Cytomegalovirus (CMV) infection represents a significant public health concern that affects individuals across all age groups [1]. It belongs to the Herpesviridae family [2], a group of viruses consisting of Varicella-zoster virus, Epstein Barr virus, human herpes virus 6 (variants A and B), human herpes virus 7, herpes simplex virus types 1 and 2, Kaposi sarcoma herpes virus (KSHV) (human herpes virus 8) [3,1]. These viruses infect various cell types, including endothelial cells, fibroblasts, and hematopoietic cells with a common characteristic of lifelong latency in the host [4]. 

Cytomegalovirus is an important member of the herpes viral family due to its propensity to cause congenital infections, adverse birth outcomes [5], and severe diseases in immunocompromised individuals [6,7]. Maternal cytomegalovirus (CMV) infection is a prevalent viral pathogen during the perinatal period and a primary etiological factor for congenital infections linked to neurological deficits, as well as permanent auditory and visual impairments [8,9]. CMV infection predominantly poses a significant risk to specific high-risk populations, including fetuses whose mother’s contract CMV during gestation, as well as individuals—both pediatric and adult—whose immune systems are compromised due to medical conditions or pharmacological interventions, such as organ transplant recipients and individuals living with HIV [10].

Cytomegalovirus (CMV) stands as the leading viral agent responsible for congenital infections globally, impacting approximately 1% of all live births. In Nigeria, the prevalence of CMV infection among pregnant women is alarmingly high, with seroprevalence rates reported between 80% and 96%. This strikingly elevated seroprevalence is driven by a confluence of factors, including deficient in healthcare infrastructure, lack of awareness regarding CMV transmission and its implications. Addressing these challenges is crucial to mitigating the profound public health impact of this congenital virus. Therefore, this study aimed to detect human cytomegalovirus IgM antibodies among pregnant women attending Faith Alive Foundation Jos, Plateau state, Nigeria.

Study Area

Faith Alive Foundation is a non-governmental institution located in Jos metropolis, the capital city of Plateau State, Nigeria. The state is home to approximately 3.5 million residents and encompasses more than forty distinct ethnolinguistic communities. Most of these groups are primarily engaged in agriculture and share cultural and traditional lifestyles akin to those found in various regions of the country. The state experiences a semi-temperate climate, with temperatures varying between 180C and 250C.

Study Population and Design

This was a cross-sectional study carried out among pregnant women of all age categories attending the antenatal clinic in Faith Alive Foundation within the Jos metropolis.

Ethical Approval and Consent

Ethical approval was obtained from the Health Research and Ethics Committee of Faith Alive Foundation Jos (FAFHREC 08/34/2024) for the conduct of this research. Written consent was sorted first before enrolling participants into this study.

Data Collection

Before sample collection, a structured questionnaire was administered to the participants who consented to the study, and data on socio-demographic and risk factors associated with CMV infection were collected. This information included age, marital status, educational status, occupation, blood group and diabetes status.

Collection of Samples and Processing

Aseptically, 3-5ml of blood was collected from each participant via venipuncture using vacutainer system. The samples were allowed to clot and the sera were subsequently separated using a sterile micropipette. Aliquots (2.0ml) of the sera were dispensed into cryovials each and stored at -200C for further analysis.

Detection of CMV IgM Antibodies

All samples were screened for CMV IgM antibodies using a CMV IgM ELISA kit (Diagnostic Automation, Inc., Calabasas USA) following the manufacturer’s instructions. This qualitative assay features a comprehensive detection range, effectively identifying positive, negative, and cutoff results. The assay provides reliable outcomes with a specificity of 98% and a sensitivity of 97%. Results are obtained by measuring the optical density (OD) of the wells at 450 nm using a microwell reader for precise interpretation

Statistical Analysis

The differences in CMV infection seroprevalence across various data categories were analyzed using the Chi-square (χ²) test. Univariate logistic regression was employed to assess the risk factors. A P-value of ≤ 0.05 was considered statistically significant.

