The public health impact of congenital cytomegalovirus
infection in Belgium
G Suzanne A SMIT, Elizaveta PADALKO, Jos van ACKER,
Pierre DORNY, Niko SPEYBROECK, Edwin CLAEREBOUT
and Brecht DEVLEESSCHAUWER
Aim
Suzanne Smit The public health impact of congenital cytomegalovirus infection in Belgium
“Assessing the public health impact of congenital cytomegalovirus infection (cCMC) in Belgium by using
available scientific publications”
Impact measurement ‣ Incidence
‣ Burden of disease (DALY)
Introduction
Impact measurement
Suzanne Smit The public health impact of congenital cytomegalovirus infection in Belgium
Vital for ‣ boosting awareness ‣ evidence-based health policy ‣ prioritizing the development of much needed prevention and intervention programs
Future ‣ Monitoring of trends in time ‣ Impact and cost effectiveness of possible prevention and intervention strategies
Suzanne Smit The public health impact of congenital cytomegalovirus infection in Belgium
Systematic review and meta analysis
‣ cCMV incidence modeled from seroprevalence data
‣ cCMV incidence data published
Incidence estimation
Methodology
Burden of disease - DALY
Suzanne Smit The public health impact of congenital cytomegalovirus infection in Belgium
“Number of healthy life years lost due to
morbidity and mortality”
Global Burden of Disease-studies
Disease or Disability Healthy life Early death
Burden of disease - DALY
Suzanne Smit The public health impact of congenital cytomegalovirus infection in Belgium
DALY = YLD + YLL
Years Lived with Disability (YLD)
YLD = Cases * Duration * Disability Weight (DW)
Years of Life Lost (YLL)
YLL = Deaths * Life Expectancy at Age of Death
Burden of disease - DALY
Suzanne Smit The public health impact of congenital cytomegalovirus infection in Belgium
1 Case * 10 years * 0.1 DW = 1 YLD
1 case * 6 years = 6 YLL
Disease or Disability Healthy life Early death
80
years
70
years
86
years
6 YLL 1 YLD
1 YLD + 6 YLL = 7 DALY
Suzanne Smit The public health impact of congenital cytomegalovirus infection in Belgium
Method cCMV incidence/
10000 births [95% UI]
DALYs/ 10000 births
[95% UI]
cCMV incidence estimation from seroprevalence Frequency of sequelae adapted from Fowler et al. (1992) and de Vries (2012)
37 [28-49] 164 [100-249]
Published cCMV incidence Frequency of sequelae adapted from Dollard et al. (2007)
52 [41-64] 157 [70-298]
Published cCMV incidence + Frequency of sequelae adapted from Remington and Klein (2011) and de Vries (2012)
52 [41-64] 272 [170-403]
Results
Suzanne Smit The public health impact of congenital cytomegalovirus infection in Belgium
Suzanne Smit The public health impact of congenital cytomegalovirus infection in Belgium
Standardized data missing on outcomes such as
‣ TOP
‣ Fetal and neonatal death
‣ Visual impairment
Short follow-up
Belgium
‣ Uneven coverage over Belgium
‣ No age-stratified seroprevalence data
Data gaps
Discussion
Suzanne Smit The public health impact of congenital cytomegalovirus infection in Belgium
‣ Currently underestimated
‣ Significant incidence
‣ Long-term sequelae from an early age
important impact on the lives of patients
and their families
Public health impact
Future
Suzanne Smit The public health impact of congenital cytomegalovirus infection in Belgium
A more accurate and representative estimation of the burden
Identical studies in other countries to stimulate public health interventions against this disease
Suzanne Smit The public health impact of congenital cytomegalovirus infection in Belgium
Thank you for your attention!
