Meta-analysis of cytomegalovirus seroprevalence in volunteer blood donors and healthy subjects in Iran from 1992 to 2013

Document Type : Review Article


1 Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Immunohematology Department, Tehran, Iran

2 Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Tehran, Iran

3 Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Microbilogy Department, Tehran, Iran


Objective(s):Human cytomegalovirus (CMV), a double-strand DNA herpesvirus, can be transmitted via blood transfusion which is especially important for immunocompromised recipients and can cause a fatal infection. CMV seroprevalence in Iran was studied on blood donors, healthy subjects, and some patients. Highly variable rates were detected. The purpose of this study was to review CMV seroprevalence in blood donors and apparently healthy individuals, in Iran.[m1] 
Materials and Methods: One hundred and fifty-eight electronic and paper-based resources and databases including published articles in internal and external journals, seminars, dissertations, and theses available in the databaseand different websites were used to be systematically reviewed as a meta-analysis. Less related articles to the issue, papers of specific high risk population, and articles with not enough information, were excluded. Eventually 22 articles that satisfied our selection criteria were systematically reviewed and analyzed. To explore heterogeneity between studies the I square (I2) index was used. Data were analyzed using the statistical software package (STATA) 11.
Results: The heterogeneity between selected studies was 97% with an I2 statistic. In this study a random effects model was used for meta-analysis. The prevalence of CMV IgG and CMV IgM antibodies in the country were estimated to be 92% (95% CI: 90-94) and 2.6% (95% CI: 1.7-3.6), respectively.
Conclusion: Given high rate of CMV seropositivity in Iran, it seems that CMVAbs screening would not be a reasonable and affordable approach to prevent CMV infection via transfusion especially for immune compromised recipients, so alternative strategies should be considered.