This study determines the prevalence of cytomegalovirus among pregnant women attending Faith Alive Foundation in Jos, Nigeria. Out of the 88 pregnant women who participated in this study, 36.36% (32/88) tested positive for CMV IgM (Figure 1).

An analysis of the data, based on socio-demographic variables such as age, marital status, education level, and occupational status, reveals no statistically significant association between CMV infection and the variables assessed at P ≤ 0.05 (Table 1). Notably, infection rates exhibited an upward trend with age, increasing from 44.44% in the 15-24 age group to 50.00% among individuals aged 56 and older. Among the women, married women had the highest prevalence of CMV infection at (37.50%), surpassing infection among single women (30.00%). Further examination of the socio-demographic variables related to CMV infection in pregnant women indicated that those with secondary education exhibited the highest seroprevalence of CMV (66.67%), while the lowest prevalence was observed among women with tertiary education (33.33%). In terms of occupational status, the seroprevalence of CMV among pregnant women was highest among businesswomen, with a prevalence rate of 54.55%, whereas clergywomen exhibited the lowest prevalence rate at 0.00%.

The seroprevalence of CMV infection among pregnant woman with respect to diabetic status and blood groups is presented in table 2. This table revealed 75.00% CMV infection rate among the women who were diabetic. Majority of the women (61.36%) who participated in this study were blood group O+ and they had the highest CMV infection rate of 40.74% and blood group A+ women have the lowest CMV prevalence rate of 22.22%.

Figure 1: Prevalence of Cytomegalovirus IgM among Pregnant Women Attending Faith Alive Foundation Jos, Nigeria.

Table 1: Prevalence of Cytomegalovirus Infection among Pregnant Women Attending Faith Alive Foundation Jos in Relation to some Socio-demographic Variables.

Table 2: Prevalence of Cytomegalovirus Infection among Pregnant Women Attending Faith Alive Foundation Jos in Relation to Diabetic Status and Blood Group.

The prevalence of cytomegalovirus (CMV) infection among pregnant women attending Faith Alive Foundation in Jos reveals a significant health concern, with 36.36% of the participants testing positive for CMV IgM antibodies. This implies that almost half of the pregnant women have an ongoing viral replication due to primary infection, reactivation of latent infection or reinfection with new strains of CMV [11]. Although most of these pregnant women might be asymptomatic, viral reactivation or infection at this stage could result in fetal infection and congenital CMV syndromes [12]. The CMV IgM prevalence rate of 36.36% observed in this study is higher than that in previous reports among pregnant women in Madrid (5%) [13], Italy (2.4%) [14], Romania (2.26%) (Radoi et al., 2024), Portugal (0.67%) [15], Brazil (2.5%) [16], Iran (8.2%) [17] and the 0.5% and 0.4% reported in Argentina and Japan respectively among congenital CMV patients [18,19]. Previous studies have also reported lower rates among women of reproductive age in the United States of America (4.9 %), Europe (1.0 %-4.6 %), North America (2.3 %-4.5 %), Japan (0.8 %), Poland (2.2 %), Croatia (4.3 %) [20] and Pakistan (4.3%) [21]. The observed differences across these locations could be attributed to variations in awareness of the risk of CMV infection during pregnancy, hygiene status, socioeconomic status, geographic region, and ethnicity [22,23].

Our finding is also greater than previous studies on CMV IgM among pregnant women in some African countries such as Angola (2.0%) [24], Kenya (8.00%), Ethiopia (16.00%), Sudan (3.00%), Egypt (7.00 %) and Tanzania (0.4%) [25]. Genetic variability among pregnant women [26], cultural practices in different countries of Africa, dense population and circulating strains of the virus could account for the differences observed in the infection rates. Furthermore, a comparative study within Northern Nigeria shows that our result is higher than the 32.6% reported by [27] in Kaduna, 4.8% in Jos [28] and 8.2% in Kwara. However, our prevalence is lower than the 39.33% documented in Bauchi by Waje, et al [1] and 57.9 % in Sokoto among blood donors by Osaro, et al. This variation will not be far from the lifestyle, socioeconomic status, and number of study participants.

