Prevalence of Herpes -, Measles Morbillivirus-, Parvovirus
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Prevalence of herpes -, measles morbillivirus-, parvovirus B19 - and rubella viruses immunoglobulin G among women with chronic hepatitis B of reproductive age in Denmark A cross-sectional study Bergløv, Anne; Hallager, Sofie; Panum, Inge; Weis, Nina Published in: International Journal of Infectious Diseases DOI: 10.1016/j.ijid.2020.09.1477 Publication date: 2020 Document version Publisher's PDF, also known as Version of record Document license: CC BY-NC-ND Citation for published version (APA): Bergløv, A., Hallager, S., Panum, I., & Weis, N. (2020). Prevalence of herpes -, measles morbillivirus-, parvovirus B19 - and rubella viruses immunoglobulin G among women with chronic hepatitis B of reproductive age in Denmark: A cross-sectional study. International Journal of Infectious Diseases, 101, 269-275. https://doi.org/10.1016/j.ijid.2020.09.1477 Download date: 01. Oct. 2021 International Journal of Infectious Diseases 101 (2020) 269–275 Contents lists available at ScienceDirect International Journal of Infectious Diseases journal homepage: www.elsevier.com/locate/ijid Prevalence of herpes -, measles morbillivirus-, parvovirus B19 - and rubella viruses immunoglobulin G among women with chronic hepatitis B of reproductive age in Denmark: A cross-sectional study a a b a,c, Anne Bergløv , Sofie Hallager , Inge Panum , Nina Weis * a Department of Infectious Diseases, Copenhagen University Hospital Hvidovre, Kettegaard Alle 30, DK 2650 Hvidovre, Denmark b Department of Clinical Microbiology, Copenhagen University Hospital Hvidovre, Kettegaard Alle 30, DK 2650 Hvidovre, Denmark c Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, DK 2200 Copenhagen, Denmark A R T I C L E I N F O A B S T R A C T Article history: Objectives: The aim of this study was to investigate whether the seroprevalence of IgG antibodies against Received 20 August 2020 seven viruses (cytomegalovirus, herpes simplex virus 1&2, measles morbillivirus, parvovirus B19, rubella, Received in revised form 25 September 2020 and varicella-zoster virus), which can potentially compromise maternal and fetal wellbeing, differs based Accepted 27 September 2020 on country of origin among women with chronic hepatitis B (CHB). Method: This study was a single-center, hospital-based cross-sectional study. The study included women Keywords: with CHB 15–45 years of age, included in the Danish Database for Hepatitis B and C. Seroprevalence Seroprevalence estimates were calculated with a 95% confidence interval and were compared between age groups, Chronic hepatitis B regions of origin, and to the general population. Herpes viruses Morbillivirus Results: 177 women were included in the study. Overall, the seroprevalences of antibodies were similar Parvovirus B19 rubella among women with CHB with origin outside Denmark and compared to the general population in Pregnancy Denmark, but there was a notable difference in the seroprevalence of antibodies against herpes simplex 2 between women from Africa (37.1% CI 95% 22.0;55.1) and women from the Middle East (2.5% CI 95% 0.1;14.7). Conclusion: Women with CHB whose origin is outside Denmark do not appear to differ, based on origin, or be at greater risk of acquiring these viruses during pregnancy than their Danish counterparts. © 2020 The Authors. Published by Elsevier Ltd on behalf of International Society for Infectious Diseases. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc- nd/4.0/). Introduction first two trimesters of pregnancy can lead to congenital malformation or fetal death (MMWR 2001; Tan and Koren Vertical transmission of viral infections during pregnancy is a 2006; Ornoy and Ergaz 2017). Viral infection towards the end of significant cause of maternal and fetal morbidity and mortality. the pregnancy can lead to preterm birth or neonatal morbidity and The clinical manifestations vary depending on the viral agent and mortality (Brown et al. 2003; Rasmussen and Jamieson 2015; De the gestational age of pregnancy at infection. A viral infection in the Paschale and Clerici 2016). Further, primary infection with varicella-zoster virus (VZV) in the last trimester of pregnancy may lead to varicella pneumonia in the mother; this is associated with a mortality as high as 14% (Tan and Koren 2006). In this study, Abbreviations: CMV, Cytomegalovirus; CHB, chronic hepatitis B; CRS, Congenital we have chosen to focus on the following seven viruses due to their Rubella Syndrome; CSV, Congenital Varicella Syndrome; DANHEP, Danish Database potential harm caused during pregnancy: cytomegalovirus (CMV), for Hepatitis B and C; HBV, Hepatitis B virus; HSV1, Herpes Simplex virus 