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ORIGINAL ARTICLE Table of Contents   
Year : 2008  |  Volume : 51  |  Issue : 3  |  Page : 351-352
Is seroprevalence of anti-IGM CMV among blood donors relevant in India?


Department of Transfusion Medicine, Armed Forces Medical College, Pune - 411 040, India

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   Abstract 

Background: Infection with cytomegalovirus (CMV) is more common in developing nations and the people belonging to the lower socioeconomic section of the society. The immunosuppressed population for whom CMV-seronegative blood products are requested is increasing due to advances in medical care. Aim: To study the prevalence of CMV antibodies among the different sexes and age groups in healthy blood donors. Materials and Methods: A retrospective study was done on 5600 serum samples stored frozen in a repository for CMV antibodies using the ELISA technique. Results: Five thousand three hundred and fifty (95.5%) were male and 250 (4.5%) were female. Four cases (0.071%) out of 5600 samples were positive for anti-IgM CMV with 95% Confidence Interval (95% C.I) of 0.02 - 0.17. Conclusion: In a developing country like India, screening for IgM antibody on a routine basis may not be feasible, given the likely positive yield to be low and the cost being high. It is recommended that in a tertiary care hospital, blood units to be transfused to neonates, organ transplant recipients, those suffering from malignancies and other immunocompromised patients should be screened for anti-IgM CMV or preventive strategies like universal leucodepletion to be implemented to decrease the transmission of CMV in these groups of patients.

Keywords: Blood donors, cytomegalovirus, immunocompromised, leucodepletion

How to cite this article:
Kumar H, Gupta P K, Kumar S, Sarkar R S. Is seroprevalence of anti-IGM CMV among blood donors relevant in India?. Indian J Pathol Microbiol 2008;51:351-2

How to cite this URL:
Kumar H, Gupta P K, Kumar S, Sarkar R S. Is seroprevalence of anti-IGM CMV among blood donors relevant in India?. Indian J Pathol Microbiol [serial online] 2008 [cited 2020 Nov 25];51:351-2. Available from: https://www.ijpmonline.org/text.asp?2008/51/3/351/42509



   Introduction Top


Cytomegalovirus (CMV) is a ubiquitous organism, found universally in all geographic locations and socioeconomic groups. However, infection with CMV is more common in developing nations and the people belonging to the lower socioeconomic section of the society. CMV is known to be a significant cause of morbidity and mortality following blood transfusions, especially in children and immunocompromised patients, most notably transplant recipients and HIV-infected persons. [1],[2] It is also the virus most frequently transmitted to the developing fetus before birth and causes symptoms from moderate hepatosplenomegaly to fatal illness. Since about 95% of the healthy blood donors in India are seropositive for IgG antibody to CMV, [3] determining the presence of IgM antibody is more relevant, as otherwise very few seronegative units of blood would be suitable for transfusion.

The immunosuppressed population for whom CMV-seronegative blood products are requested is increasing due to advances in medical care afforded to premature infants, increasing use of transplantation procedures, immunosuppressive cancer therapies and spread of acquired immune deficiency syndrome (AIDS). This study was performed to determine the seroprevalence of anti-IgM CMV antibodies in Indian blood donors in different age groups and to determine the incidence of acute infection.


   Materials and Methods Top


This study was conducted at a tertiary care hospital Blood Bank. It was a retrospective study on serum sample stored frozen in a repository. Five thousand six hundred samples of serum were collected for screening for anti-IgM CMV from healthy voluntary blood donors.

The samples were screened for using the ELISA technique (NovaTec Immundiagnostica, GmbH). Positive and negative standard sera accompanying the kit were included in each assay. The diagnostic specificity and sensitivity of the kit was greater than 98% and 91%, respectively.

Statistical analysis of the results was done using SPSS software. When relating variables to each other, multivariate analysis was done. Chi-square test and Student's t -test were employed to detect any significant correlation between the different variables.


   Results Top


A total of 5600 voluntary blood donors came in the ambit of this study. Of these, 5350 (95.5%) were male and 250 (4.5%) were female. The mean age of the sample was 29.2 ± 8.2 years (median 22 years, range 18-54 years). In all, four cases (0.071%) were positive for anti-IgM CMV with 95% confidence interval (95% C.I) of 0.02-0.17 [Table 1].