The trends in cytomegalovirus (CMV) infection observed across different age groups exhibited a predictable pattern of increasing prevalence. Specifically, the infection rate among the youngest women stood at 44.44%, while it rose to 50.00% in the oldest individuals. The observed seroprevalence of CMV infection among the younger age group could be associated with their increased engagement in sexual activities exposing them to primary infection, or reinfection with new strains of CMV ([11]. Younger individuals often lack comprehensive knowledge about viral transmission and may not consistently employ protective measures, making them more vulnerable to infections. On the other hand, in older adults, viral reactivation due to immune senescence, and re-emergence could explain the higher prevalence observed in their demography. Studies have shown that elderly individuals are more likely to experience viral reactivation and tend to have higher viral loads), which can contribute to an increased incidence of infections in this age group. This duality highlights the importance of targeted education on prevention strategies across different age groups to mitigate the risks of viral infections.

Our analysis of the data concerning cytomegalovirus (CMV) infection in relation to marital status revealed that married women exhibited the highest seroprevalence rate at 38.24%. This finding conforms with the reports of among HIV-positive individuals in Kwara State, Nigeria. Several contributing factors may account for this increased prevalence among married women, including inadequate hygiene practices, high birth rates, and cultural customs such as polygamy, which facilitate the transmission of CMV in these populations.

Participants who received secondary education exhibited a higher CMV infection rate of 66.67%, while those with tertiary education had a lower prevalence of 33.33%. Infection with cytomegalovirus (CMV) has been shown to correlate with patients’ educational status. This observation is consistent with patterns observed among pregnant women in Bauchi State, where the lowest prevalence was reported in individuals without any formal education [1].  The elevated rate of CMV infection observed among women with secondary education in this study may suggest a lack of awareness regarding health practices and preventive measures against infectious diseases. Socioeconomic factors and inadequate personal hygiene could also play significant roles in this increased prevalence. Limited access to information about CMV transmission and its implications may hinder effective prevention efforts.

Demography based on the occupation of study participants revealed that there were more civil servants (43.18%) than any of the other occupations. However, the highest occurrence (54.55%) of CMV infection was among businesswomen, while women who were clergies recorded the lowest infection rate [1]. In a similar study reported a high occurrence of CMV IgM antibodies among women with one form of business or the other. The lower prevalence rate among clergywomen in our study contrasts with previous studies conducted by Ndako and Waje which reported the least prevalence among civil servants and artisans, respectively. These differences in infection rates may be influenced by various factors, including lifestyle choices, geographical location, hygiene practices, and socioeconomic status, as observed by Fowler, et al [6].

Human cytomegalovirus (CMV) seropositivity has been increasingly associated with heart diseases and diabetes. Our study observed a higher CMV infection rate among diabetic patients (75.00%), compared to 34.52% in non-diabetic patients. This observed difference was not statistically significant, reported a significant association between HCMV infection in patients with Type-2 Diabetes Mellitus compared with healthy controls. Comparatively, basic clinical indicators such as age, gender, race, and sample size may have contributed to the observed differences. This suggests that while there may be a trend indicating a higher prevalence of CMV in individuals with diabetes, further investigation is necessary to establish any definitive relationship.

