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10/10/2023  |   11:45 AM - 12:10 PM   |  6619

Intrafamilial CMV Transmission in the First Two Years Postpartum

Abstract Summary

Objective: To precisely define intrafamilial CMV transmission in order to characterize determinants of transmission including likely route, viral load (VL), and genotypic factors in a high seroprevalence setting. Methods: A cohort of Kenyan women were recruited in the third trimester of pregnancy with two-year follow up. Weekly samples were collected from mothers and children including breast milk, saliva, and urine. Congenital CMV (cCMV) was identified by qPCR of infant day 4 urine; postnatal infection was identified by infant urine qPCR, narrowing down to identify week of infection. Maternal and sibling peri-infection samples (week of infection and preceding 4 weeks) underwent qPCR to identify CMV exposures. Exposure in controls was assessed through quarterly qPCR of contact samples. T-tests were used to compare log-transformed exposure VLs between CMV-infected and uninfected groups. Results: Among 188 infants, there was one confirmed cCMV case (0.5%); cCMV could not be ruled out in an additional 5 infants (2.7%). Only 46 (24.5%) children remained CMV-uninfected at 2 years. Cumulative incidence was 52.8% at 6 months and 66.7% at 1 year. Rates of in-utero HIV exposure and maternal saliva CMV VL were similar between CMV-infected and uninfected children by 2 years of age (41% vs. 39%; median 2.38 vs. 2.44 log IU/mL [p=0.10]). Maternal breast milk and sibling saliva VL were significantly higher among contacts of CMV-infected children (median 4.52 vs. 3.86 [p<0.001] and 4.30 vs. 3.02 [p=0.001], respectively). All children aside from one CMV-uninfected child were exposed to CMV shedding. Conclusion: Only 24.5% of children remained CMV-uninfected at 2 years old. All children except one were exposed through maternal or sibling contacts. Breast milk is a common and high VL source of infant exposure to CMV, as well as shedding by siblings. Additional testing is underway to assess maternal reinfections and perform next-generation sequencing of transmitted viral strains.

Learning Objectives

  • Describe early life CMV acquisition in a high seroprevalence setting
  • Discuss likely sources of CMV exposure amongst familial contacts
  • Evaluate next steps for sequencing of transmitted viral strains and their implications

Presentation

3440589_16098ElisabethMcClymont.pdf

Handouts

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Presenters


Elisabeth McClymont | Primary Presenter

elisabeth.mcclymont@cw.bc.ca;
Dr. McClymont is a postdoctoral fellow at the University of British Columbia, Canada with a research focus on reproductive infectious diseases.

ASHA DISCLOSURE

Financial - Receives Salary for Other activities from Michael Smith Health Research BC.  

Nonfinancial - No relevant nonfinancial relationship exists.

AAA DISCLOSURE

Financial - Receives support from NIH for Research grants.  


Emily R Begnel | Author, Co-Author

erb29@uw.edu;
PhD Student

ASHA DISCLOSURE

Financial -

Nonfinancial -

AAA DISCLOSURE

Financial - No relevant financial relationship exists.


Ednah Ojee | Co-Author

ojeeakinyi@gmail.com;
Dr. Ednah Ojee is a Consultant Paediatrician with a passion for Child Health, Advocacy, Research and Medical education. She is a tutorial fellow at the University of Nairobi, Faculty of Health Sciences in the Department of Paediatrics and Child Health, where she is earning her PhD.

ASHA DISCLOSURE

Financial -

Nonfinancial -

AAA DISCLOSURE

Financial - No relevant financial relationship exists.


Judith Adhiambo | Co-Author

adhiamboj69@yahoo.com;
Assistant Study Physician at University of Nairobi in Collaboration with University of Washington OPH Project (Pediatric HIV Clinic)

ASHA DISCLOSURE

Financial -

Nonfinancial -

AAA DISCLOSURE

Financial - No relevant financial relationship exists.


Brenda Wandika | Co-Author

bwandik@uw.edu;
Registered clinical nurse and a Study Clinician Coordinator

ASHA DISCLOSURE

Financial -

Nonfinancial -

AAA DISCLOSURE

Financial - No relevant financial relationship exists.


Bhavna H Chohan | Author, Co-Author

bchohan@uw.edu;
Clinical Assistant Professor, Global Health Senior Research Scientist, Kenya Medical Research Institute, Nairobi, Kenya

ASHA DISCLOSURE

Financial - No relevant financial relationship exists.

Nonfinancial - No relevant nonfinancial relationship exists.

AAA DISCLOSURE

Financial - No relevant financial relationship exists.


Preston Owiti | Co-Author

prestonomondi@gmail.com;
Laboratory Manager for the University of Washington/University of Nairobi’s Pediatrics Collaborative Research Laboratory in Nairobi, Kenya

ASHA DISCLOSURE

Financial -

Nonfinancial -

AAA DISCLOSURE

Financial - No relevant financial relationship exists.


Dara A Lehman | Co-Author

dlehman@fredhutch.org;
Affiliate Associate Professor, Global Health, University of Washington

ASHA DISCLOSURE

Financial -

Nonfinancial -

AAA DISCLOSURE

Financial - No relevant financial relationship exists.


Dalton Wamalwa | Co-Author

dalton.wamalwa@uonbi.ac.ke;
Associate Professor in the Department of Paediatrics and Child Health and a Consultant paeditrician. Prof Wamalwa has experience in conducting research studies in Maternal Newborn and Child Health as well as Paediatric HIV.

ASHA DISCLOSURE

Financial -

Nonfinancial -

AAA DISCLOSURE

Financial - No relevant financial relationship exists.


John Kinuthia | Co-Author

kinuthia@uw.edu;
Dr John Kinuthia is an Obstetrician Gynecologist and Head of Research and Programs at Kenyatta National Hospital and honorary lecturer, at the University of Nairobi Institute of Tropical and Infectious Diseases and the Department of Obstetrics and Gynaecology.

ASHA DISCLOSURE

Financial -

Nonfinancial -

AAA DISCLOSURE

Financial - No relevant financial relationship exists.


Jennifer Slyker | Co-Author

jslyker@uw.edu;
Associate Professor, Global Health Adjunct Associate Professor, Epidemiology

ASHA DISCLOSURE

Financial - No relevant financial relationship exists.

Nonfinancial - No relevant nonfinancial relationship exists.

AAA DISCLOSURE

Financial - Receives support from Canadian Institutes of Health Research (CIHR) National institutes of Health (NIH) for Research grants awarded to UBC/Montreal: Soren Gantt, and Fred Hutch/UW: Dara Lehman, Jennifer Slyker.  


Soren Gantt | Co-Author

soren.gantt.med@ssss.gouv.qc.ca;
Dr. Gantt is a Pediatric Infectious Diseases specialist, the Director of Clinical Research at CHU Sainte-Justine, and Full Professor in the Departments of Microbiology, Infectious Diseases & Immunology and of Pediatrics at the University of Montreal. Dr. Gantt’s current research focuses primarily on the development of CMV vaccines as well as newborn CMV screening programs.

ASHA DISCLOSURE

Financial -

Nonfinancial -

AAA DISCLOSURE

Financial - Receives support from Moderna, Merck, GSK, VBI, Pfizer, Altona, Meridian Biosciences, CMV Canada, National CMV Foundation for Consultant (Moderna, Merck, GSK) Research support (Moderna, Merck, GSK, VBI, Altona, Meridian) Advisory Board (CMV Canada, National CMV Foundation).