Seroprevalence of Cytomegalovirus among Pregnant Women in Singapore

doi:10.21203/rs.3.rs-4372488/v1

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Seroprevalence of Cytomegalovirus among Pregnant Women in Singapore

https://doi.org/10.21203/rs.3.rs-4372488/v1

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published 03 Oct, 2024

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Background Cytomegalovirus (CMV) is the most common congenital infection in pregnancy with potential long-term adverse effects on the fetus. There is limited data on CMV seroprevalence in pregnant women in Singapore, with last reported study dating back over two decades. We look at the latest CMV seroprevalence in antenatal population in Singapore.

Methods Between January 2021 and August 2021, 385 pregnant women receiving antenatal care at Singapore General Hospital were randomly selected for CMV IgG test to be performed on their blood samples collected during the first trimester of their pregnancies. Positivity for CMV IgG represents past exposure prior to pregnancy.

Results Overall CMV seroprevalence was 71.7% (276/385). The trend of CMV IgG positivity increased with age, 68.3% in those aged 20-29, 72.5% in the 30-39 age group, and 79.0% in women over 40.

Conclusions There is a declining trend in CMV seroprevalence among pregnant women in Singapore, which indicates that a substantial portion of this population faces the risk of primary maternal CMV infection during pregnancy. Emerging research suggests that prenatal treatment with valacyclovir effectively reduces the likelihood of vertical transmission. Considering this evidence, it is imperative to reevaluate the recommendations for universal maternal CMV screening during pregnancy.

cytomegalovirus

seroprevalence

antenatal

Singapore

Cytomegalovirus (CMV; Herpesvirus 5) is the most common congenital infectious conditionin pregnancy, with a prevalence of up to 6% of live births in low- and middle-income populations and 0.3–0.7% in high-income populations (1–7). This ubiquitous virus typically leads to asymptomatic or mild, self-limiting infection in immunocompetent children and adults. However, when CMV in maternal circulation crosses the placenta and infects the immunologically immature fetus, it can lead to long-term permanent sequalae, including hearing loss, visual impairment, neurodevelopmental disability, cerebral palsy, and death (2, 8–10). CMV is the leading cause of non-hereditary sensorineural hearing loss in childhood, accounting for up to 23% of all cases with profound permanent childhood hearing impairment (11).

Just like other members of the Herpesviridae family, CMV remains latent in human cells following primary infection, enabling episodes of reactivation with viral replication in seropositive individual. Both primary and non-primary CMV infections during pregnancy can lead to fetal infection. However, the greatest risk to the fetus mainly occurs in primary acquisition of the virus during pregnancy (maternal primary infection), where there is a four-fold higher rate of congenital abnormalities compared to seropositive women (12). Timing of primary maternal infection during pregnancy is an important prognosticating factor of fetal consequences, with long-term neonatal sequalae being unique to mothers with primary infection in the first trimester (13). Yves Ville and colleagues estimated that up to 57% of infected neonates from primary maternal CMV infection in the first trimester of pregnancy would develop long-term sequalae (14).

CMV seroprevalence varies between different countries, typically being high in developing countries and lower in developed countries. CMV IgG seropositivity in pregnant women ranges from 61% in France (15) to nearly 100% in developing countries like Brazil (16). There is strong epidemiological evidence showing causal link between hygiene measures and infections (17). Better standard of cleanliness and higher socioeconomic status in developed countries have positive effects on delaying exposure to CMV.

Studies on CMV seroprevalence in Singapore are limited. The last published data on CMV seroprevalence in Singapore antenatal population was reported by Wong et al from a small cohort of 120 patients using older enzyme-linked immunosorbent assay more than 20 years ago (18). In their study, CMV IgG positivity was observed in 87% of pregnant women in 1998, which is a much higher seroprevalence expected from an industrialized country. Since then, there has been no published reports on CMV IgG positivity in pregnant women in Singapore for the last two decades.

The aim of this study is to examine changes in CMV seroprevalence in antenatal populations in Singapore. We hypothesize that CMV IgG seropositivity in Singaporeans has changed with improving socioeconomic conditions over the past several decades, with current figures resembling that of other developed countries. Women who are seronegative at the start of their pregnancy are at risk of primary CMV infection, for whom interventions may help reduce vertical transmission and prevent congenital CMV disease. Data on the most updated CMV seroprevalence in pregnant women in Singapore is an important epidemiological tool to determine the value of implementing universal screen for CMV.

