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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
Review
  • 74 Downloads

Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusions

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.

Keywords

CMV Cytomegalovirus Daycare educators Kindergarten teachers Occupational disease Occupational risk 

Notes

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.

Funding

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)

References

  1. Ahlfors K, Forsgren M, Ivarsson S-A, Harris S, Svanberg L (1983) Congenital cytomegalovirus infection: on the relation between type and time of maternal infection and infant’s symptoms. Scand J Infect Dis 15:129–138CrossRefGoogle Scholar
  2. Bakkalbasi N, Bauer K, Glover J, Wang L (2006) Three options for citation tracking: Google Scholar, Scopus and Web of Science. Biomed Digital Libraries 3:7CrossRefGoogle Scholar
  3. Boppana SB, Fowler KB, Britt WJ, Stagno S, Pass RF (1999) Symptomatic congenital cytomegalovirus infection in infants born to mothers with preexisting immunity to cytomegalovirus. Pediatrics 104:55–60CrossRefGoogle Scholar
  4. Cannon MJ, Schmid DS, Hyde TB (2010) Review of cytomegalovirus seroprevalence and demographic characteristics associated with infection. Rev Med Virol 20:202–213CrossRefGoogle Scholar
  5. Cannon MJ, Hyde TB, Schmid DS (2011) Review of cytomegalovirus shedding in bodily fluids and relevance to congenital cytomegalovirus infection. Rev Med Virol 21:240–255CrossRefGoogle Scholar
  6. Clair PK, Embil JA, Fahey J (1990) A seroepidemiologic study of cytomegalovirus infection in a canadian recruit population. Mil Med 155:489–492CrossRefGoogle Scholar
  7. Covidence Systematic Review Software. Melborne, Australia: Veritas Health InnovationGoogle Scholar
  8. Critical Appraisal Skills Programme (2018a) CASP Cohort Study Checklist. Available at: https://casp-uk.net/wp-content/uploads/2018/03/CASPCohort-Study-Checklist-2018_fillable_form.pdf. Accessed 1 Feb 2018
  9. Critical Appraisal Skills Programme (2018b) CASP Qualitative Checklist. Available at: https://casp-uk.net/wp-content/uploads/2018/01/CASPQualitative-Checklist-2018.pdf. Accessed 1 Feb 2018
  10. de Villemeur AB, Gratacap-Cavallier B, Casey R, Baccard-Longere M, Goirand L, Seigneurin JM, Morand P (2011) Occupational risk for cytomegalovirus, but not for parvovirus B19 in child-care personnel in France. J Infect 63:457–467CrossRefGoogle Scholar
  11. de Vries JJC, van zwet EW, Dekker FW, Kroes ACM, Verkerk PH, Vossen ACTM (2013) The apparent paradox of maternal seropositivity as a risk factor for congenital cytomegalovirus infection: a population-based prediction model. Rev Med Virol 23:241–249CrossRefGoogle Scholar
  12. Elsner G, Nienhaus A (2009) Berufsbedingte Infektionen bei Erzieherinnen und Erziehern in Kindergärten. Zbl Arbeitsmed 59:39–42Google Scholar
  13. Enders G, Bäder U, Lindemann L, Schalasta G, Daiminger A (2001) Prenatal diagnosis of congenital cytomegalovirus infection in 189 pregnancies with known outcome. Prenat Diagn 21:362–377CrossRefGoogle Scholar
  14. Enders G, Daiminger A, Lindemann L, Knotek F, Bäder U, Exler S, Enders M (2012) Cytomegalovirus (CMV) seroprevalence in pregnant women, bone marrow donors and adolescents in Germany, 1996–2010. Med Microbiol Immunol 201:303–309CrossRefGoogle Scholar
  15. Fowler KB, Stagno S, Pass RF, Britt WJ, Boll TJ, Alford CA (1992) The outcome of congenital cytomegalovirus infection in relation to maternal antibody status. New Engl J Med 326:663–667CrossRefGoogle Scholar