1.Piri S. Cytomegalovirus infection in pregnancy.J Iran Obs Gynec 2011; 6:1-7.
2.Staras SA, Dollard SC, Radford KW, Flanders           WD, Pass RF, Cannon MJ. Seroprevalence of cytomegalovirus infection in the United States, 1988-1994. Clin Infect Dis 2006; 43:1143-1151. 
3.Bate SL, Dollard SC, Cannon MJ. Cytomegalovirus seroprevalence in the United States: the national health and nutrition examination surveys, 1988-2004. Clin Infect Dis 2010; 50:1439.
4.Jain M, Duggal S, Das Chugh T.  Cytomegalovirus infection in non-immunosuppressed critically ill patients.  J Infect Dev Ctries 2011; 5:571-579.
5.Lopo S, Vinagre E, Palminha P, Paixao MT, Nogueira P, Freitas MG. Seroprevalence to cytomegalovirus in the Portuguese population, 2002-2003. Eurosurvivelance 2011; 16:1-6.
6.Munro SC, Hall B, Whybin LR, Leader L, Robertson P et al. Diagnosis of and screening for cytomegalovirus infection in pregnant women. J Clin Microbiol 2005; 43:4713-4718.
7.Aghaeipour M, Tarabadi FA, Shaeigan M, Babaei GR. Detection of serologic prevalence of anti-CMV antibodies in thalassemia major patients and blood donors. Sci J Iran Blood Transfus Organ 2004; 1:37-42.
8.Tarabadi F, Ghaledi J, Shaeigan M, Babaei GR. Comparison of prevalence of anti-CMV antibodies (IgM & IgG) and CMV Ag in renal transplant recipients. Sci J Iran Blood Transfusion Organization 2005; 2:145-150.
9.Tarabadi F, Aghaeipour M, Shaiegan M, Babaei GR: Correlation between anti-cytomegalovirus IgM antibody and HIV Positivity in HIV+ Subjects. (S93). In: 28th International ISBT Congress - Edinburgh, Scotland- 2004, Vox Sang. 2004.p.104- A 3.29.
10.Khameneh  ZR. Occurrence of cytomegalovirus infection and factors causing reactivation of the infection among renal transplant recipients: a single center study. Saudi J Kidney Dis Transplant 2008; 19:41.
11.Asadi MH, Esmaeilzadeh AR. Frequency of cytomegalovirus antibodies (IgG and IgM) in blood donors in Zanjan province during 2004. J Zanjan Univ Med Sci 2004; 13:43-48.
12.Delfan-Beiranvand M, Sheikhian A, Birjandi M, Fazeli Ml. Seroprevalence of cytomegalovirus infection in pregnant women referred to health care center of Khorramabad. Iran J Virol 2012; 5:11-16.
13.Safabakhsh H, Tehranian F, Tehranian B, Hatami H,  Karimi G,Shahabi M. Prevalence of anti-CMV antibodies in blood donors in Mashhad, Iran. Iran J Epidemiol 2013; 9:52-57.
14.Moniri R, Mosayebii Z, Mossavi GA. Seroprevalence of cytomegalovirus, hepatitis B, hepatitis C and human immunodeficiency virus antibodies among volunteer blood donors. Iran J Pub Health 2004; 33:38-42.
15.Mostafavi SN, Ataei B, Nokhodian Z, Yaran B, Babak A, Salehi A, et al. Seroprevalence of Cytomegalovirus infection and estimate of congenital Cytomegalovirus infection in Isfahan state, Iran: A population based study. Pak J Med Sci 2013; 29:418-422.
16.Mostafavi SN, Ataei. B, Salehi A, Nokhodian Z, Yaran, M, Babak A. Seroprevalence of human cytomegalovirus diseases in Isfahan, Iran. J Isfahan Univ Med Sci 2011; 29:2475-2483.
17.Hashemzadeh Z, Motamedifar M. The comparison of ELISA test and nested- PCR for detection of human Cytomegalovirus (HCMV)  infection. Armaghan Danesh 2007; 12:89-97.
18.Zandieh T, Kavian S, Rakhshan M. The evaluation of cytomegalovirus in infants following transfusion in children medical historical. Sci J Iran Blood Transfus Organ 2:83-89.
19.Noorbakhsh S, Farhadi M, Tabatabaei A. Cytomegalovirus, a common cause of intrauterine infection: a case-control study in Tehran, Iran. J Comprehensive Pediatr 2010; 1:31-36.
20.Sanadgol N, Ramroodi N, Ahmadi GA, Komijani  M, Moghtaderi A  et al. Prevalence of cytomegalovirus infection and its role in total immunoglobulin pattern in Iranian patients with different subtypes of multiple sclerosis. New Microbiologica 2011; 34:263-274.
21.Hejazi S, Molla-Abaszadeh A, Karamiyar M. Prevalence of anti-CMV antibodies in blood donors in Urmia. Sci J Iran Blood Transfus Organ 2006; 3:427-435.
22.Abdollahi A, Shoar S, Sheikhbahaei S, Jafari S. Sero-prevalence of cytomegalovirus and toxoplasma infections among newly diagnosed HIV patients in Iran; assessing the correlation with CD4+ Cell Counts. Iran J Pathol 2013; 2:81-88.
23.Tarabadi F, Babaei G R, Hashemi E, Broumand B, Shaiegan M. Comparison of anti-CMV (IgG-IgM) serologic prevalence among Controls and patients under maintanance hemodialysis candidate for renal transplantation. Hakim J 2001; 4:243-247.
24.Hamkar R, Azarian B, Saadatmand Z. Sero-epidemiology of CMV in people under 45 years in the city of Urmia, Iran. Iran J Infect Dis Trop Med 2005; 10:29-33.
25.Vahdat K, Jafari SM, Pazoki R, Nabipour I. Current sensitivity C-Resactice Protein and chronic infections are associated with coronary artery disease: A population based study. Ind J Med Soc 2007; 61:135-143.
