Infectious reactivation of cytomegalovirus explaining age- and sex-specific patterns of seroprevalence.
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Authorsvan Boven, Michiel
van de Kassteele, Jan
Korndewal, Marjolein J
van Dorp, Christiaan H
van der Klis, Fiona
de Melker, Hester E
Vossen, Ann C
van Baarle, Debbie
MetadataShow full item record
TitleInfectious reactivation of cytomegalovirus explaining age- and sex-specific patterns of seroprevalence.
Published inPlos Comput Biol 2017; 13(9):e1005719
PubliekssamenvattingHuman cytomegalovirus (CMV) is a herpes virus with poorly understood transmission dynamics. Person-to-person transmission is thought to occur primarily through transfer of saliva or urine, but no quantitative estimates are available for the contribution of different infection routes. Using data from a large population-based serological study (n = 5,179), we provide quantitative estimates of key epidemiological parameters, including the transmissibility of primary infection, reactivation, and re-infection. Mixture models are fitted to age- and sex-specific antibody response data from the Netherlands, showing that the data can be described by a model with three distributions of antibody measurements, i.e. uninfected, infected, and infected with increased antibody concentration. Estimates of seroprevalence increase gradually with age, such that at 80 years 73% (95%CrI: 64%-78%) of females and 62% (95%CrI: 55%-68%) of males are infected, while 57% (95%CrI: 47%-67%) of females and 37% (95%CrI: 28%-46%) of males have increased antibody concentration. Merging the statistical analyses with transmission models, we find that models with infectious reactivation (i.e. reactivation that can lead to the virus being transmitted to a novel host) fit the data significantly better than models without infectious reactivation. Estimated reactivation rates increase from low values in children to 2%-4% per year in women older than 50 years. The results advance a hypothesis in which transmission from adults after infectious reactivation is a key driver of transmission. We discuss the implications for control strategies aimed at reducing CMV infection in vulnerable groups.
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