Escribir un comentario

This review is the result of a virtual, collaborative live review discussion organized and hosted by PREreview and AREN on July 15, 2026. The discussion was joined by 49 people, including 2 facilitators from the PREreview Team and 1 member of the AREN team. We thank all participants who contributed to the discussion and made it possible for us to provide feedback on this preprint.

Summary

This study aimed to determine the molecular prevalence and characterize congenital Cytomegalovirus (CMV) infection among neonates attending tertiary health institutions in Jos, Nigeria. The study also focuses on the importance of continued surveillance and early diagnosis, which is not always performed in low and middle income countries, resulting in incomplete data about the burden of the disease.

The approach consisted of a cross-sectional study among neonates aged ≤21 days recruited from three tertiary hospitals in Jos between January 2021 and December 2022, through PCR screening with the use of buccal swab samples.

The main finding was that only one of the 180 neonates tested positive for CMV DNA, giving a molecular prevalence of 0.6% (95% CI: 0.02–3.1%). Sequence analysis of the positive sample revealed a 98.9% similarity to Human herpesvirus 5 strain HAN22.

This work is very important as if repeated on a larger scale, it would contribute to early detection of CMV which is necessary for implementation of prevention measures of CMV-associated neurodevelopmental abnormalities. However, there are some concerns about the sample size and statistical analysis used for experimental design, together with the need for further work to assess assay sensitivity, that are summarized below.

List of concerns and feedback

• Some reviewers raised concerns about the sample size being inadequate. However, others pointed out that the study included a sample size that exceeded the authors' a priori calculation, so the identification of only a single positive case should not, on its own, be interpreted as evidence that the sample size was inadequate. At the same time, the lower-than-expected prevalence reduced the statistical power to draw conclusions about this outcome, and a larger sample might have provided greater precision or captured additional positive cases. We also recognize that expanding the sample may not be straightforward, as recruitment depends on infants presenting to the hospital within the study setting. If increasing the sample size is not feasible, it would strengthen the manuscript for the authors to briefly discuss these practical constraints and the implications of the lower-than-expected prevalence for interpreting the findings.

• The detection of a lower number of positive cases than expected could be related to several reasons, such as differences in the methods or population data used for sample size estimation (for example, was the prevalence used for sample size calculation measured by the same technique and sample type as the one used in this study?), in addition to low sensitivity of the assay, including type of sample, sample integrity, or PCR efficiency. A deeper discussion on the limitations of the study would prevent wrong generalizations and provide suggestions for future studies.

• Regarding technical aspects of the molecular test that authors used in this study, a calibration curve for estimation of PCR limit of detection would improve precision and interpretation of results. In addition, there is no justification about the selection of buccal swabs over conventional gold-standard samples and how this could impact the results.

• To enhance reproducibility of the study, please add further details on the methodology (timing of sample collection, PCR quality control procedure), statistical software used for analysis.

• Uploading of the sequencing data in the public repository GenBank is of great value. However, the sequence used for lineage analysis was the PCR product, therefore this could limit resolution compared to sequencing the complete viral genome. A discussion about this limitation would contribute to interpretation of results and suggest improvements for future studies.

• Please comment on the safety measures for neonates during the study, such as prevention of infections in newborns.

• The tables and figures are well presented scientifically and understandable at glance. However, please revise headers of table 2, which are not visible. In addition, some comments about why risk factors are evaluated only from the perspective of the mothers rather than neonates would improve comprehension from non-experts.

• The phylogenetic tree is constructed using neighbouring-joining. Could maximum likelihood be used in this regard to show the relationship?

• In general, the conclusions stated by the authors are supported by the data. However, there are some differences between conclusions and what the abstract states, reading both sections results in contradictory statements about CMV infection frequency.

• Limitations were mentioned but not sufficiently outlined. This section would be improved if authors mentioned factors such as low sample size, consecutive sampling and technical aspects of the samples and molecular assay chosen for this study.

• The introduction section would be benefited by a description of other methods used for the detection of CMV in neonates, and a justification for the method used in this study.

• Authors could add an explanation or justification of the inclusion of variables that have no impact on the study, such as the survey conducted among the mothers of the children, that finally were not used for statistical analysis.

• The references require careful verification. For instance, some references repeat the study title after the authors' names, while in other places, the name of the journal is missing. Furthermore, the references in this preprint must strictly adhere to a single style, in accordance with the requirements of the target journal. The authors are advised to take all these observations into account in order to improve the content.

Concluding remarks

We thank the authors of the preprint for posting their work openly for feedback. We also thank all participants of the Live Review call for their time and for engaging in the lively discussion that generated this review.

Competing interests

Maria Sol Ruiz was a facilitator of this call and one of the organizers. No other competing interests were declared by the reviewers.

Use of Artificial Intelligence (AI)

The authors declare that they did not use generative AI to come up with new ideas for their review.