26.Arabpour M, Kaviyanee K, Jankhah A, Yaghobi R.  Human cytomegalovirus infection in women of childbearing age throughout Fars Province - Iran: a population-based cohort study. Malays J Microbiol 2007; 2007:23-28.
27.Choobineh H, Alizadeh SH, Sharifi –Yazdi MK, Vaezzadeh F, Dargahi H, Pourfatholah AA. Serologic evaluation of Major Beta Thalassemia below 15 for cytomegalovirus infection in Iran. Res J Biomed Sci 2007; 2:584-589.
28.Saghafi H, Qorashi M, Heidar A. Is screening for IgG antibody to cytomegalovirus and epstein-barr virus infections mandatory in potential renal transplant recipients and donors in Iran? Transplant Proc 2009; 41:2761–2763.
29.Alavi SM, Hasan –Adel SM, Rajabzadeh AR. An Evidence against the effect of chronic cytomegalovirus infection in unstable angina pectoris. Acta Medica Iranica 2011; 49:78-80.
30.Taiebi D, Tabatabaei M, Rahsaz M, Sharifi S, Shariati M , Sohrabi I. Seroepidemiology of CMV among femal students of Azad University in Kazeroon. Iran J Epidemiol 2009; 5:55-60. 
31.Sotoodeh-Jahromi A, Makiani MJ, Farjam MR,Madani A,Amirian M et al. Cytomegalovirus immunity in pregnancy in South of Iran. Am J Infect Dis 2010; 6:8-12.
32.Abdolmohammadi K, Ghorban K, Dormanesh B, Dadmanesh M, Zarei S. Cellular and humoral immunity investigation in the Air Force Pilots of Islamic Republic of Iran. J Med Ebnesina 2013; 15:19-27.
33.Barazesh A,  Zandi K, Hadavand F, Mootamed N, Hafzollah F, et al . Seroepidemiology of rubella, Cytomegalovirus, Herpes simplex & Varicella zoster virus in college women of Bushehr. Iran South Med J 2014; 16:459-466.
34.Adjei A, Armah H, Narter-Olaga E. Seroprevalence of cytomegalovirus among some voluntary blood donors at the 37 military hospital, Accra, Ghana. Ghana Med J 2006; 40:99–104.
35.Souza MA, Passos AM, Treitinger A, Spada C. Seroprevalence of cytomegalovirus antibodies in blood donors in southern, Brazil. Rev Soc Bras Med Trop 2010; 43:359-361.
36.Kothari1 A, Ramachandran VG, Gupta P, Singh B, Talwar V. Seroprevalence of Cytomegalovirus among Voluntary Blood Donors in Delhi, India. J Health Popul Nutr 2002; 20:348-351.
37.Amarapal p, Tantivanich S, Balachandra K. Prevalence of Cytomegalovirus in Thai Blood donors by monoclonal staining of blood leukocytes. Southeast Asian J Trop Med Public Health 2001; 32:148-153.
38.Hecker M, Qiu D, Marquardt K, Bein G, Hackstein H. Continuous cytomegalovirus seroconversion in a large group of healthy blood donors. Vox Sang 2004; 86:41-44.
39.Mutlu B, Günlemez A, Türker G, Gokalp AS, Willke A. Is serologic screening necessary in the donor bloods for cytomegalovirus seronegative blood transfusion to risky patients? Mikrobiyol Bul 2008; 42:337-341.
40.Kumar H, Gupta PK, Kumar S, Sarkar RS. Is seroprevalence of anti-IGM CMV among blood donors relevant in India. Indian J Pathol Microbiol 2008; 51:351-352.
41.Akinbami AA, Akanmu AS, Adeyemo TA, Wright KO, Dada MO, Dosunmu A. Cytomegalovirus antibodies amongst healthy blood donors at Lagos University Teaching Hospital (Luth). South Afr Med J 2009; 99:528.
42.Kafi S, Eldouma E, Saeed S, Musa H. Seroprevalence of Cytomegalovirus among blood donors and antenatal women attending two hospitals in Khartoum State. Sudan J Med Sci 2009; 4:48-52.
43.Jahan M, Tabassum S, Aziz A, Ahmed M, Islam N. Transfusion associated CMV infection: Transfusion strategies for high risk patients.  Bangladesh J Med Microbiol 2010; 04:24-27.
44.Al-Dabbagh KA. Detection of toxoplasma gondii IgM and cytomegalovirus IgM antibodies among blood donors in Mosul. Irq J Pharm 2011; 11:86-91.
45.Alao O, Mamman A, Araoye MO, Joseph E. Effect of demographic variables on cytomegalovirus antibody seropositivity among prospective blood donors in Jos, Nigeria. Niger Postgrad Med J 2009; 16:139-142.
46.Ojide CK, Ophori EA, Eghafona N, Omoti C. Seroprevalence of cytomegalovirus (CMV)amongst voluntary blood donors in University of Benin Teaching Hospital (UBTH), Edo State, Nigeria. Br J Med Med Res 2012; 2:15-20.
47.Barah F. Prevalence of herpes simplex types 1 and 2, varicella zoster virus, cytomegalovirus, and 
immunoglobulin G antibodies among female university students in Syria. Saudi Med J 2012; 33:990-994.
48.Hani A. Seroprevalence of cytomegalovirus in healthy voluntary blood donors in renowned Jordanian Hospital. Int J Biol Med Res 2012; 3:2193.
49.Furui Y, Satake M, Hoshi Y, Uchida S, Suzuki K, Tadokoro K.  Cytomegalovirus (CMV) seroprevalence in Japanese blood donors and high detection frequency of CMV DNA in elderly donors. Transfusion 2013; 53:2190-2197.
50.Ziemann M,  Hennig H. Prevention of transfusion-transmitted cytomegalovirus infections: which is the optimal strategy? Transfus Med Hemother 2014; 41:40–44.
51.Amini Kafi-abad S, Ranjbar- Kermani F, Ferdowsian F, Sobhani M, Samie S. Assessing the frequency of cytomegalovirus viremia in Iranian (Tehran) blood donors by polymerase Chain reaction method. Hakim Res J 2009; 12:61-67.