Data collection and analysis of sample

Pregnant women who received perinatal care and had their routine antenatal screening blood test done within the first trimester of their pregnancy in the Obstetrics Department of Singapore General Hospital between 1 January 2021 and 1 August 2021 were enrolled in this study. It is routine practice in our centre to have residual blood samples stored in the laboratory for at least 12 months. 385 samples were randomly selected for CMV IgG test by chemiluminescent microparticle immunoassay. The manufacturer reported a sensitivity of 100% with 99.15% specificity for this assay. The presence of CMV-specific IgG (positive result interpreted according to the manufacturer’s specifications) indicates past exposure prior to pregnancy.

Statistical analysis

Data were entered and analysed using the statistical software SPSS 28.0 (IBM Corp., Armonk, NY, USA). The relationship between age and CMV seropositivity was analysed by the Pearson’s χ² test. A P-value of < 0.05 was considered statistically significant. Statistical analysis was supported by the institute’s Health Service Research Unit.

This study was granted a waiver of consent for research by the Singhealth Centralised Institutional Review Board as stipulated by Human Biomedical Research Act (HBRA) and was supported by the Singhealth RHS PULSES Grant.

The participants’ ages ranged from 19 to 44 years (median age 32). Two (0.5%) women were less than 20 years old, 120 (31.2%) were between 20 and 29 years old, 244 (63.4%) were in 30 to 39 years old, and 19 (4.9%) were more than 40 years old.

Overall seroprevalence of CMV in our antenatal population

CMV IgG was positive in 276 women and negative in 109 women. Thus, overall, 71.7% of pregnant women in our study were CMV IgG seropositive.

Seroprevalence of CMV by age groups

Except in the youngest age group, CMV IgG positivity trend was noted to increase with age; where it was 100% in women <20 years, 68.3% in the 20–29-year age group, 72.5% in the 30-39-year age group, and 79.0% in the above 40 years (Figure 1).

This is the first study in over two decades to provide important epidemiological data on the seroprevalence of CMV amongst pregnant women in Singapore. Our data estimated 71.7% of our antenatal population to be seropositive for CMV IgG. This is 15.3% lower than the seropositivity rate for CMV IgG reported by Wong and colleagues in 1998 (18), and supports our initial hypothesis that the proportion of women seropositive for CMV IgG is likely to have fallen with improved hygiene and socioeconomic conditions in Singapore.

This seroprevalence rate is higher than that reported in France (15), similar to Italy (19) and Finland (20), and lower than countries like Japan (21), China (22), Romania (23), and Pakistan(24), where seroprevalence rates close to 100% have been reported (Table I). The chronologic change of CMV seroprevalence observed in our country is similar to that reported in other countries, such as Spain and Germany, which observed statistically significant decreases in IgG positivity in their population over the past decade (25,26). Interestingly, this change has not been universal among developed countries, even within Asia. South Korea continued to report a high seroprevalence of CMV at 94.1% between 2006 and 2015, without significant change in CMV seropositivity since 1995 (27).

Wong and colleagues (18) previously studied the influence of age on CMV seropositivity, and reported an increased seroprevalence in women above 30 years of age (80.8% for age >30 vs 76.5% for age ≤30). This trend has persisted, and our study found a seroprevalence of 73.0% in women aged 30 years and older versus 68.9% in those under 30 years of age (P=0.66). The 100% CMV IgG positivity reported in the <20-year age group is unlikely to be representative of the seroprevalence in that age group as only two samples were available for analysis in that cohort.

Table I.

CMV seroprevalence in pregnant women of different countries

	Leruez-Ville et al, 2017 (15)	Trombetta et al, 2021 (19)	Our study, 2021	Kaneko et al, 2023 (21)	Waseem et al, 2017 (24)
Country	France	Italy	Singapore	Japan	Pakistan
Number of participants (n)	2378	360	385	1163	172
CMV seroprevalence in antenatal population (%)	61	70.8	71.7	82.5	99.4

A declining trend in CMV seropositivity in women of reproductive age is important from a public health standpoint for two reasons. Firstly, as larger proportion of women will now be at risk of acquiring primary CMV infection during pregnancy, primary prevention efforts will be more important. Our data suggests that more than a quarter (109/385, 28.3%) of women were seronegative for CMV at the start of their pregnancy.

