title: Sociodemographic factors associated with IgG and IgM seroprevalence for human cytomegalovirus infection in adult populations of Pakistan: a seroprevalence survey.
abstract: The seroprevalence of human cytomegalovirus (HCMV) infection ranges from 30 to 90 % in developed countries. Reliable estimates of HCMV seroprevalence are not available for Pakistan. This study determined the seroprevalence and sociodemographic factors associated with HCMV infection in adult populations of Karachi, Pakistan.
  
  
  
  A seroprevalence survey was conducted on 1000 adults, including residents of two semi-urban communities, and visitors to a government and a private hospital. Questionnaire-based interviews were conducted. Sera were analysed for HCMV-specific IgG and IgM. Chi-square or Fisher's exact test was used for comparing sociodemographic variables against seropositivity of HCMV-IgG or IgM. Multiple logistic regression modeling was performed for IgG seroprevalence and adjusted odds ratios were computed.
  
  
  
  The seroprevalence of HCMV-IgG and IgM was 93.2 and 4.3 % respectively. 95.3 % of individuals who were IgM seropositive were also seropositive for IgG. Around 6 % (15/250) of women of childbearing age remained uninfected and were therefore susceptible to primary infection. HCMV-IgG seroprevalence was associated with being female (p = 0.001), increasing age (p = 0.002) and crowding index (p = 0.003) and also with lower levels of both education (p < 0.001) and income (p = 0.008). Seroprevalence also differed significantly by marital status (p = 0.008) and sampling location (p < 0.001). A logistic regression model for HCMV-IgG seroprevalence showed associations with being female (OR = 1.89; 95 % CI: 1.10-3.25), increasing age (OR = 3.95; 95 % CI: 1.79-8.71) and decreasing income (OR = 0.72; 95 % CI: 0.54-0.96). A strong association was observed between increased seroprevalence of HCMV-IgM and decreasing household size (p = 0.008).
  
  
  
  Seroprevalence of HCMV is very high in Pakistan, although 6 % of women of childbearing age remain at risk of primary infection. The IgM seropositivity observed in some individuals living in small household size (1-3 individuals) with persistent HCMV infection could have resulted from a recurrent HCMV infection. Future longitudinal research in pregnant women and neonates is required to study the trends in HCMV seroprevalence over time in Pakistan for the development of a potential HCMV prevention and vaccination programme.
authors: Department of Biological and Biomedical Sciences, Aga Khan University, PO Box 3500, Stadium Road, Karachi, 74800, Pakistan.
authors: Saira
authors: S
authors: Ibrahim
authors: Department of Biological and Biomedical Sciences, Aga Khan University, PO Box 3500, Stadium Road, Karachi, 74800, Pakistan.
authors: Anwar A
authors: AA
authors: Siddiqui
authors: Department of Community Health Sciences, Aga Khan University, PO Box 3500, Stadium Road, Karachi, 74800, Pakistan.
authors: Amna R
authors: AR
authors: Siddiqui
authors: Pakistan Medical Research Council, Research Centre, Jinnah Postgraduate Medical Centre, Rafique Shaheed Road, Karachi, Pakistan.
authors: Waquaruddin
authors: W
authors: Ahmed
authors: Institute of Immunology and Immunotherapy, University of Birmingham, Vincent Drive, Edgbaston, Birmingham, B15 2TT, UK.
authors: Paul A H
authors: PA
authors: Moss
authors: Department of Pathology and Laboratory Medicine, Aga Khan University, PO Box 3500, Stadium Road, Karachi, 74800, Pakistan. elnasir.lalani@aku.edu.
authors: El-Nasir M A
authors: EM
authors: Lalani
mesh_terms: D000328:Adult; D000367:Age Factors; D000914:Antibodies, Viral / Q000097:blood*; D003587:Cytomegalovirus / Q000276:immunology*; D003586:Cytomegalovirus Infections / Q000453:epidemiology* / Q000276:immunology; D004522:Educational Status; D005191:Family Characteristics; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood*; D007075:Immunoglobulin M / Q000097:blood*; D007182:Income; D016015:Logistic Models; D008297:Male; D017533:Marital Status; D008875:Middle Aged; D010154:Pakistan / Q000453:epidemiology; D015995:Prevalence; D016036:Seroepidemiologic Studies; D012737:Sex Factors; D011795:Surveys and Questionnaires; D055815:Young Adult
chemical_list: D000914:Antibodies, Viral; D007074:Immunoglobulin G; D007075:Immunoglobulin M
keywords: Human cytomegalovirus; IgG; IgM; Pakistan; Seroprevalence; Sociodemographic factors