Cytomegalovirus infection in a day-care center in the municipality of São Paulo

Mello, Ana L. R. de; Ferreira, Elizabeth C.; Vilas Boas, Lucy S.; Pannuti, Claudio S.

doi:10.1590/S0036-46651996000300001

Abstracts

The prevalence of antibodies against cytomegalovirus (CMV) and the incidence of CMV infection were tested in 98 children aged 5 to 36 months who attended the day-care center of a University hospital in São Paulo. At the beginning of the study the overall prevalence of anti-CMV IgG antibodies was 44% (43/98). Saliva and/or urine samples were obtained from 38 of the 43 children that were seropositive at the beginning of the study for isolation of the virus, and 52.6% of these children were found to excrete CMV in one of the two materials. Among the 37 children that were initially seronegative from whom it was possible to obtain a new blood sample 6 to 12 months later, 22 (59.5%) presented seroconversion. The rate of viral excretion through urine or saliva from the children that seroconverted was 50%. These results indicate that CMV infection is frequent and occurs early among the children who attend this day-care center. However, controlled studies using molecular epidemiology techniques are needed to define more precisely the role of day-care centers in CMV dissemination.

Cytomegalovirus; Day-Care center; Epidemiology

A prevalência de anticorpos e a incidência de infecção por citomegalovírus (CMV) foram estudadas em 98 crianças de 5 a 36 meses de idade que freqüentavam a creche de um hospital universitário em São Paulo. No início do estudo, a prevalência geral de anticorpos para o CMV foi de 44% (43/98). Obteve-se para o isolamento viral, amostras de saliva e/ou urina de 36 das 43 crianças que eram soropositivas, constatando-se que 55,6% das mesmas estavam excretando CMV em um dos materiais. Das 37 crianças inicialmente soronegativas, das quais foi possível obter nova amostra de sangue 6 a 12 meses após, 22 (59,5%) apresentaram soroconversão. A taxa de excreção viral na urina ou saliva nas crianças que soroconverteram foi de 52,4%. Estes resultados indicam que a infecção por CMV foi freqüente e ocorreu precocemente nas crianças que freqüentavam esta creche. Contudo, estudos controlados usando técnicas de epidemiologia molecular são necessários para definir mais precisamente o papel da creche na disseminação do CMV.

VIROLOGY

Cytomegalovirus infection in a day-care center in the municipality of São Paulo

Infecção por citomegalovírus em creche do município de São Paulo

Ana L. R. de Mello^I; Elizabeth C. Ferreira^II; Lucy S. Vilas Boas^II; Claudio S. Pannuti^II

^IDepartamento de Medicina Tropical, Instituto Oswaldo Cruz, Fiocruz, Rio de Janeiro

^IIDepartamento de Doenças Infecciosas e Parasitárias da Faculdade de Medicina da Universidade de São Paulo (LIMHCFMUSP) Instituto de Medicina Tropical de São Paulo

^{Correspondence to} Correspondence to: C.S. Pannuti Instituto de Medicina Tropical de S. Paulo Av. Dr. Enéas de Carvalho Aguiar 470 05403-000 S. Paulo, SP, Brasil

SUMMARY

The prevalence of antibodies against cytomegalovirus (CMV) and the incidence of CMV infection were tested in 98 children aged 5 to 36 months who attended the day-care center of a University hospital in São Paulo. At the beginning of the study the overall prevalence of anti-CMV IgG antibodies was 44% (43/98). Saliva and/or urine samples were obtained from 38 of the 43 children that were seropositive at the beginning of the study for isolation of the virus, and 52.6% of these children were found to excrete CMV in one of the two materials. Among the 37 children that were initially seronegative from whom it was possible to obtain a new blood sample 6 to 12 months later, 22 (59.5%) presented seroconversion. The rate of viral excretion through urine or saliva from the children that seroconverted was 50%.

These results indicate that CMV infection is frequent and occurs early among the children who attend this day-care center. However, controlled studies using molecular epidemiology techniques are needed to define more precisely the role of day-care centers in CMV dissemination.

Keywords: Cytomegalovirus; Day-Care center; Epidemiology.