1; HSV2, herpes simplex virus 1 and 2 (HSV1 and HSV2), measles Herpes Simplex virus 2; MMR, Measles, mumps, and rubella; VZV, Varicella-zoster virus; Morbillivirus, Measles morbillivirus. morbillivirus (morbillivirus), parvovirus B19, rubella virus, and * Corresponding author at: Department of Infectious Diseases, Copenhagen VZV. University Hospital, Hvidovre, Kettegaard Alle 30, DK 2650 Hvidovre, Denmark. Due to differences in exposure and different immunization E-mail addresses: [email protected] (A. Bergløv), schedules, women of childbearing age born outside Denmark sofi[email protected] (S. Hallager), [email protected] (I. Panum), might not be immune to the same viruses as women born and [email protected] (N. Weis). https://doi.org/10.1016/j.ijid.2020.09.1477 1201-9712/© 2020 The Authors. Published by Elsevier Ltd on behalf of International Society for Infectious Diseases. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Downloaded for Anonymous User (n/a) at BS - University of Copenhagen from ClinicalKey.com by Elsevier on November 17, 2020. For personal use only. No other uses without permission. Copyright ©2020. Elsevier Inc. All rights reserved. A. Bergløv, S. Hallager, I. Panum et al. International Journal of Infectious Diseases 101 (2020) 269–275 raised in Denmark. Consequently, in our clinical practice, the HSV 1&2, morbillivirus, parvovirus B19, rubella virus, and VZV) question is often raised whether pregnant women born outside differs based on country of origin in women with CHB, 15–45 years Denmark have the same risk of acquiring any of the viruses of age, with origin outside Denmark, and to compare these to mentioned above during pregnancy compared to women born in official seroprevalence estimates from the Danish population. Denmark. Patients chronically infected with hepatitis B virus (HBV, CHB) Method living in Denmark are typically immigrants from Africa or Asia (Weis 2009), making them a target population for this study. As well, all This study was conducted as a single-center, hospital-based pregnant women have since 2005been tested for HBV infection early cross-sectional study. in pregnancy (Knigge and Fouchard 2010); only if a woman is exposed to other viruses during pregnancy do the Danish guidelines Study population recommend testing the woman's level of specific antibodies to guide further treatment, clinical follow-up, and counseling. Women with CHB living in Denmark were used as a Among adults in Denmark, the prevalence of immunoglobulin G convenient sample to serve as a proxy for immigrants in antibodies (IgG) against CMV is 80%; HSV1 and HSV2 80% and 33%, Denmark. Hence potential subjects for inclusion were required respectively; parvovirus B19 65% and against VZV 98% (Sundheds- to have CHB (HBsAg positive >6 months) and be aged 15–45 styrelsen 2019; Statens Serum Institut 2019a, 2019b; Agner et al. years of age at enrollment in the Danish Database for Hepatitis 2020). The varicella vaccine is not a part of the Danish childhood B and C (DANHEP) (Weis 2009). Women eligible for inclusion vaccination program. In 2017, 94% of infants in Denmark were were referred to the Department of Infectious Diseases at vaccinated with the first dose of the measles, mumps, and rubella Copenhagen University Hospital, Hvidovre, between Jan 1, (MMR) vaccine, and 88% received the second dose (Sundheds- 2005, and Dec 31, 2016. DANHEP is a nationwide clinical styrelsen 2017). However, there is no knowledge about the database of patients with chronic hepatitis B and C, 15 years prevalence of antibodies against these viral infections in women of age, admitted or referred to a hospital in Denmark. The currently living in Denmark, but with an origin outside Denmark database contains demographic, clinical and paraclinical from countries with varying immunization coverage. According to information, and includes a biobank. In Denmark, all patients the World Health Organization (WHO), the lowest coverage of with chronic hepatitis B and C exclusively attend hospital measles immunization is found in South-East Asia (75%) and Africa departments of infectious diseases, or gastroenterology. (73%), and the highest coverage is found in Europe (94%) (WHO). Seroprevalence estimates from the Danish population were Women born outside Denmark might therefore be at higher risk of obtained from official Danish sources. contracting one or more of these viral infections during pregnancy, if they do not have protection from vaccination or previous Blood samples infections. Thus, the aim of this study was to investigate whether the The blood samples used in this study were collected from the seroprevalence of IgG antibodies against these seven viruses (CMV, preexisting DANHEP biobank. Blood samples