Prevalence of Old and New Torch Infection in Pregnant Women from Mombasa and Kisumu Counties in Kenya in 2017

Abstract

Introduction: Toxoplasma gondii, Rubella, Cytomegalovirus (CMV) and Herpes simplex viruses, known briefly as TORCH are infectious agents that lead to the development of a maternal infection and may enter the intrauterine circulation at any gestational age increasing the risk of congenital malformations and abortion. Despite this, the testing for these infections is not commonly included in antenatal screenings nationwide in Kenya because it is quite costly and is also considered less prevalent in our population by obstetricians. It is mainly tested to confirm the cause of recurrent unexplained pregnancy losses in mothers with a bad obstetric history. Objectives: Through this study, we aim to confirm the prevalence current and old TORCH infections in the pregnant women in two largely populated counties of Kenya. This would give us estimated of successful vaccination coverage of the MMR vaccine, the lowest age with exposure to the infections, and the possible benefit for conducting the test in all pregnant women. Also to identify possible biographic factors correlated with increased risk of positivity to infection in the population. Methodology: Using stratified method of randomization and selection of centers, one of the largest centers with antenatal clinics (ANC) was chosen in each county and all their patients attending their ANC were screened for the infection using the On-Site TORCH Panel Rapid Test CTK Biotech, Inc. (San Diego, CA 92121, USA) with a specificity of between 85% and 97%. Positive results for IgM were verified using ELISA. Results: There was extremely low prevalence of confirmed active infection of TORCH in the population (only 2 cases which did not have any complications in pregnancy as a result), but presence of old infection was at about 30% for Toxoplasma, 50% for Rubella and HSV-1, 20% for HSV-2 and 10% for CMV. There seems to be an interruption in effective Rubella vaccination around the year 1987 which would be worth investigating. Conclusion: Testing pregnant women for TORCH is not of much benefit in pregnancy in Kenya due to low prevalence. However, the test can be used to screen populations at risk as is being conducted currently.