RESUMO

A prevalência de anticorpos e a incidência de infecção por citomegalovírus (CMV) foram estudadas em 98 crianças de 5 a 36 meses de idade que freqüentavam a creche de um hospital universitário em São Paulo. No início do estudo, a prevalência geral de anticorpos para o CMV foi de 44% (43/98). Obteve-se para o isolamento viral, amostras de saliva e/ou urina de 36 das 43 crianças que eram soropositivas, constatando-se que 55,6% das mesmas estavam excretando CMV em um dos materiais. Das 37 crianças inicialmente soronegativas, das quais foi possível obter nova amostra de sangue 6 a 12 meses após, 22 (59,5%) apresentaram soroconversão. A taxa de excreção viral na urina ou saliva nas crianças que soroconverteram foi de 52,4%.

Estes resultados indicam que a infecção por CMV foi freqüente e ocorreu precocemente nas crianças que freqüentavam esta creche. Contudo, estudos controlados usando técnicas de epidemiologia molecular são necessários para definir mais precisamente o papel da creche na disseminação do CMV.

Full text available only in PDF format.

Texto completo disponível apenas em PDF.

ACKNOWLEDGMENT

We thank Dr. Heitor Franco de Andrade for statistical analysis and critical review of the manuscript.

Recebido para publicação em 22/04/1996

Aceito para publicação em 21/05/1996

1. ADLER, S.P. - Cytomegalovirus and child day care. Evidence for an increased infecton rate among day-care workers. New Engl. J. Med., 321: 1290-1296, 1989.
2. THE CHILD DAY CARE INFECTIOUS DISEASE STUDY GROUP - Public health considerations of infectious diseases in child day care centers. J. Pediat., 105: 683-701, 1984.
3. CARVALHO, R.P.S.; PANNUTI, C.S.; AMATO NETO, V.; OSELKA, G.W. & ANGELO, M.J.O. - Estudo soro-epidemiológico da infecçăo pelo citomegalovírus em Săo Paulo, Brasil. Rev. Inst. Med. trop. S. Paulo, 18: 1-5, 1976.
4. CHOU, S.W. & DENNISON, K.M. - Analysis of in terstrain variation in cytomegalovirus glycoprotein B sequences encoding neutralization-related epitopes. J. infect. Dis., 163: 1229-1234, 1991.
5. CHOU, S. - Molecular epidemiology of envelope glycoprotein H of human cytomegalovirus. J. infect. Dis., 166: 604-607, 1992.
6. DWORSKY, M.; LAKEMAN, A. & STAGNO, S. - Cytomegalovirus transmission within a family. Pediat. infect. Dis., 3: 236-238, 1984.
7. FAIX, R.G. - Survival of cytomegalovirus on environmental surfaces. J. Pediat., 106: 649-652, 1985.
8. HO, M. - Epidemiology of cytomegalovirus infections. Rev. infect. Dis., 12(suppl. 7): S701-S710, 1990.
9. HUTTO, C.; RICKS, R.; GARVIE, M. & PASS, R.F. - Epidemiology of cytomegalovirus infections in young children: day care vs. home care. Pediat. infect. Dis., 4: 149-152, 1985.
10. HUTTO, C.; RICKS, R.E. & PASS, R.F. - Prevalence of cytomegalovirus excretion from children in five day-care centers. J. Amer. med. Ass., 253: 1236-1240, 1985.
11. MACHADO, C.M.M.; FINK, M.C.D.S.; VILAS BOAS, L.S. et al. - Infecçăo perinatal pelo citomegalovírus em hospital público do município de Săo Paulo: estudo prospectivo. Rev. Inst. Med. trop. S.Paulo, 33: 159-166, 1991.
12. MURPH, J.R.; BALE Jr., J.F.; MURRAY, J.C.; STINSKI, M.F. & PERLMAN, S. - Cytomegalovirus transmission in a midwest day care center: possible relationship to child care practices. J. Pediat., 109: 35-39, 1986.
13. MURPH, J.R. & BALE Jr., F.J. - The natural history of acquired cytomegalovirus infection among children in group day care. Amer. J. Dis. Child., 142: 843-846, 1988.
14. NOGUEIRA, R.M.R.; SCHATZMAYR, H.G.; ASSIS, C.E.R. & PINHĂO, A.T. - Infecçőes pelo citomegalovírus e herpes simplex tipo 2. Amostragem em crianças de baixa idade no município do Rio de Janeiro. Clin. pediat. (S. Paulo), 10: 22-28, 1986.
15. PANNUTI, C.S.; VILAS BOAS, L.S.; ANGELO, M.J.O.; CARVALHO, R.P.S. & SEGRE, C.M. - Congenital cytomegalovirus infection. Occurrence in two socioeconomically distinct populations of a developing country. Rev. Inst. Med. trop. S. Paulo, 27: 105-107, 1985.
16. PASS, R.F.; AUGUST, A.M.; DWORSKY, M. & REYNOLDS, D.W. - Cytomegalovirus infection in a day-care center. New Engl. J. Med., 307: 477-479, 1982.
17. PASS, R.F.; HUTTO, C.; REYNOLDS, D.W. & POLHILL, R.B. - Increased frequency of cytomegalovirus infection in children in group day care. Pediatrics, 74: 121-126, 1984.
18. PASS, R.F. & HUTTO, C. - Group day care and cytomegalovirus infections of mothers and children. Rev. infect. Dis., 8: 599-605, 1986.
19. PASS, R.F.; LITTLE, E.A.; STAGNO, S.; BRITT, W.J. & ALFORD, C.A. - Young children as a probable source of maternal and congenital cytomegalovirus infection. New Engl. J. Med., 316: 1366-1370, 1987.
20. SOUZA, S.L. & CAMARGO, M.E. - The use of filter paper blood smears in a practical fluorescent test for American trypanosomiasis serodiagnosis. Rev. Inst. Med. trop. S. Paulo, 8: 255-258, 1966.
21. SOUZA, I.E.; NICHOLSON, D.; MATTHEY, S. et al. - Rapid epidemiologic characterization of cytomegalovirus strains from pediatric bone marrow transplant patients. Infect. Control Hosp. Epidem., 16: 399-404, 1995.
22. STAGNO, S.; CLOUD, G.; PASS, R.F.; BRITT, W.J. & ALFORD, C.A. - Factors associated with primary cytomegalovirus infection during pregnancy. J. med. Virol., 13: 347-353, 1984.
23. STRANGERT, K.; CARLSTRÖM, G.; JEANSSON, S. & NORD, C.E. - Infections in preschool children in group day care. Acta paediat. scand., 65: 455-463, 1976.

