title: Congenital cytomegalovirus infection is associated with high maternal socio-economic status and corresponding low maternal cytomegalovirus seropositivity.
abstract: OBJECTIVE
  Human cytomegalovirus (CMV) is the leading infectious cause of congenital infection in developed countries. Globally, CMV seropositivity has been associated with low socio-economic status (SES); however, Australian data are lacking. Therefore, we examined the association between SES and CMV seroprevalence in children and pregnant women.
  
  
  METHODS
  Three groups were examined: 1, a prospective cohort of Australian children aged 0-15 years (n = 220); 2, a clinic-based sample of pregnant women (n = 778); and 3, a case series of infants and children (n = 219) with symptomatic congenital CMV infection. SES was determined using a postcode-based score from the Australian Bureau of Statistics.Group 1 was recruited from endocrinology clinics and follow-up at Prince of Wales Hospital and Children's Hospital at Westmead. Group 2 was recruited at the Royal Hospital for Women. Congenitally infected infants were identified through the Australian Paediatric Surveillance Unit.
  
  
  RESULTS
  CMV seroprevalence among all children was 20% (95% confidence interval (CI) 15-25%), and there was no association with SES (P = 0.58). Seroprevalence among pregnant women was 57% (53-60%), and higher rates of CMV seropositivity were associated with lower SES (P < 0.001). More congenital CMV cases were reported in the highest socio-economic groups (55%) than the lowest (9%) (P < 0.001).
  
  
  CONCLUSIONS
  A marked socio-economic gradient in CMV seroprevalence is evident in Australian pregnant women and cases of congenital CMV but not in unselected Australian children. These findings highlight the importance of a community-wide approach to CMV awareness and the potential for hygienic measures to reduce the burden of congenital CMV in Australia.
authors.affiliation: Virology, Department of Microbiology, SEALS, Prince of Wales Hospital, Randwick, New South Wales, Australia; School of Medical Sciences, Faculty of Medicine, University of New South Wales, Kensington, New South Wales, Australia.
authors.forename: James
authors.initials: J
authors.lastname: Basha
authors.forename: Jenna M
authors.initials: JM
authors.lastname: Iwasenko
authors.forename: Peter
authors.initials: P
authors.lastname: Robertson
authors.forename: Maria E
authors.initials: ME
authors.lastname: Craig
authors.forename: William D
authors.initials: WD
authors.lastname: Rawlinson
mesh_terms: D000293:Adolescent; D001315:Australia / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D003586:Cytomegalovirus Infections / Q000151:congenital / Q000453:epidemiology / Q000209:etiology* / Q000635:transmission; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000706:statistics & numerical data; D008297:Male; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology / Q000209:etiology*; D011446:Prospective Studies; D012307:Risk Factors; D016036:Seroepidemiologic Studies; D012923:Social Class
keywords: Australia; congenital infection; cytomegalovirus; seroprevalence; socio-economic status