Primary CMV infections have a higher risk of vertical transmission, symptomatic congenital infection and more severe sequelae compared to non-primary infections (28). These incidences can be reduced through preventative measures such as hygiene interventions (29,30). Examples include avoiding contact with infected bodily fluids (e.g. saliva, tears and urine), hand hygiene and regular cleaning of potential fomites such as diaper change areas and toys (31). These measures need to be undertaken during the preconception period and throughout pregnancy and are particularly important for women living in households with young children as they are a frequent source of CMV and can shed the virus for extended periods after infection (32).

The lack of public health education on CMV is reflected in a local study published by Lim and colleagues, who reported that only 20% of pregnant women attending antenatal care had heard of CMV (33). With a larger proportion of pregnant women who are now at risk of primary CMV infections, public health interventions focusing on improving prenatal education of CMV infections in pregnancy and behavioural modifications to reduce the risk of acquisition are urgently needed.

The second important public health consideration is that with fewer women being seropositive, it is anticipated that the incidence of congenital CMV infections is likely to rise. This means that secondary prevention efforts such as antenatal screening and treatment will become more important as well. Antenatal serological screening can be done in the first trimester to detect periconceptional and first trimester primary infections that pose the highest risk of fetal sequalae (14). Treatment wise, data from Shahar-Nissan and colleagues has suggested that daily administration of 8 grams of valaciclovir in women with primary CMV infection acquired early in pregnancy resulted in a 71% reduction in the rate of fetal transmission when compared to placebo (34). A recent systematic review similarly concluded that prenatal valacyclovir administration with maternal primary CMV infection reduces the risk of congenital CMV infection, with a low risk of reversible acute renal failure (35).

In terms of cost, cost-effectiveness studies on screening for congenital CMV infection have shown the prevalence of congenital CMV infection to be an important factor influencing incremental cost-effectiveness ratios (36). Offering screening therefore may become more cost-effective in light of these updated lower seroprevalence rates where a larger proportion of women are at risk. Further studies evaluating the cost-effectiveness of universal maternal CMV screening with subsequent antenatal valacyclovir treatment in the local context are needed.

In conclusion, the seroprevalence of CMV in pregnant women has decreased compared to 20 years ago. As a larger proportion of pregnancies are now at risk of congenital CMV, primary and secondary prevention efforts to reduce the incidence of primary CMV infections during pregnancy will become more important. This study provides a much-needed update on the changing CMV seroprevalence in the antenatal population in Singapore, more than 20 years after the first study of its kind. The sample size of this study is also three times larger than that of the previous study. We acknowledge the study’s limitation in terms of its single-centre nature; nevertheless, it remains representative of the national data as samples were randomly selected and include the varying demographics of pregnant women in Singapore. A multicenter cohort study with a larger number of participants will be helpful to provide a better picture on the overall CMV seroprevalence in the antenatal population in Singapore.

Ethics approval and consent to participate

The study protocol was approved and granted a waiver of consent for research by the Singhealth Centralised Institutional Review Board as stipulated by Human Biomedical Research Act (HBRA) (CIRB Ref No: 2021/2811)

Consent for publications

Not applicable

Availability of data and materials

The datasets used during the current study are available from the corresponding author upon reasonable request.

Competing interests

The authors declare that they have no competing interests

Funding

This study was supported by the SingHealth RHS (PULSES) Centre Grant

Authors’ contributions

PP contributed to data analysis and drafted the manuscript. VXYC was responsible for the study’s conceptualisation. JKYC, TLK, and TWC provided project supervision and were involved in revising the manuscript. LGH conducted the statistical analysis. WWY and YL both designed and equally led the study and involved in revision of the manuscript. All authors read and approved the final manuscript

