Seroprevalence of human cytomegalovirus infection in Singapore

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Background: The human cytomegalovirus virus (HCMV) is a ubiquitous betaherpesvirus, common in all human populations, with seroprevalence of 80-100% in adults across the world. Most infections are harmless, but it can cause congenital HCMV infection in neonates or disseminated disease in the immunocompromised hosts. Till date, there has been scarce seroprevalence data of this disease in our country.

Methods: A retrospective analysis of the HCMV IgG assays performed in our laboratory was done. The period of study was from 2004 to 2007.

Results: A total of 3582 patient data were available. Duplicates and patient with missing variables (age, sex) were removed, leaving 2042 patients (median of 707 patients per year) for analysis. Across the 4 years of data, there was no significant difference seen in across the age groups, sex or race. An overall seropositivity rate was 40% for the 1-10 year age group.

This rises gradually to 44%, 73%, 82%, 90%, 97% and 100% for each decade increase. The males and females have a similar rate of acquisition of HCMV seropositivity at age group 1-10 of 40%. However, seropositivity in females increases rapidly compared to the males in the age groups 10-20 to 40-50 before being similar again in the older age groups. This difference becomes statistically different in the 20-30 year age group (p=0.0024). Amongst the races, the predominant Chinese race group has a lower seropositivity in all age groups from 1-10 to 40-50 compared to the minority races of Indians and Malays combined. This difference was statistically different in the 20-30 year age group (p=0.001). The differences are likely related to the social habits of each race, and sex.

Conclusion: The result show a HCMV seroprevalence of 73% in the adult age group of 20-30. This prevalence is higher for females and in the minority races. This data has implications in estimating the risk for congenital CMV disease in neonates born to mothers acquiring their primary infection during pregnancy, and risk of CMV disease in transplant programmes.