1. Seroprevalence and Social Determinants of Human Cytomegalovirus Infection in Subgroups of the Population in Sindh, Pakistan
Saira Ibrahim1, Waqaruddin Ahmed2, Amna Rehana Siddiqui3, Paul Moss4, El-Nasir Lalani5 and Anwar Ali Siddiqui1
1Department of Biological and Biomedical Sciences, 5Department of Pathology and Microbiology, The Aga Khan University, Karachi, Pakistan, 2Pakistan Medical Research Council, Jinnah Postgraduate Medical Centre, Karachi, Pakistan, 3Department of Family and Community Medicine, King Saud University, Riyadh, Saudi Arabia, 4School of Cancer Sciences, University of Birmingham, Birmingham, United Kingdom
Abstract
Results
Introduction: Human Cytomegalovirus (HCMV) is a ubiquitous pathogen. Seroprevalence of HCMV varies in different populations and in different age groups.
Objective: To determine seroprevalence of HCMV infection and its association with socio-demographic factors in subgroups of population from Sindh province of Pakistan.
Methods: Study participants aged ≥18 years from hospital and community settings; namely Aga Khan University (AKU), Jinnah Postgraduate Medical Centre (JPMC) which are private and government tertiary care hospitals respectively, Malir and Gadap rural communities were recruited. A questionnaire was used to collect socio-demographic and other data. An ELISA kit was used to detect HCMV IgG and IgM antibodies. Univariate and multivariate analyses were performed to calculate crude and adjusted odds ratios (ORs).
Results & Conclusion: The overall HCMV-IgG and IgM seroprevalence were 93.2% (95% CI, 91.47% %) and 4.3% (95% CI, 3.21% %) respectively. HCMV IgG seroprevalence increased with age, and differed by gender, monthly income, educational level, crowding status and settings. Multivariate logistic regression model showed , female gender, increasing age, and decreasing income, remained as predictors adjusted for setting for chronic HCMV infection. In Pakistan, HCMV is very common and tends to vary greatly across gender, age, setting and socio-economic groups.
378
Table 1. Distribution of CMV-IgG Seroprevalence by Socio-demographic Characteristics of the Study Population.
Table 2. Multiple Logistic Regression Model for Determinants of HCMV-IgG Seropositivity.
256
Frequency
% Positive
Total
OR (95% CI)
Study Setting
Pvt. Hospital
Govt. Hospital
Rural Community 1
Rural Community 2
83.89
94.95
86.11
96.13
149
634 36
181 1
3.61 ( )
0.20 ( )
4.77 (1.88–12.60)
Age Groups (Years)
≤25
26-34
35-45
>45
89.23
91.73
97.10
94.52
260
242
276
219
1.34 ( )
4.04 ( )
2.08 ( )
Gender
Female
Male
95.71
90.28
537
463
2.41 ( )
Household Income (Rs)
≤7000
>
>
>20000
95.09
93.83
94.86
88.26
306
211
253
230
2.58 ( )
2.03 ( )
2.46 ( )
Education Level (Years)
1-6
7-10
≥10
96.73
96.37
92.82
86.77
368
138
237
257
4.52 ( )
4.06 ( )
1.97 ( )
Crowding Index ≤2
>2-3
>3-5
>5
88.46
95.16
94.85
95.08
286
207
272
224
2.57 ( )
2.40 ( )
2.53 ( )
Marital Status
Married
Single
765
235
2.00 ( )
Characteristics
Adjusted OR
95% CI
Gender
Males (Reference)
Females
1.89 1
1.10–3.25
Monthly Income in Rs (Log Transformed)
0.73
Age in Years
(Log Transformed)
3.96
Study Setting
Pvt. Hospital (Reference)
Govt. Hospital
Rural Community 1
Rural Community 2
2.46
0.61
3.16 99 82 82 67 26 10
Figure 1. Distribution of Males and Females at Four Different Study Settings
93.2
95.7
Conclusions
Introduction
Our baseline data on seroprevalence of HCMV-IgG and IgM indicate that HCMV infection is very common in Pakistan.
The HCMV-IgG seroprevalence is 93.2%.
The HCMV-IgM seroprevalence is 4.3%.
The IgG seroprevalence is already very high among individuals aged between years and by 45 years of age an even higher proportion of the population is exposed to HCMV.
Women show an increasing trend of HCMV infection than men.
The infection is more prevalent in lower socio-economic strata.
In future, longitudinal studies focused on children and younger individuals from subgroups of Pakistan are needed to identify the first age at which HCMV infection is acquired.
Further studies focused on women susceptible to HCMV infection in Pakistan are essential to raise awareness among women as well as the public health sector to initiate counseling of pregnant women about the basic prevention strategies.
Human Cytomegalovirus (HCMV) is a ubiquitous pathogen distributed in diverse populations.
The epidemiology of HCMV infection varies as high income countries report a lower HCMV prevalence than lower middle and upper middle income countries1-4.
An earlier study from Pakistan (1987) had limitations in terms of sample size and inadequate selection criteria5.
Objective: To determine seroprevalence and socio-demographic profile of HCMV infection in subgroups of population from Sindh province of Pakistan.
HCMV-IgG Seroprevalence (%)
6.8
4.3
Methods
Figure 2. Seroprevalence (%) of HMV-IgG and IgM in Persons Aged 18 Years and Older
References
96.39
96.66
97.57
94.35
93.65
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91.91
Blood Collection
IgG and IgM ELISA
89.65
Acknowledgements
HCMV-IgG Seroprevalence (%)
84.55
This study was fully supported by British Council’s INSPIRE Strategic Partnership Award. We are grateful to Dr. Romaina Iqbal (Department of Community Health Sciences, AKU) and her team for their cooperation and assistance in sample and data collection. We also thank Dr. Saeed Hamid (Department of Medicine, AKU) and all the nursing and phlebotomy staff for their generous help and support in blood collection.
N = 1000
( Years)
Figure 3. Patterns of HCMV-IgG Seroprevalence (%) Across Different Age Groups in Males (n = 463) and Females (n = 537)
Questionnaire Based Socio-Demographic Information
Statistical Analysis