Acknowledgement

Not applicable

5.3. Congenital cytomegalovirus (cCMV) | CDC [Internet]. [cited 2023 Jun 2]. https://www.cdc.gov/ncbddd/birthdefects/surveillancemanual/chapters/chapter-5/chapter5-3.html.
Goderis J, De Leenheer E, Smets K, Van Hoecke H, Keymeulen A, Dhooge I. Hearing loss and congenital CMV infection: a systematic review. Pediatrics [Internet]. 2014 Nov 1 [cited 2023 Jun 2];134(5):972–82. https://pubmed.ncbi.nlm.nih.gov/25349318/.
Lanzieri TM, Dollard SC, Bialek SR, Grosse SD. Systematic review of the birth prevalence of congenital cytomegalovirus infection in developing countries. Int J Infect Dis. 2014;22:44–8.
Dollard SC, Grosse SD, Ross DS. New estimates of the prevalence of neurological and sensory sequelae and mortality associated with congenital cytomegalovirus infection. Rev Med Virol [Internet]. 2007 Sep [cited 2023 Jun 2];17(5):355–63. https://pubmed.ncbi.nlm.nih.gov/17542052/.
Naing ZW, Scott GM, Shand A, Hamilton ST, Van Zuylen WJ, Basha J et al. Congenital cytomegalovirus infection in pregnancy: a review of prevalence, clinical features, diagnosis and prevention. Australian and New Zealand Journal of Obstetrics and Gynaecology [Internet]. 2016 Feb 1 [cited 2023 Jun 2];56(1):9–18. https://onlinelibrary.wiley.com/doi/full/10.1111/ajo.12408.
Zhang XW, Li F, Yu XW, Shi XW, Shi J, Zhang JP. Physical and intellectual development in children with asymptomatic congenital cytomegalovirus infection: A longitudinal cohort study in Qinba mountain area, China. J Clin Virol. 2007;40(3):180–5.
van der Sande MAB, Kaye S, Miles DJC, Waight P, Jeffries DJ, Ojuola OO et al. Risk Factors for and Clinical Outcome of Congenital Cytomegalovirus Infection in a Peri-Urban West-African Birth Cohort. PLoS One [Internet]. 2007 [cited 2023 Jun 2];2(6):e492. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0000492.
Smithers-Sheedy H, Raynes-Greenow C, Badawi N, Fernandez MA, Kesson A, McIntyre S et al. Congenital Cytomegalovirus among Children with Cerebral Palsy. J Pediatr [Internet]. 2017 Feb 1 [cited 2023 Jun 2];181:267–271.e1. https://pubmed.ncbi.nlm.nih.gov/27816221/.
Korver AMH, de Vries JJC, Konings S, de Jong JW, Dekker FW, Vossen ACTM et al. DECIBEL study: Congenital cytomegalovirus infection in young children with permanent bilateral hearing impairment in the Netherlands. J Clin Virol [Internet]. 2009 Dec [cited 2023 Jun 2];46 Suppl 4(SUPPL. 4). https://pubmed.ncbi.nlm.nih.gov/19836301/.
Avettand-Fenoël V, Marlin S, Vauloup-Fellous C, Loundon N, François M, Couloigner V et al. Congenital cytomegalovirus is the second most frequent cause of bilateral hearing loss in young French children. J Pediatr [Internet]. 2013 Mar [cited 2023 Jun 2];162(3):593–9. https://pubmed.ncbi.nlm.nih.gov/23022111/.
Korver AMH, de Vries JJC, Konings S, de Jong JW, Dekker FW, Vossen ACTM et al. DECIBEL study: Congenital cytomegalovirus infection in young children with permanent bilateral hearing impairment in the Netherlands. J Clin Virol [Internet]. 2009 Dec [cited 2023 Jun 2];46 Suppl 4(SUPPL. 4). https://pubmed.ncbi.nlm.nih.gov/19836301/.
Ville Y. Advocating for cytomegalovirus maternal serologic screening in the first trimester of pregnancy: if you do not know where you are going, you will wind up somewhere else. Am J Obstet Gynecol MFM [Internet]. 2021 Jul 1 [cited 2023 Jun 2];3(4). http://www.ajogmfm.org/article/S2589933321000513/fulltext.
Faure-Bardon V, Magny JF, Parodi M, Couderc S, Garcia P, Maillotte AM et al. Sequelae of Congenital Cytomegalovirus Following Maternal Primary Infections Are Limited to Those Acquired in the First Trimester of Pregnancy. Clin Infect Dis [Internet]. 2019 Oct 15 [cited 2023 Jun 2];69(9):1526–32. https://pubmed.ncbi.nlm.nih.gov/30596974/.
