111(84.1%)

results Out of 260 pregnant women, 201 (77.3%) were CMV IgG 21(8.1%) CMV IgM being on acute stage of the disease. Marital status (OR = 3.7533, 95% CI =3.0231-6.9631, P < 0.0001), parity (OR = 3.7533, 95% CI = 3.0231-6.9631, P < 0.0001), and education (OR = 3.7533, 95% CI = 3.0231-6.9631, P < 0.0001), history of blood transfusion (OR = 0.0374, 95% CI = 0.00120-0.1168, OR = 0.3804) were found to significantly influence seropostivity in univariate analysis. Those with AI >35% were 43 (79.63%) while those with AI<or equal to 35% were 11 (20.37%).

discussion This is the first data on the epidemiology of CMV infections among pregnant women in Kenya. women who were married, illiterate, aged or with high parity, were found to be at higher risk for CMV infection These factors increased susceptibility to acquisition of CMV infection. These findings were similar to those obtained in other developing countries

conclusion The prevalence of CMV is high significant relationship between CMV prevalence and social demographic information The level of chronic infection is higher than acute infection Protective antibodies were higher than active antibodies

recommendation A follow up study is necessary. Further studies be carried out on the different strains of CMV-(awaiting ethical approval) Large scale studies to ascertain the consequences of CMV infection in infants The 88.4% CMV prevalence rate being detected among pregnant women calls for vaccine and routine screening for CMV infections and its associated risk factors in this kind of settings.

Special thanks National Research Institute of Chinese Medicine Kenyatta University Microbiology department

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