Suzanne Smit The public health impact of congenital cytomegalovirus infection in Belgium
Data CMV:
• Seroprevalence
P(cCMV incidence per 10 000 births due to primary infection)
P(cCMV incidence per 10 000 births due to recurrent infection)
Incidence estimation
Suzanne Smit The public health impact of congenital cytomegalovirus infection in Belgium
Data CMV:
• Incidence
• Study from Brussel
Incidence estimation
Suzanne Smit The public health impact of congenital cytomegalovirus infection in Belgium
Method Sero-
prevalence Sero-
conversion Trans-
mission cCMV incidence /10000 births
Estimation from seroprevalence
Women of childbearing age
41% [32-50]
Primary infection 0.7% [0.5-1.0]
32% [30-35]
13 [11-16]
Non-Primary infection
1.4% [1.1-1.7]
24 [15-36]
Total 37 [28-49]
Published 52 [41-64]
Results
Congenital cytomegalovirus infection– Incidence estimation
Suzanne Smit The public health impact of congenital cytomegalovirus infection in Belgium
Method cCMV incidence/
10000 births [95% UI]
DALYs/ 10000 births
[95% UI]
Estimation from seroprevalence Incidence of symptoms adapted from de Vries and al and Fowler et al
Primary infection 13 [11-16] 118 [69-182]
Non-Primary infection
24 [15-36] 46 [21-88]
Total 37 [28-49] 164 [100-249]
Results
Suzanne Smit The public health impact of congenital cytomegalovirus infection in Belgium
Method
cCMV incidence/10000
births [95% UI]
DALYs/ 10000 births
[95% UI]
Published Incidence of symptoms adapted from Dollard et al. (2007)
Symptomatic 82 [65-101] 80 [23-192]
Asymptomatic 566 [449-697] 77 [30-155]
Total 52 [41-64] 157 [70-298]
Published+ Incidence of symptoms adapted from Remington and Klein (2011) and de Vries (2012)
Symptomatic 82 [65-101] 184 [106-289]
Asymptomatic 566 [449-697] 89 [57-125]
Total 52 [41-64] 272 [170-403]
Results
Syndrome Incidence*
per 100 cases [95% UI]
D n
years Disability weight
[95% UI]
DALY/ 10000 births
[95% UI]
Primary infection
Non-primary infection
Hearing loss later 5.8 [2.9-9.8]w 5.4 [2.0-10]w 83 0.159 [0.122-0.199] 27 [13-50]
Hearing loss at birth
9.9 [5.9-15]w 6.3 [2.6-12]w 86 0.159 [0.122-0.199] 38 [20-66]
IQ <70 13 [6.3-22] 0 86 0.154 [0.032-0.277] 23 [4.0-55]
Chorioretinitis 6.2 [2.6-11] 1.9 [0.05-6.7] 86 0.031 [0.019-0.049] 3.4 [1.1-7.9]
Microcephaly 4.8 [1.8-9.2] 1.6 [0.04-5.7] 86 0.215 [0.022-0.411] 19 [1.4-55]
Seizures 4.8 [1.8-9.2] 0 86 0.442 [0.187-0.696] 24 [6.1-56]
Paresis or paralysis 0.8 [0.02-2.9] 0 86 0.275 [0.018-0.531] 2.5 [0.03-11]
Death 2.4 [0.5-5.7] 0 86 1 27 [5.5-65]
Total primary 118 [69-182]
Total recurrent 46 [21-88]
Total modelled 164 [100-249]
Suzanne Smit The public health impact of congenital cytomegalovirus infection in Belgium
Syndrome Incidence*
per 100 cases [95% UI]
D n years
Disability weight
[95% UI]
DALY/ 10000 births
[95% UI]
Symptomatic at birth
Asymptomatic at birth
Symptomatic at birth 100 0 0.019 0.210 [0.139-0.298]
0.02 [0.01-0.04]
Hearing loss 33 [6.8-68] 7.7 [2.8-15] 86/83 0.159 [0.122-0.199]
73 [31-133]
Cognitive deficit 41 [10-77] 2.0 [0.15-6.1] 86 0.154 [0.032-0.277]
43 [6.3-112]
Motor deficit 18 [0.06-67] 0.6 [0.02-2.3] 86 0.275 [0.018-0.531]
31 [0.7-130]
Death 0.08 [0-0.8] 0.3 [0-1.7] 86 1 11 [0-69]
Total symptomatic
80 [23-192]
Total asymptomatic
77 [30-155]
Total 157 [70-298]
Published -> Dollard
Syndrome Incidence*
per 100 cases [95% UI]
D n
years Disability weight
[95% UI]
DALY/ 10000 births
[95% UI]
Symptomatic at birth
Asymptomatic at birth
Symptomatic at birth
100 0 0.019 0.210 [0.139-0.298] 0.02 [0.01-0.04]
Hearing loss at birth
58 7 83/86 0.159 [0.122-0.199] 87 [59-122]
IQ <70 55 4 86 0.154 [0.032-0.277] 66 [13-130]
Chorioretinitis 20 3 86 0.031 [0.019-0.049] 6.7 [3.5-11]
Seizures 23 1 86 0.442 [0.187-0.696] 67 [26-120]
Paresis or paralysis 13 0 86 0.275 [0.018-0.531] 17 [1.1-39]
Death 6 0 86 1 29 [19-42]
Total primary 184 [106-289]
Total recurrent 89 [57-125]
Total 272 [170-403]
Published + -> Remmington and Klein
Suzanne Smit The public health impact of congenital cytomegalovirus infection in Belgium