Correspondence to:

C.S. Pannuti

Instituto de Medicina Tropical de S. Paulo

Av. Dr. Enéas de Carvalho Aguiar 470

05403-000 S. Paulo, SP, Brasil

Publication Dates

Publication in this collection
22 Sept 2006
Date of issue
June 1996

History

Received
26 Apr 1996
Accepted
21 May 1996

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. ADLER, S.P. - Cytomegalovirus and child day care. Evidence for an increased infecton rate among day-care workers. New Engl. J. Med., 321: 1290-1296, 1989.

[2] 2. THE CHILD DAY CARE INFECTIOUS DISEASE STUDY GROUP - Public health considerations of infectious diseases in child day care centers. J. Pediat., 105: 683-701, 1984.

[3] 3. CARVALHO, R.P.S.; PANNUTI, C.S.; AMATO NETO, V.; OSELKA, G.W. & ANGELO, M.J.O. - Estudo soro-epidemiológico da infecçăo pelo citomegalovírus em Săo Paulo, Brasil. Rev. Inst. Med. trop. S. Paulo, 18: 1-5, 1976.

[4] 4. CHOU, S.W. & DENNISON, K.M. - Analysis of in terstrain variation in cytomegalovirus glycoprotein B sequences encoding neutralization-related epitopes. J. infect. Dis., 163: 1229-1234, 1991.

[5] 5. CHOU, S. - Molecular epidemiology of envelope glycoprotein H of human cytomegalovirus. J. infect. Dis., 166: 604-607, 1992.

[6] 6. DWORSKY, M.; LAKEMAN, A. & STAGNO, S. - Cytomegalovirus transmission within a family. Pediat. infect. Dis., 3: 236-238, 1984.

