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