The risk of cytomegalovirus infection in daycare workers: a systematic review and meta-analysis

  • Karla Romero StarkeEmail author
  • Marlen Kofahl
  • Alice Freiberg
  • Melanie Schubert
  • Mascha Luisa Groß
  • Stefanie Schmauder
  • Janice Hegewald
  • Daniel Kämpf
  • Johanna Stranzinger
  • Albert Nienhaus
  • Andreas Seidler



The primary aim of this review was to summarize the evidence on the relationship between being a daycare worker working with children and the possible increased risk of cytomegalovirus infection.


We searched the Medline and Embase databases using search strings defined according to the population, exposure, comparison, and outcomes (PECO) applicable to our research questions in order to find studies published since 2000. Two independent reviewers evaluated the search hits using predefined inclusion and exclusion criteria. A manual search was performed to identify additional relevant literature. We extracted the resulting studies and assessed them in eight domains of bias. The pooled CMV seroprevalence for daycare workers compared to the general population was calculated.


After evaluating the 6879 records, six methodologically adequate studies were identified: five cross-sectional studies and one cohort study. The pooled seroprevalence of daycare workers was 59.3% (95% CI 47.6–70.9). The four studies investigating risk of infection indicated an increased seroprevalence for daycare workers compared to a reference population (prevalence ratio, PR = 1.54, 95% CI 1.33–1.77). No study evaluated CMV seroconversions for daycare workers.


Our findings suggest a higher CMV seroprevalence for daycare workers compared to the general population. Notwithstanding the need for longitudinal and intervention studies, preventative efforts are needed. A pooled PR of 1.54 is compatible with a doubled seroconversion risk corresponding to a vocational probability of 50% if the substantial underestimation of the actual occupational seroconversion risk by prevalence-based estimators is considered.


CMV Cytomegalovirus Daycare educators Kindergarten teachers Occupational disease Occupational risk 


Author contributions

The requirements for authorship have been met by all of the authors, with each author having either been actively involved in the development of the study design (AF, MS, MK, JS, AN, JH, AS), screening the articles (KR, MK, MG, SS), extracting data (KR, MK), evaluation of bias (KR, AS, DK, SS) or in performing the meta-analysis (KR). All of the authors have read and approved of the manuscript.


The Institute and Policlinic of Occupational and Social Medicine (IPAS) received funds from the Institution for Statutory Accident Insurance and Prevention in the Health and Welfare services (BGW) to conduct the study. The study was carried out in cooperation with the research department of the BGW. The funds are provided by a non-profit organization that is part of the social security system in Germany.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

420_2019_1464_MOESM1_ESM.docx (33 kb)
Supplementary material 1 (DOCX 34 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Karla Romero Starke
    • 1
    Email author
  • Marlen Kofahl
    • 1
  • Alice Freiberg
    • 1
  • Melanie Schubert
    • 1
  • Mascha Luisa Groß
    • 1
  • Stefanie Schmauder
    • 1
  • Janice Hegewald
    • 1
  • Daniel Kämpf
    • 1
  • Johanna Stranzinger
    • 2
  • Albert Nienhaus
    • 2
    • 3
  • Andreas Seidler
    • 1
  1. 1.Institute and Policlinic of Occupational and Social Medicine (IPAS), Faculty of Medicine Carl Gustav CarusTechnische Universität DresdenDresdenGermany
  2. 2.Institution for Statutory Social Accident Insurance and Prevention in the Health Care and Welfare Services (BGW), Basic Principles of Prevention and Rehabilitation, Section Occupational HealthHamburgGermany
  3. 3.Competence Centre for Epidemiology and Health Services Research for Healthcare Professionals (CVcare)University Medical Centre Hamburg-Eppendorf (UKE)HamburgGermany

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