Our findings on CMV infection and blood group type indicate that pregnant women with O+ blood type exhibited the highest rates of CMV infection (40.74%) while those with A+ blood type have the lowest rates of 22.22%. Numerous studies have established a connection between a person's ABO blood type and their susceptibility to a range of diseases. This connection suggests that certain blood types may increase the risk of developing specific illnesses or provide protection against various health conditions, encompassing both infectious diseases and non-infectious ailments. The observed prevalence of 40.74% among women with blood group O+ aligns with trends documented among blood donors at Usman Dan Fodio University Teaching Hospital (UDUTH) in Sokoto, Nigeria, as well as findings by Waje, et al [1]. Among pregnant antenatal women in the Bauchi metropolis, Nigeria. This correlation may be attributed to the general genetic distribution of ABO phenotypes reported within the human population [1].

This study recorded a 36.36% prevalence of CMV IgM antibodies among pregnant women attending the Faith Alive Foundation in Jos, Nigeria, which raises significant public health concerns. The prevalence was notably higher among older, married women who had received secondary education and were engaged in various business activities. Additionally, three-quarters of the diabetic patients examined were found to have a CMV infection, with a 40.74% infection rate observed in participants with blood group O+. Therefore, we strongly recommend implementing educational programs targeting pregnant women, particularly those who are older, married, and engaged in business activities, to raise awareness about CMV, its transmission, and potential risks during pregnancy. Enhanced screening, monitoring, prevention and treatment protocols should also be implemented for diabetic patients. Encourage further research to explore the definitive relationship between diabetes types I & II, Blood group O+ type and their relationship with CMV infection. Discriminatory research on antibody avidity and CMV infection among older women should be carried out to ascertain whether CMV infections are due to primary infection or viral reactivation due to frailty or immune senescence.