  16. Francisse S, Revelard P, de Maertelaer V, Strebelle E, Englert Y, Liesnard C (2009) Human cytomegalovirus seroprevalence and risk of seroconversion in a fertility clinic population. Obstet Gynecol 114:285–291CrossRefGoogle Scholar
  17. Gail JD (1991) Infectious Diseases Society of America and Centers for Disease Control: summary of a workshop on surveillance for congenital cytomegalovirus disease. Rev Infect Dis 13:315–329CrossRefGoogle Scholar
  18. Giles J (2005) Start your engines. Nature 438:554CrossRefGoogle Scholar
  19. Guyatt G, Oxman AD, Akl EA, Kunz R, Vist G, Brozek J, Norris S, Falck-Ytter Y, Glasziou P, Jaeschke R (2011) GRADE guidelines: 1. Introduction—GRADE evidence profiles and summary of findings tables. J Clin Epidemiol 64:383–394CrossRefGoogle Scholar
  20. Hamprecht K, Jahn G (2007) Humanes Cytomegalovirus und kongenitale Infektion. Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz 50:1379–1392CrossRefGoogle Scholar
  21. Hecker M, Qiu D, Marquardt K, Bein G, Hackstein H (2004) Continuous cytomegalovirus seroconversion in a large group of healthy blood donors. Vox Sang 86:41–44CrossRefGoogle Scholar
  22. Higgins JPT, Green S (eds) (2011) Cochrane handbook for systematic reviews of interventions, Vol 4. WileyGoogle Scholar
  23. Hyde TB, Schmid DS, Cannon MJ (2010) Cytomegalovirus seroconversion rates and risk factors: implications for congenital CMV. Rev Med Virol 20:311–326CrossRefGoogle Scholar
  24. Ijaz S, Verbeek J, Seidler A, Lindbohm ML, Ojajärvi A, Orsini N, Costa G, Neuvonen K (2013) Night-shift work and breast cancer—a systematic review and meta-analysis. Scand J Work Environ Health 39(5):431–447CrossRefGoogle Scholar
  25. Joseph SA, Beliveau C, Muecke CJ, Rahme E, Soto JC, Flowerdew G, Johnston L, Langille D, Gyorkos TW (2005) Risk factors for cytomegalovirus seropositivity in a population of day care educators in Montreal, Canada. Occup Med (Lond) 55:564–567CrossRefGoogle Scholar
  26. Joseph SA, Beliveau C, Muecke CJ, Rahme E, Soto JC, Flowerdew G, Johnston L, Langille D, Gyorkos TW (2006) Cytomegalovirus as an occupational risk in daycare educators. Paediatr Child Health 11:401–407CrossRefGoogle Scholar
  27. Kenneson A, Cannon MJ (2007) Review and meta-analysis of the epidemiology of congenital cytomegalovirus (CMV) infection. Rev Med Virol 17:253–276CrossRefGoogle Scholar
  28. Kiss P, de Bacquer D, Sergooris L, de Meester M, Vanhoorne M (2002) Cytomegalovirus infection: an occupational hazard to kindergarten teachers working with children aged 2.5–6 years. Int J Occup Environ Health 8:79–86CrossRefGoogle Scholar
  29. Kuijer PPFM, Verbeek JH, Seidler A, Ellegast R, Hulshof CTJ, Frings-Dresen MHW, van der Molen HF (2018) Work-relatedness of lumbosacral radiculopathy syndrome. Rev Dose Response Meta Anal 91:558–564Google Scholar
  30. Lachmann R, Loenenbach A, Waterboer T, Brenner N, Pawlita M, Michel A, Thamm M, Poethko-Müller C, Wichmann O, Wiese-Posselt M (2018) Cytomegalovirus (CMV) seroprevalence in the adult population of Germany. PLoS One 13:e0200267–e0200267CrossRefGoogle Scholar
  31. Lamarre V, Gilbert NL, Rousseau C, Gyorkos TW, Fraser WD (2016) Seroconversion for cytomegalovirus infection in a cohort of pregnant women in Québec, 2010–2013. Epidemiol Infect 144:1701–1709CrossRefGoogle Scholar
  32. Manicklal S, Emery VC, Lazzarotto T, Boppana SB, Gupta RK (2013) The “silent” global burden of congenital cytomegalovirus. Clin Microbiol Rev 26:86–102CrossRefGoogle Scholar
