title: Dynamics of Persistent Oral Cytomegalovirus Shedding During Primary Infection in Ugandan Infants.
abstract: Cytomegalovirus (CMV) infection occurs frequently in young children, who, when infected, are then a major source of transmission. Oral CMV shedding by 14 infants with primary infection was comprehensively characterized using quantitative polymerase chain reaction weekly for ≥9 months. Three phases of oral shedding were identified: expansion, transition, and clearance. Viral expansion occurred over a median of 7 weeks, with a median doubling time of 3 days. During the transition phase, expansion slowed over a median of 6 weeks before peak viral load was reached. Clearance was slow (22-day median half-life), and shedding did not resolve during observation for any infant. Mathematical modeling demonstrated that prolonged oral CMV expansion is explained by a low within-host reproduction number (median, 1.63) and a delayed immune response that only decreases the infected cell half-life by 44%. Thus, the prolonged oral CMV shedding observed during primary infection can be explained by slow viral expansion and inefficient immunologic control.
authors.affiliation: Vaccine and Infectious Disease Division.
authors.forename: Bryan T
authors.initials: BT
authors.lastname: Mayer
authors.affiliation: Vaccine and Infectious Disease Division.
authors.forename: Laura
authors.initials: L
authors.lastname: Matrajt
authors.affiliation: Vaccine and Infectious Disease Division.|Clinical Research Division.|Public Health Science Division, Fred Hutchinson Cancer Research Center.|Department of Medicine.|Department of Epidemiology.|Department of Global Health.
authors.forename: Corey
authors.initials: C
authors.lastname: Casper
authors.affiliation: Vaccine and Infectious Disease Division.
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Krantz
authors.affiliation: Vaccine and Infectious Disease Division.|Clinical Research Division.|Department of Medicine.|Department of Laboratory Medicine, University of Washington, Seattle.
authors.forename: Lawrence
authors.initials: L
authors.lastname: Corey
authors.affiliation: Vaccine and Infectious Disease Division.|Department of Medicine.|Department of Epidemiology.|Department of Laboratory Medicine, University of Washington, Seattle.
authors.forename: Anna
authors.initials: A
authors.lastname: Wald
authors.affiliation: Vaccine and Infectious Disease Division.|BC Children's Hospital, University of British Columbia, Vancouver, Canada.
authors.forename: Soren
authors.initials: S
authors.lastname: Gantt
authors.affiliation: Vaccine and Infectious Disease Division.|Clinical Research Division.|Department of Medicine.
authors.forename: Joshua T
authors.initials: JT
authors.lastname: Schiffer
mesh_terms: D002675:Child, Preschool; D015331:Cohort Studies; D003587:Cytomegalovirus / Q000302:isolation & purification*; D003586:Cytomegalovirus Infections / Q000473:pathology* / Q000821:virology*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008962:Models, Theoretical; D009055:Mouth / Q000821:virology*; D011247:Pregnancy; D060888:Real-Time Polymerase Chain Reaction; D013997:Time Factors; D014454:Uganda; D017201:Virus Shedding
keywords: cytomegalovirus; epidemiology; immunology; mathematical model; theoretical biology; transmission