Velaphi, Sithembiso; Madewell, Zachary J; Tippett-Barr, Beth; Blau, Dianna M; Rogena, Emily A; Lala, Sanjay G; Mahtab, Sana; Swart, Peter J; Akelo, Victor; Onyango, Dickens; +28 more... Otieno, Kephas; Rogena, Emily A; Were, Joyce A; Bassat, Quique; Carrilho, Carla; Mandomando, Inacio; Torres-Fernandez, David; Varo, Rosauro; Luke, Ronita; Moses, Francis; Nwajiobi-Princewill, Philip; Ogbuanu, Ikechukwu Udo; Ojulong, Julius; El Arifeen, Shams; Gurley, Emily S; Assefa, Nega; Gedefa, Letta; Madrid, Lola; Scott, J Anthony G; Wale, Henok; Juma, Jane; Keita, Adama Mamby; Kotloff, Karen L; Sow, Samba O; Tapia, Milagritos D; Mutevedzi, Portia; Whitney, Cynthia G; Madhi, Shabir A; (2025) Investigating the role of cytomegalovirus as a cause of stillbirths and child deaths in low and middle-income countries through postmortem minimally invasive tissue sampling. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. ciaf098-. ISSN 1058-4838 DOI: https://doi.org/10.1093/cid/ciaf098
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Abstract
BACKGROUND: There is paucity of information on the role of cytomegalovirus (CMV) infection as a cause of stillbirths or childhood deaths in low-and middle-income countries (LMICs). We investigated attribution of CMV-disease in the causal pathway to stillbirths and deaths in children <5 years of age in seven LMICs participating in the Child Health and Mortality Prevention Surveillance (CHAMPS) network. METHODS: We analyzed stillbirths and decedents enrolled between December 2016 and July 2023. Deaths were investigated using post-mortem minimally invasive tissue sampling with histopathology and molecular diagnostic investigations of tissues and body fluids, along with review of clinical records. Multi-disciplinary expert panels reviewed findings and reported on the causal pathway to death. RESULTS: CMV was detected in 19.5%(1140/5841) of all evaluated deaths, including 5.0% (111/2204), 6.2% (139/2229), 41.2% (107/260), 68.1%(323/474) and 68.2%(460/674) of stillbirths, neonates (deaths 0-<28 days postnatal), young infants (28-<90 days), older infants (90-<365 days) and children (12-<60 months), respectively. CMV-disease was attributed in the causal pathway to death in 0.9%(20/2204) of stillbirths, 0.8%(17/2229) of neonates, 13.1% (34/260) of young infants, 9.7%(46/474) of older infants and 3.3%(22/674) of children. Decedents with CMV-disease compared with those without CMV-disease in the causal pathway, were more likely to have severe microcephaly (38.2% vs. 21.1%; aOR 2.2, 95%CI: 1.3-3.6) and HIV-infected (36.9% vs. 6.2%; aOR: 10.9, 95%CI: 6.5-18.5). CONCLUSIONS: CMV-disease is an important contributor to deaths during infancy and childhood and is often associated with severe microcephaly and HIV-infection. Improving management of CMV in HIV-infected children and a vaccine to prevent CMV are needed interventions.
Item Type | Article |
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Faculty and Department | Faculty of Epidemiology and Population Health > Dept of Infectious Disease Epidemiology & International Health (2023-) |
PubMed ID | 40059623 |
Elements ID | 237485 |
Official URL | https://doi.org/10.1093/cid/ciaf098 |
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