1. Whitley JR. Medical microbiology-herpes viruses. In: Baron S, ed. Chapter 68 Herpes viruses. University of Texas Medical Branch at Galveston. 1996.
2. Luangsirithanya P, Treewaree S, Pongpaibul A, Pausawasdi N, Limsrivilai J. Cytomegalovirus enterocolitis with subsequent diagnosis of coexisting new-onset inflammatory bowel disease: two case reports and review of the literature. Medicine. 2021;100: 24914.
3. Cannon MJ, Griffiths PD, Aston V, Rawlinson WD. Universal newborn screening for congenital CMV infection: What is the evidence of potential benefit? Reviews in Medical Virology. 2014; 24: 171-187.
4. Fowler K, Mucha J, Neumann M, Lewandowski W, Kaczanowska M, Grys M, et al. A systematic literature review of the global seroprevalence of cytomegalovirus: possible implications for treatment, screening, and vaccine development. BMC Pub Heal. 2022; 22: 1659.
5. Aliyu MS, Sani K, Hussaini IM, Tijjani MB, Garba I, Doko MHI, et al. Seroprevalence of cytomegalovirus infection among pregnant women attending some hospitals in Kaduna state, Nigeria. Mic Inf Dis. 2024; 5: 516-523.
6. Hamdan HZ, Abdelbagi IE, Nasser NM, Adam I. Seroprevalence of cytomegalovirus and rubella among pregnant women in Western Sudan. Virol J. 2011; 8: 217.
7. Ben SA, Schlesinger Y, Miskin I, Kalderon Z, Michaelson?Cohen R, Wiener Well Y. Cytomegalovirus (CMV) seroprevalence among women at childbearing age, maternal and congenital CMV infection: policy implications of a descriptive, retrospective, community-based study. Isr J Health Policy Res. 2023; 12: 16.
8. Yeroh M, Aminu M, Musa BOP. Seroprevalence of Cytomegalovirus Infection amongst Pregnant Women in Kaduna State, Nigeria. Afr J Clin Exper Microbiol. 2015; 16: 37-44.
9. Mussi-Pinhata MM, Yamamoto AY. Natural history of congenital cytomegalovirus infection in highly seropositive populations. J Infect Dis. 2020; 221: 15-22.
10. Lazzarotto T, Blazquez-Gamero D, Delforge ML, Foulon I, Luck S, Modrow S, et al. Congenital cytomegalovirus infection: a narrative review of the issues in screening and management from a panel of European experts. Front Pediatr. 2020; 8: 13.
11. MT Mestre-Prad G, Recio-Comi, MC, Molina-Clavero. Cytomegalovirus seroprevalence in pregnant women in Madrid: First step for a systematic screening. Enfermedades Infecciosas y Microbiologia Clinica. 2023; 50-61.
12. Trombetta CM, Viviani S, Montomoli E, Marchi S. Seroprevalence of antibodies to cytomegalovirus in pregnant women in the Apulia region (Italy). J preven med hyg. 2021; 62: 372-76.
13. Fernandez C, Chasqueira MJ, Marques A, Rodrigues L, Marcal M, Tuna M, et al. Lower prevalence of congenital cytomegalovirus infection in Portugal: possible impact of COVID-19 lockdown? Eur J ped. 2022; 181: 1259-1262.
14. Spano LC, Gatti J, Nascimento, JP, Leite JP. Prevalence of human cytomegalovirus infection in pregnant and non-pregnant women. Th J infec. 2004; 48: 213-220.
15. Lakzayi E, Fozouni L, Pordeli H. Seromolecular study on the prevalence of Cytomegalovirus in Pregnant Women living in Golestan Province, Iran. Shiraz E Med J. 2020; 21: 96238.
16. Salmeron MB, Barreneche GG. Estimation of the prevalence of congenital cytomegalovirus infection and maternal seroprevalence in Tucuman. Rev Argent Salud Publica. 2021; 13: 33.
17. 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 Jap Soc Chemother. 2023; 29: 485-489.
18. Wang C, Dollard SC, Amin MM, Bialek SR. Cytomegalovirus IgM seroprevalence among women of reproductive age in the United States. PLoS One. 2016; 11: 0151996.
19. Ibrahim S, Siddiqui AA, Siddiqui AR, Ahmed W, Moss PAH, MA Lalani EIN. Sociodemographic factors associated with IgG and IgM seroprevalence for human cytomegalovirus infection in adult populations of Pakistan: a seroprevalence survey. BMC Pub Heal. 2016; 16: 1112.
20. Leruez-Ville M, Magny JF, Couderc S, Pichon C, Parodi M, Bussières L, et al. Risks factors for congenital CMV infection following primary and non-primary maternal infection: a prospective neonatal screening study using PCR in saliva. Clin Infect Dis. 2017; 65: 398-404.
21. Greye H, Wex T, Taneva E, Redlich A, Costa S, Rissmann A. Cytomegalovirus seronegativity rate in pregnant women and primary cytomegalovirus infection during pregnancy in rural Germany. BMC Preg Childbir. 2023; 23: 1-9.
22. Vueba A, Faria C, Almendra R, Santana P, Sousa MDC. Seroepidemiology study of Cytomegalovirus and Rubella in pregnant women in Luanda, Angola: geospatial distribution and its association with socio-demographic and clinical-obstetric determinants. BMC Infec Dis. 2022; 22: 124.
23. Joseph A, Mahida N, Clark G, Irving W, Soo S. Congenital cytomegalovirus infections. Ped Chil Heal. 2018; 28: 277-281.
24. Mhandire DZ, Mhandire K, Magadze M, Wonkam A, Kengne AP, Dandara C. Genetic variation in toll like receptors 2, 7, 9 and interleukin-6 is associated with cytomegalovirus infection in late pregnancy. BMC Med Genet. 2020; 21: 113.
25. Aliyu MS, Sani K, Hussaini IM, Tijjani MB, Garba I, Doko MHI, et al. Seroprevalence of cytomegalovirus infection among pregnant women attending some hospitals in Kaduna state, Nigeria. Mic Inf Dis. 2024; 5: 516-523.
26. Akunaeziri UA, Anyaka C, Magaji FA, Ocheke AN. Cytomegalovirus Infection among Women with Recurrent Miscarriages. Trop J Obst Gyn. 2021; 38: 129-138.