  33. Moher D, Liberati A, Tetzlaff J, Altman DG, The PG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 6:e1000097CrossRefGoogle Scholar
  34. Puhakka L, Renko M, Helminen M, Peltola V, Heiskanen-Kosma T, Lappalainen M, Surcel H-M, Lönnqvist T, Saxen H (2017) Primary versus non-primary maternal cytomegalovirus infection as a cause of symptomatic congenital infection – register-based study from Finland. Infect Dis 49:445–453CrossRefGoogle Scholar
  35. Robert Koch Institut (2014) Zytomegalievirus-Infektion RKI Ratgeber. Robert Koch Institute. https://www.rki.de/DE/Content/Infekt/EpidBull/Merkblaetter/Ratgeber_Zytomegalievirus.html. Accessed 20 Jan 2014
  36. Schober PSJ (2014) Childcare trends in Germany: increasing socio-economic disparities in East and West. Deutsches Institut für Wirtschaftsforschung (DIW) Economic BulletingGoogle Scholar
  37. Scholz H, Deutsche Gesellschaft für Pädiatrische Infektiologie (2009) DGPI-Handbuch Infektionen bei Kindern und Jugendlichen. Thieme, StuttgartGoogle Scholar
  38. Scottish Intercollegiate Guidelines Network (SIGN) (2012) Methodology checklist 3: cohort studies. SIGN, EdinburghGoogle Scholar
  39. Stagno S, Pass RF, Cloud G et al (1986) Primary cytomegalovirus infection in pregnancy: incidence, transmission to fetus, and clinical outcome. JAMA 256:1904–1908CrossRefGoogle Scholar
  40. Stagno S, Pass RF, Dworsky ME, Henderson RE, Moore EG, Walton PD, Alford CA (1982) Congenital cytomegalovirus infection. New Engl J Med 306:945–949CrossRefGoogle Scholar
  41. Stowell JD, Forlin-Passoni D, Din E, Radford K, Brown D, White A, Bate SL, Dollard SC, Bialek SR, Cannon MJ, Schmid DS (2012) Cytomegalovirus survival on common environmental surfaces: opportunities for viral transmission. J Infect Dis 205:211–214CrossRefGoogle Scholar
  42. Stranzinger J (2017) Protecting the health of pregnant women. Dtsch Arztebl Int 114:504–505Google Scholar
  43. Stranzinger J, Kozak A, Schilgen B, Paris D, Niessen T, Schmidt L, Wille A, Wagner NL, Nienhaus A (2016) Are female daycare workers at greater risk of cytomegalovirus infection? A secondary data analysis of CMV seroprevalence between 2010 and 2013 in Hamburg, Germany. GMS Hyg Infect Control 11:Doc09Google Scholar
  44. Stroup DF, Berlin JA, Morton SC et al (2000) Meta-analysis of observational studies in epidemiology: a proposal for reporting. JAMA 283:2008–2012CrossRefGoogle Scholar
  45. Van Laethem Y, Dubois J, Braeckman L, Delforge M, Donner C, de Mol P, de Ridder M, de Schryver A, Keymeulen A, Rezette J, Smets K, Naessens A, van Hooste W (2015) Avis du conseil superieur de la sante N 9262: La problematique du cytomegalovirus chez la femme einceinte: Conseil Superieur de la SanteGoogle Scholar
  46. van Rijckevorsel GG, Bovee LP, Damen M, Sonder GJ, Schim van der Loeff MF, van den Hoek A (2012) Increased seroprevalence of IgG-class antibodies against cytomegalovirus, parvovirus B19, and varicella-zoster virus in women working in child day care. BMC Publ Health 12:475CrossRefGoogle Scholar
  47. Yow MD, White NH, Taber LH, Frank AL, Gruber WC, May RA, Norton HJ (1987) Acquisition of cytomegalovirus infection from birth to 10 years: a longitudinal serologic study. J Pediatr 110:37–42CrossRefGoogle Scholar
  48. Zhang J, Yu KF (1998) What’s the relative risk? A method of correcting the odds ratio in cohort studies of common outcomes. JAMA 280:1690–1691CrossRefGoogle Scholar

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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