Abstract
BackgroundHuman cytomegalovirus (CMV) is a common herpesvirus which is estimated to infect 83% of the global population. Whilst many infections are asymptomatic, it is an important cause of morbidity and mortality, particularly for immunocompromised people and for infants who are congenitally infected. A vaccine against CMV has been stated as a public health priority, but there are gaps in our understanding of CMV epidemiology. To guide potential future vaccination strategies, our aim was to examine risk factors for CMV seropositivity in young people in England.MethodsThe Health Survey for England (HSE) is an annual, cross-sectional representative survey of households in England during which data are collected through questionnaires, and blood samples are taken. We randomly selected individuals who participated in the HSE 2002, aiming for 25 participants of each sex in each single year age group from 11 to 24 years. Stored samples were tested for CMV antibodies. We undertook descriptive and regression analyses of CMV seroprevalence and risk factors for infection.ResultsDemographic data and serostatus were available for 732 individuals, of whom 175 (23.7%) were CMV-seropositive. CMV seroprevalence was associated with age, with 18.3% seropositive at 11–14 years compared to 28.3% at 22–24 years. CMV serostatus was also higher in people of non-white ethnicity (adjusted odds ratio [aOR] 6.22, 95% confidence interval [CI] 3.47–11.14), and in adults who were seropositive for EBV (aOR 2.08 [1.06–4.09]). There was no evidence that smoking status, occupation, body mass index and region of England were associated with CMV serostatus.ConclusionsCMV seroprevalence is strongly associated with ethnicity, and modestly increases with age in 11–24-year-olds. A greater understanding of the transmission dynamics of CMV, and the impact of this on CMV-associated morbidity and mortality, is necessary to inform effective vaccination strategies when a vaccine for CMV becomes available.
Highlights
Human cytomegalovirus (CMV) is a common herpesvirus which is estimated to infect 83% of the global population
Outcome: Seropositivity for Cytomegalovirus infection We used stored blood serum samples collected by the Health Survey for England (HSE)
CMV and Epstein-Barr virus (EBV) serostatus were positively associated in univariable analyses, and when the multivariable analysis was restricted to adults, but not in the multivariable model which included children aged 11–15 years
Summary
Human cytomegalovirus (CMV) is a common herpesvirus which is estimated to infect 83% of the global population. In immunocompetent people in the UK, Gkrania-Klotsas et al found that CMV seropositivity was associated with lower life expectancy [6] This confirmed the association reported in a population-based cohort study from the US [7], as well as populations in older patients [8] and those with cardiovascular disease [9]. Other studies in the United States, Finland and United Kingdom found that, in immunocompetent individuals, CMV infection and higher levels of CMV IgG antibodies were linked to higher rates of both cardiovascular [9] and allcause mortality [7], as well as to cancer incidence [10] and ischemic heart disease [11]. CMV is negatively associated with multiple sclerosis onset [12]
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