Leruez-Ville M, Foulon I, Pass R, Ville Y. Cytomegalovirus infection during pregnancy: state of the science. Am J Obstet Gynecol [Internet]. 2020 Sep 1 [cited 2023 Jun 2];223(3):330–49. https://pubmed.ncbi.nlm.nih.gov/32105678/.
Leruez-Ville M, Magny JF, Couderc S, Pichon C, Parodi M, Bussières L et al. Risk Factors for Congenital Cytomegalovirus Infection Following Primary and Nonprimary Maternal InfectionA Prospective Neonatal Screening Study Using Polymerase Chain Reaction in Saliva. Clinical Infectious Diseases [Internet]. 2017 Aug 1 [cited 2023 Jul 20];65(3):398–404. https://dx.doi.org/10.1093/cid/cix337.
Mussi-Pinhata MM, Yamamoto AY, Aragon DC, Duarte G, Fowler KB, Boppana S et al. Seroconversion for Cytomegalovirus Infection During Pregnancy and Fetal Infection in a Highly Seropositive Population: The BraCHS Study. J Infect Dis [Internet]. 2018 Sep 8 [cited 2023 Jul 20];218(8):1200–4. https://pubmed.ncbi.nlm.nih.gov/29868783/.
Aiello AE, Larson EL. What is the evidence for a causal link between hygiene and infections? Lancet Infectious Diseases [Internet]. 2002 Feb 1 [cited 2023 Jul 20];2(2):103–10. https://pubmed.ncbi.nlm.nih.gov/11901641/.
Wong A, Tan KH, Tee CS, Yeo GSH. Seroprevalence of Cytomegalovirus, Toxoplasma and Parvovirus in Pregnancy. Singap Med J. 2000;41(4):151–5.
Trombetta CM, Viviani S, Montomoli E, Marchi S. Seroprevalence of antibodies to cytomegalovirus in pregnant women in the Apulia region (Italy). J Prev Med Hyg [Internet]. 2021 Jul 1 [cited 2023 Jul 21];62(2):E372. /pmc/articles/PMC8451340/.
Puhakka L, Sarvikivi E, Lappalainen M, Surcel HM, Saxen H. Decrease in seroprevalence for herpesviruses among pregnant women in Finland: cross-sectional study of three time points 1992, 2002 and 2012. http://dx.doi.org/103109/2374423520151123290 [Internet]. 2015 [cited 2023 Jul 21];48(5):406–10. https://www.tandfonline.com/doi/abs/10.3109/23744235.2015.1123290.
Kaneko M, Yang L, Tanabe A, Fujii Y, Nakao H, Minematsu T. Prevalence of congenital cytomegalovirus infection according to the type of maternal infection in Japan. J Infect Chemother. 2023;29(5):485–9.
Zhang S, Hu L, Chen J, Xu B, Zhou YH, Hu Y. Cytomegalovirus Seroprevalence in Pregnant Women and Association with Adverse Pregnancy/Neonatal Outcomes in Jiangsu Province, China. PLoS One [Internet]. 2014 Sep 1 [cited 2023 Jul 21];9(9):e107645. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0107645.
Gorun F, Motoi S, Malita D, Navolan DB, Nemescu D, Olariu TR et al. Cytomegalovirus seroprevalence in pregnant women in the western region of Romania: A largescale study. Exp Ther Med [Internet]. 2020 Sep 1 [cited 2023 Jul 21];20(3):2439–43. http://www.spandidos-publications.com/10.3892/etm.2020.8945/abstract.
Waseem H, Ali J, Umair Ullah Jamil S, Ali A, Jameel S, Jafar Ali C. Seroprevalence of Cytomegalovirus among pregnant women in Islamabad. Pakistan ~ 1788 ~ J Entomol Zool Stud. 2017;5(2):1788–91.
De Ory F, Ramírez R, García Comas L, León P, Sagües MJ, Sanz JC. Is there a change in cytomegalovirus seroepidemiology in Spain? Eur J Epidemiol [Internet]. 2004 [cited 2023 Jul 21];19(1):85–9. https://pubmed.ncbi.nlm.nih.gov/15012028/.
Enders G, Daiminger A, Lindemann L, Knotek F, Bäder U, Exler S et al. Cytomegalovirus (CMV) seroprevalence in pregnant women, bone marrow donors and adolescents in Germany, 1996–2010. Med Microbiol Immunol [Internet]. 2012 Aug [cited 2023 Jul 21];201(3):303–9. https://pubmed.ncbi.nlm.nih.gov/22398714/.
