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. 2020 Oct 11;5(3):158-176.
doi: 10.3138/jammi-2020-0005. eCollection 2020 Oct.

Using blood donors and solid organ transplant donors and recipients to estimate the seroprevalence of cytomegalovirus and Epstein-Barr virus in Canada: A cross-sectional study

Curtis Mabilangan  1 , Catherine Burton  1 , Sheila O'Brien  2   3 , Sabrina Plitt  4 , Dean Eurich  4 , Jutta Preiksaitis  5
Affiliations

Using blood donors and solid organ transplant donors and recipients to estimate the seroprevalence of cytomegalovirus and Epstein-Barr virus in Canada: A cross-sectional study

Curtis Mabilangan et al. J Assoc Med Microbiol Infect Dis Can. .

Abstract
in English, French

Background: Cytomegalovirus (CMV) and Epstein-Barr virus (EBV) infections are common, causing significant morbidity in pregnancy (congenital CMV) and transplant recipients (CMV, EBV). Canadian prevalence data are needed to model disease burden and develop strategies for future vaccines. We estimated prevalence using screening data from blood donors and solid organ transplant (SOT) donors and recipients.

Methods: We retrospectively analyzed CMV and EBV serology from Alberta SOT donors (n = 3,016) and recipients (n = 4,614) (1984-2013) and Canadian Blood Services blood donors (n = 1,253,350) (2005-2014), studying associations with age, sex, organ, year, and geographic region.

Results: CMV seroprevalence rises gradually with age. By age 70, CMV seropositivity ranged from 67% (blood donors) to 73% (SOT recipients). Significant proportions of women of child-bearing age were CMV-seronegative (organ donors, 44%; SOT recipients, 43%; blood donors, 61%). Blood donor CMV seroprevalence decreased from 48% in Western Canada to 30% in Eastern Canada. Women were more likely to be CMV-seropositive (ORs = 1.58, 1.45, and 1.11 for organ donors, SOT recipients, and blood donors, respectively) and EBV-seropositive (ORs = 1.87 and 1.46 for organ donors and SOT recipients, respectively). EBV prevalence rises rapidly, and by age 17-29 years, 81% of SOT recipients and 90% of organ donors were seropositive.

Conclusions: Canada has relatively low and perhaps decreasing age-specific EBV and CMV prevalence, making Canadians vulnerable to primary infection-associated morbidity and suggesting benefit from future vaccines. Collection and analysis of routine serology screening data are useful for observing trends.

Historique: Les infections à cytomégalovirus (CMV) et au virus d’Epstein–Barr (EBV) sont courantes et responsables d’une morbidité importante pendant la grossesse (infection congénitale à CMV) et les receveurs d’organes (CMV, EBV). Il faut colliger des données de prévalence au Canada pour en modéliser le fardeau et établir des stratégies en vue de futurs vaccins. Les chercheurs en ont évalué la prévalence à l’aide des données de dépistage des donneurs de sang et des donneurs d’organes pleins.

Méthodologie: Les auteurs ont procédé à l’analyse rétrospective de la sérologie du CMV et de l’EBV des donneurs (n = 3 016) et des receveurs (n = 4 614) d’organes pleins de l’Alberta entre 1984 et 2013 et des donneurs de sang de la Société canadienne du sang de 2005 à 2014 (n = 1 253 350) et étudié les associations avec l’âge, le sexe, l’organe, l’année et la région géographique.

Résultats: Le statut sérologique pour le CMV augmente graduellement avec l’âge. À l’âge 70 ans, la séropositivité au CMV se situait entre 67 % (donneurs de sang) et 73 % (receveurs d’organes pleins). Des proportions importantes de femmes en âge de procréer étaient séronégatives au CMV (donneuses d’organes, 44 %; receveuses d’organes pleins, 43 %; donneuses de sang, 61 %). La séroprévalence du CMV chez les donneurs de sang passait de 48 % dans l’Ouest canadien à 30 % dans les Maritimes. Les femmes étaient plus susceptibles d’être séropositives au CMV (RC = 1,58, 1,45, et 1,11 pour les donneuses d’organes, les receveuses d’organes pleins et les donneuses de sang, respectivement) et à l’EBV (RC = 1,87 et 1,46 pour les donneuses d’organes et les receveuses d’organes pleins, respectivement). La prévalence de l’EBV augmente rapidement: entre l’âge de 17 et 29 ans, 81 % des receveurs d’organes pleins et 90 % des donneurs d’organes étaient séropositifs.

Conclusions: Le Canada présente une prévalence relativement faible – et peut-être même à la baisse – d’EBV et de CMV liée à l’âge, ce qui rend les Canadiens vulnérables aux morbidités associées à la primo-infection et laissent croire au caractère avantageux de futurs vaccins. Il est utile d’amasser et d’analyser des données de dépistage pour observer les tendances.

Keywords: CMV serostatus; EBV serostatus; Epstein-Barr virus; cytomegalovirus; seroprevalence.

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Conflict of interest statement

The authors report grants from Canadian Blood Services during the conduct of the study.

Figures

Figure 1:
Figure 1:
Study population flow chart Notes: Superscript numerals indicate the table in which these data are analyzed. * 4,548 first-event transplants and 407 total re-transplant events (362 second-event transplants, 42 third-event transplants, 3 fourth-event transplants) † Includes 4,548 recipients first transplanted during the study period plus 66 recipients first transplanted before the study period ‡ Age was missing for 80 donors; thus, they were not included in the adult or pediatric dataset.
Figure 2:
Figure 2:
CMV prevalence among blood donors across Canada Notes: Red error bars show 95% confidence intervals for the seroprevalence indicated above the error bar. A trend of decreasing prevalence across Canada is visible. Women’s seroprevalence is higher than men’s seroprevalence in all regions. CMV = Cytomegalovirus
Figure 3:
Figure 3:
EBV seroprevalence versus age Notes: Red error bars show 95% confidence intervals for the seroprevalence indicated above the error bar. The rapid rise of EBV seroprevalence is clear among recipients. This pattern is less clear among donors. EBV = Epstein-Barr virus
Figure S.1:
Figure S.1:
Cytomegalovirus seroprevalence versus age among blood donors, organ donors, and recipients Notes: Red error bars show 95% confidence intervals for the seroprevalence indicated above the error bar. Seroprevalence in individuals aged younger than 12 mo is inflated by presence of maternal antibodies. Women’s seroprevalence tends to be higher than men’s.
Figure S.2. A:
Figure S.2. A:
Age-specific CMV seroprevalence in blood donors over time. B: CMV seroprevalence in blood donors by age group over time Notes: Bar height represents the overall CMV seroprevalence of blood donors each year. Bar proportions represent the age distribution of blood donors each year. CMV = Cytomegalovirus
See this image and copyright information in PMC

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