Dynamics of Persistent Oral Cytomegalovirus Shedding During Primary Infection in Ugandan Infants

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 o...

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Bibliographic Details
Published in:The Journal of infectious diseases 2016-12, Vol.214 (11), p.1735-1743
Main Authors: Mayer, Bryan T., Matrajt, Laura, Casper, Corey, Krantz, Elizabeth M., Corey, Lawrence, Wald, Anna, Gantt, Soren, Schiffer, Joshua T.
Format: Article
Language:English
Subjects:
Child, Preschool
Cohort Studies
Cytomegalovirus - isolation & purification
Cytomegalovirus Infections - pathology
Cytomegalovirus Infections - virology
Female
Humans
Infant
Infant, Newborn
Major and Brief Reports
Male
Models, Theoretical
Mouth - virology
Pregnancy
Real-Time Polymerase Chain Reaction
Time Factors
Uganda
Virus Shedding
VIRUSES
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Summary: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. Clearnace 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.
ISSN:0022-1899
1537-6613
DOI:10.1093/infdis/jiw442