Choi SR, Kim KR, Kim DS, Kang JM, Kim SJ, Kim JM et al. Changes in Cytomegalovirus Seroprevalence in Korea for 21 Years: a Single Center Study. Pediatric Infection & Vaccine [Internet]. 2018 Dec 1 [cited 2023 May 31];25(3):123–31. https://doi.org/10.14776/piv.2018.25.e8.
CIOBANU AM, GICA N, GICA C, BOTEZATU R, FURTUNA M, PELTECU G et al. Cytomegalovirus Infection in Pregnancy – Counselling Challenges in the Setting of Generalised Testing. Maedica (Bucur) [Internet]. 2020 Jun [cited 2023 Sep 25];15(2):253. /pmc/articles/PMC7482684/.
Revello MG, Tibaldi C, Masuelli G, Frisina V, Sacchi A, Furione M et al. Prevention of Primary Cytomegalovirus Infection in Pregnancy. EBioMedicine [Internet]. 2015 Sep 1 [cited 2023 Jun 3];2(9):1205–10. https://pubmed.ncbi.nlm.nih.gov/26501119/.
Vauloup-Fellous C, Picone O, Cordier AG, Parent-du-Châtelet I, Senat MV, Frydman R et al. Does hygiene counseling have an impact on the rate of CMV primary infection during pregnancy? Results of a 3-year prospective study in a French hospital. J Clin Virol [Internet]. 2009 Dec [cited 2023 Jun 3];46 Suppl 4(SUPPL. 4). https://pubmed.ncbi.nlm.nih.gov/19811947/.
Update on congenital cytomegalovirus infection. Prenatal prevention, newborn diagnosis, and management | Canadian Paediatric Society [Internet]. [cited 2023 Sep 25]. https://cps.ca/en/documents/position/update-on-congenital-cytomegalovirus-infection-prenatal-prevention-newborn-diagnosis-and-management.
Cannon MJ, Hyde TB, Schmid DS. Review of cytomegalovirus shedding in bodily fluids and relevance to congenital cytomegalovirus infection. Rev Med Virol [Internet]. 2011 Jul [cited 2023 Sep 25];21(4):240–55. https://pubmed.ncbi.nlm.nih.gov/21674676/.
Lim SL, Tan WC, Tan LK. Awareness of and attitudes toward congenital cytomegalovirus infection among pregnant women in Singapore. Int J Gynaecol Obstet [Internet]. 2012 [cited 2023 Jun 3];117(3):268–72. https://pubmed.ncbi.nlm.nih.gov/22445422/.
Shahar-Nissan K, Pardo J, Peled O, Krause I, Bilavsky E, Wiznitzer A et al. Valaciclovir to prevent vertical transmission of cytomegalovirus after maternal primary infection during pregnancy: a randomised, double-blind, placebo-controlled trial. The Lancet [Internet]. 2020 Sep 12 [cited 2023 Jun 2];396(10253):779–85. http://www.thelancet.com/article/S0140673620318687/fulltext.
D’Antonio F, Marinceu D, Prasad S, Khalil A. Effectiveness and safety of prenatal valacyclovir for congenital cytomegalovirus infection: systematic review and meta-analysis. Ultrasound in Obstetrics & Gynecology [Internet]. 2023 Apr 1 [cited 2023 Sep 25];61(4):436–44. https://onlinelibrary.wiley.com/doi/full/10.1002/uog.26136.
Chen K, Zhong Y, Gu Y, Sharma R, Li M, Zhou J et al. Estimated Cost-effectiveness of Newborn Screening for Congenital Cytomegalovirus Infection in China Using a Markov Model. JAMA Netw Open [Internet]. 2020 Dec 1 [cited 2023 Sep 25];3(12):e2023949–e2023949. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2773535.

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You are reading this latest preprint version

Seroprevalence of Cytomegalovirus among Pregnant Women in Singapore

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Journal Publication

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Abstract

Figures

Introduction

Materials and methods

Data collection and analysis of sample

Statistical analysis

Results

Overall seroprevalence of CMV in our antenatal population

Seroprevalence of CMV by age groups

Discussion

Table I.

Declarations

References

Status:

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