[7] 7. FAIX, R.G. - Survival of cytomegalovirus on environmental surfaces. J. Pediat., 106: 649-652, 1985.

[8] 8. HO, M. - Epidemiology of cytomegalovirus infections. Rev. infect. Dis., 12(suppl. 7): S701-S710, 1990.

[9] 9. HUTTO, C.; RICKS, R.; GARVIE, M. & PASS, R.F. - Epidemiology of cytomegalovirus infections in young children: day care vs. home care. Pediat. infect. Dis., 4: 149-152, 1985.

[10] 10. HUTTO, C.; RICKS, R.E. & PASS, R.F. - Prevalence of cytomegalovirus excretion from children in five day-care centers. J. Amer. med. Ass., 253: 1236-1240, 1985.

[11] 11. MACHADO, C.M.M.; FINK, M.C.D.S.; VILAS BOAS, L.S. et al. - Infecçăo perinatal pelo citomegalovírus em hospital público do município de Săo Paulo: estudo prospectivo. Rev. Inst. Med. trop. S.Paulo, 33: 159-166, 1991.

[12] 12. MURPH, J.R.; BALE Jr., J.F.; MURRAY, J.C.; STINSKI, M.F. & PERLMAN, S. - Cytomegalovirus transmission in a midwest day care center: possible relationship to child care practices. J. Pediat., 109: 35-39, 1986.

[13] 13. MURPH, J.R. & BALE Jr., F.J. - The natural history of acquired cytomegalovirus infection among children in group day care. Amer. J. Dis. Child., 142: 843-846, 1988.

[14] 14. NOGUEIRA, R.M.R.; SCHATZMAYR, H.G.; ASSIS, C.E.R. & PINHĂO, A.T. - Infecçőes pelo citomegalovírus e herpes simplex tipo 2. Amostragem em crianças de baixa idade no município do Rio de Janeiro. Clin. pediat. (S. Paulo), 10: 22-28, 1986.

[15] 15. PANNUTI, C.S.; VILAS BOAS, L.S.; ANGELO, M.J.O.; CARVALHO, R.P.S. & SEGRE, C.M. - Congenital cytomegalovirus infection. Occurrence in two socioeconomically distinct populations of a developing country. Rev. Inst. Med. trop. S. Paulo, 27: 105-107, 1985.

[16] 16. PASS, R.F.; AUGUST, A.M.; DWORSKY, M. & REYNOLDS, D.W. - Cytomegalovirus infection in a day-care center. New Engl. J. Med., 307: 477-479, 1982.

[17] 17. PASS, R.F.; HUTTO, C.; REYNOLDS, D.W. & POLHILL, R.B. - Increased frequency of cytomegalovirus infection in children in group day care. Pediatrics, 74: 121-126, 1984.

[18] 18. PASS, R.F. & HUTTO, C. - Group day care and cytomegalovirus infections of mothers and children. Rev. infect. Dis., 8: 599-605, 1986.

[19] 19. PASS, R.F.; LITTLE, E.A.; STAGNO, S.; BRITT, W.J. & ALFORD, C.A. - Young children as a probable source of maternal and congenital cytomegalovirus infection. New Engl. J. Med., 316: 1366-1370, 1987.

[20] 20. SOUZA, S.L. & CAMARGO, M.E. - The use of filter paper blood smears in a practical fluorescent test for American trypanosomiasis serodiagnosis. Rev. Inst. Med. trop. S. Paulo, 8: 255-258, 1966.

[21] 21. SOUZA, I.E.; NICHOLSON, D.; MATTHEY, S. et al. - Rapid epidemiologic characterization of cytomegalovirus strains from pediatric bone marrow transplant patients. Infect. Control Hosp. Epidem., 16: 399-404, 1995.

[22] 22. STAGNO, S.; CLOUD, G.; PASS, R.F.; BRITT, W.J. & ALFORD, C.A. - Factors associated with primary cytomegalovirus infection during pregnancy. J. med. Virol., 13: 347-353, 1984.

[23] 23. STRANGERT, K.; CARLSTRÖM, G.; JEANSSON, S. & NORD, C.E. - Infections in preschool children in group day care. Acta paediat. scand., 65: 455-463, 1976.