Low cytomegalovirus sero-prevalence in Irish pregnant women.

The aim of this study was to determine the sero-prevalence of cytomegalovirus (CMV) IgG antibody in pregnant women in Ireland and assess individual risk factors for prior acquisition of CMV. In 2002, sera from 1047 pregnant women were tested by enzyme immunoassay for CMV IgG. Age and nationality were recorded for each patient. Among Irish-born women the following additional factors were also recorded: socio-economic status, number of children and occupational exposure to children. Only 30.4% (204/670) of Irish women were CMV antibody positive compared to 89.7% (322/359) of non-Irish women (p < 0.001). Non-Irish women were mostly from Sub-Saharan Africa, Eastern Europe and Asia. Lower socio-economic group and increasing number of children were significant independent predictors of CMV sero-positivity among Irish pregnant women (p < 0.05). Irish pregnant women have one of the lowest reported CMV sero-prevalence rates worldwide, indicating low circulation of CMV within the community. However, up to 70% of Irish women are susceptible to a primary infection during pregnancy.

Susceptibility to infectious rash illness in pregnant women from diverse geographical regions.

Varicella-zoster (VZV), rubella (RV) and parvovirus B19 (B19V) infections are important causes of rash illness in pregnancy, due to their potential adverse impact on both mother and fetus. We determined susceptibility to these infections in pregnant women attending our hospital in 2002. Age and nationality were recorded. Sera were tested for VZV, RV, and B19V antibody by enzyme immunoassay. Of 7,980 women screened for VZV IgG, 11.3% were seronegative and therefore susceptible to infection. Across different worldwide regions, 6.9% of Irish and other Western European women were susceptible to VZV, compared to 19.7% of other women tested (p < 0.001), most of whom were from Central and Eastern Europe, sub-Saharan Africa and Asia. Of 7,872 women screened for RV IgG, 2.3% were seronegative. Few Irish (0.6%) or other Western European women (0.7%) were rubella non-immune, but 5.5% of women from other regions tested were susceptible to rubella (p < 0.001). A random subset of 1,048 women were tested for B19V IgG. About 38% were susceptible, varying from 22% to 63% across the different regions studied. There are important differences in immunity to these infections and so of potential risk of an adverse outcome in indigenous and immigrant pregnant women in Ireland.

Antenatal hepatitis B screening - is there a need for a national policy?

Routine antenatal testing for hepatitis B carriage with maternal consent was introduced at the Rotunda in January 1998. The uptake of testing has been excellent; 99.98% of women presenting for antenatal care accepted hepatitis B (HBV) screening in the 30-months from January 1998 through June 2000. The prevalence of HBV carriage was 0.35% (58 pregnancies of 16,222 tested) increasing from 0.25% in 1998 (16 of 6227) to 0.45% in the first six months of 2000 (16 of 3484). Fifty-five women had 58 pregnancies (three women had two pregnancies). Two of these were e-antigen positive. HBV carrier status was previously unknown in 48 (87%). Two additional women had acute HBV infection in pregnancy. Forty-five infants have been born to mothers included in this screening programme. Audit of infant outcome reveals excellent compliance with immunisation and follow-up: 29 (64%) have completed the 3 dose HBV vaccination schedule to date. Thirteen infants (31%) are still attending; three are lost to follow-up including one whose family has emigrated. Routine antenatal screening for hepatitis B carriage is cost-effective and should be considered a standard of care in maternity practice.