title: Prevalence and risk factors for betaherpesvirus DNAemia in children >3 weeks and <2 years of age admitted to a large referral hospital in sub-Saharan Africa.
abstract: BACKGROUND
  Betaherpesviruses are established causes of morbidity and mortality in immunosuppressed patient groups but have been little studied in sub-Saharan Africa, the epicenter of the human immunodeficiency virus (HIV) pandemic. In this region, primary infections with human cytomegalovirus (HCMV) and human herpesvirus type 6 (HHV-6) type 6 are endemic in infancy, but the clinical impact of these infections among pediatric inpatient groups is poorly characterized and assumptive, based largely on data from Western populations.
  
  
  METHODS
  We used TaqMan polymerase chain reaction to screen sera from a group of 303 pediatric inpatients aged between 3 weeks and 2 years, at the University Teaching Hospital in Lusaka, Zambia. We report the prevalence of DNAemia and viral loads within this patient group, and evaluate possible clinical associations/risk factors for betaherpesvirus infections in these hospitalized children.
  
  
  RESULTS
  We detected betaherpesvirus DNAemia in 59.1% (179/303) of children. HCMV was the most prevalent (41.3%), followed by HHV-6B (20.5%), HHV-7 (20.1%), and HHV-6A (0.3%). HIV infection (odds ratio [OR], 2.31; 95% confidence interval [CI], 1.37-3.90; P = .002), being underweight (OR, 1.82; 95% CI, 1.06-3.12; P = .03), and an admission diagnosis of suspected meningitis (OR, 5.72; 95% CI, 1.07-30.5; P = .041) were independently associated with an increased odds of HCMV DNAemia. Conversely, HHV-6B and HHV-7 DNAemia were not associated with HIV, underweight, or admission diagnosis. Median HCMV viral load was moderately but significantly higher in HIV-infected children.
  
  
  CONCLUSIONS
  Highly prevalent HCMV DNAemia was independently associated with HIV infection and being underweight across all age groups, and was also associated with meningitis, with previously underappreciated implications for the health and development of African children.
authors.affiliation: University of Zambia - University College London Medical School Research and Training Programme HerpeZ, University Teaching Hospital, Lusaka, Zambia Institute for Infectious Diseases, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
authors.forename: John
authors.initials: J
authors.lastname: Tembo
authors.affiliation: University of Zambia - University College London Medical School Research and Training Programme HerpeZ, University Teaching Hospital, Lusaka, Zambia.
authors.forename: Mwila
authors.initials: M
authors.lastname: Kabwe
authors.affiliation: University of Zambia - University College London Medical School Research and Training Programme HerpeZ, University Teaching Hospital, Lusaka, Zambia.
authors.forename: Lophina
authors.initials: L
authors.lastname: Chilukutu
authors.affiliation: University of Zambia - University College London Medical School Research and Training Programme HerpeZ, University Teaching Hospital, Lusaka, Zambia.
authors.forename: Moses
authors.initials: M
authors.lastname: Chilufya
authors.affiliation: Department of Paediatrics and Child Health, University Teaching Hospital, Lusaka, Zambia.
authors.forename: Nyaxewo
authors.initials: N
authors.lastname: Mwaanza
authors.affiliation: Department of Paediatrics and Child Health, University Teaching Hospital, Lusaka, Zambia.
authors.forename: Chishala
authors.initials: C
authors.lastname: Chabala
authors.affiliation: University of Zambia - University College London Medical School Research and Training Programme Division of Infection and Immunity, University College London National Institute for Health Research Biomedical Research Centre, University College London Hospitals, United Kingdom.
authors.forename: Alimuddin
authors.initials: A
authors.lastname: Zumla
authors.affiliation: University of Zambia - University College London Medical School Research and Training Programme HerpeZ, University Teaching Hospital, Lusaka, Zambia Division of Infection and Immunity, University College London.
authors.forename: Matthew
authors.initials: M
authors.lastname: Bates
mesh_terms: D002675:Child, Preschool; D003587:Cytomegalovirus / Q000235:genetics / Q000302:isolation & purification*; D003586:Cytomegalovirus Infections / Q000453:epidemiology* / Q000209:etiology / Q000821:virology; D004279:DNA, Viral / Q000097:blood; D005260:Female; D015658:HIV Infections / Q000150:complications; D015654:Herpesvirus 6, Human / Q000235:genetics / Q000302:isolation & purification*; D016199:Herpesvirus 7, Human / Q000235:genetics / Q000302:isolation & purification*; D006784:Hospitals, Teaching; D006785:Hospitals, University; D006801:Humans; D016867:Immunocompromised Host; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D015995:Prevalence; D012017:Referral and Consultation; D012307:Risk Factors; D019349:Roseolovirus Infections / Q000453:epidemiology* / Q000209:etiology / Q000821:virology; D013851:Thinness; D019562:Viral Load; D015024:Zambia
chemical_list: D004279:DNA, Viral
keywords: CMV; HHV-6; HIV; malnutrition; meningitis