   Discussion Top


In this study, only four donors tested positive for anti-IgM CMV. Kothari et al [3] carried out a similar study at New Delhi, but none of the 200 donors' blood units tested positive for anti-IgM CMV. On the other hand, 95% of blood donors were positive for IgG antibodies, indicating past exposure to the infection. [3] Other Indian studies gave similar prevalence rates for IgG antibody, but remain inconclusive for anti-IgM CMV. [4],[5],[6] A study conducted in similar settings at Military Hospital in Ghana, a developing country, found none of the 264 donor blood units to be positive for anti-IgM CMV, but anti-IgG CMV seroprevalence was 93.2%. [7] This high seroprevalence in India and other developing countries is in contrast to Western literature, which describes seroprevalence in voluntary blood donors ranging from 38%-75%. [8],[9] A study representative of developed nations in the USA, by Staras et al, found a seroprevalence of CMV infection in population aged 6 years or more to be 58.9%. [10]

Due to the high seropositivity of anti-IgG CMV discarding blood positive for anti-IgG CMV is not feasible, but blood screened positive for anti-IgM CMV is recommended to be discarded. But in a developing country like India, screening for IgM antibody on a routine basis may not be feasible, given the likely yield to be low and the cost being high. Therefore, preventive strategies like leucoreduction filtration, saline-washed RBCs, frozen deglycerolized RBCs, etc. are being increasingly recommended to minimize transmission of CMV through transfusion. [3] Universal leucodepletion of blood is ideal and is in vogue in the Western world, but it is still not implemented in a developing country like ours, due to economical factors.

It is recommended that in a tertiary care hospital, blood units to be transfused to neonates, organ transplant recipients, those suffering from malignancies and other immunocompromised patients should be screened for anti-IgM CMV or preventive strategies to be implanted to decrease the transmission of CMV in these groups of patients.

 
   References Top

1.Pass RF. Cytomegalovirus. In: Knipe DM, Howley PM, editors. Fields virology. Philadelphia: Lippincott; 2001. p. 2675-706.  Back to cited text no. 1    
2.Gunter KC, Luban NL. Transfusion transmitted cytomegalovirus and Ebstein Barr virus diseases. In: Rossi EC, Simon TL, Moss GS, Gould SA, editors. Principles of Transfusion Medicine. Baltimore: Williams and Wilkins; 1996. p. 717-32.  Back to cited text no. 2    
3.Kothari A, Ramachandran VG, Gupta P, Singh, B Talwar V. Seroprevalence of Cytomegalovirus among Voluntary Blood Donors in Delhi, India. J Health Popul Nutr 2002;20:348-51.  Back to cited text no. 3    
4.Madhavan HN, Prakash K, Agarwal SC. Cytomegalovirus infections in Pondicherry: A serological survey. Indian J Med Res 1974;62:297-300.  Back to cited text no. 4  [PUBMED]  
5.Mukundan P, Jadhav M, Jacob John T. Prevalence of Cytomegalovirus antibody in young children in Vellore. Indian J Med Res 1977;65:589-92.  Back to cited text no. 5    
6.Sheevani, Jindal N, Aggarwal A. A pilot sero-epidemiological study of Cytomegalovirus infection in women of child bearing age. Indian J Med Microbiol 2005;23:34-6.  Back to cited text no. 6    
7.Adjei AA, Armah HB, Narter-Olaga EG. Seroprevalence of Cytomegalovirus among some blood donors at the 37 military hospital, Accra, Ghana. Ghana Med J 2006;40:99-104.  Back to cited text no. 7    
8.Lamberson HV Jr, McMillan JA, Weiner LB, William ML, Clark DA, McMohan CA, et al. Prevention of transfusion associated Cytomegalovirus infections in neonates by screening blood donors for IgM to CMV. J Infect Dis 1988;157:820-3.  Back to cited text no. 8    
9.Galea G, Urbaniak SJ. Cytomegalovirus studies on blood donors in North East Scotland and a review of UK data. Vox Sang 1993;64:24-30.  Back to cited text no. 9  [PUBMED]  
10.Staras S, Dollard S, Radford KW, Flanders WD, Pass RF, Cannon MJ. Seroprevalence of cytomegalovirus infection in the United States, 1988-1994. Clin Infect Dis 2006;43:1143-51.  Back to cited text no. 10    

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Correspondence Address:
P K Gupta
Department of Transfusion Medicine, Armed Forces Medical College, Pune - 411 040
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0377-4929.42509

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    Tables

  [Table 1]

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