This study shows the seropositivity of the TORCH infections in the pregnant women, in and around Varanasi. Epidemiological studies have suggested that toxoplasmosis affects a wide variety of race groups [1
]. In India, the exact seroprevalence of toxoplasmosis is not known. However, a prevalence which is as low as 5% and which is as high as 80% in adults, has been reported [2
]. In the present study, the Toxoplasma
specific IgM antibodies were found in 19.4% of the pregnant women during the first half of their pregnancies, whereas an earlier study had reported such antibodies in 12% of the women in a similar population [4
]. Though a history of petbreeders and their association with toxoplasmosis could not be elicited in this study, avoiding raw or undercooked meat and unpasteurized milk and keeping away from pets, mainly cats, should be advised in these patients. The women who show seroconversion during their pregnancies should be closely followed clinically during their pregnancies.
The presence of the Rubella IgM antibodies were found in 30.4% of the pregnant women, which was in concordance with the findings of a comparable study (26%) from Mumbai [5
]. Seroepidemiological studies have shown that 10-20% of the women who were in the childbearing ages in India, were susceptible to Rubella infection [6
]. The risk of the congenital Rubella infection following a maternal infection ranged from 5% to 50% in various studies, with an increasing severity when it was acquired in the first trimester of the pregnancy [8
]. But Rubella is such a mild disease, that not more than 1 in 10 cases are recorded. The paradox lies in the fact that a large proportion of the cases are subclinical and that the clinical diagnosis is unreliable. Moreover, there is a considerable variation in the prevalence of the Rubella specific IgG antibodies among the women of the child bearing ages, with studies suggesting a prevalence of a 71.3% Rubella immunity, thus leaving about 1/3rd of the women susceptible to the Rubella infection [9
]. As the screening for the Rubella immunity was not done in this study, the serological diagnoses of the recent infections were made on the basis of the presence of the specific IgM antibodies. The history of the vaccination against Rubella could not be gathered from the study population, but on the basis of the socioeconomic status and the educational background, it could be presumed that most of them had not been previously vaccinated. Such cases need proper monitoring, counselling and management and a consideration for a prior routine vaccination.
CMV is a member of the herpes viruses family and it is found universally throughout all the geographical locations and in the areas of low socioeconomic conditions. A majority of these infections are asymptomatic as others and they are difficult to diagnose clinically. However, the rate of the primary infection is significantly higher in pregnant women from the low socioeconomic groups. A seropositive rate of 8.4% for the CMV IgM in women with Bad Obstetric Histories (BOH) has been reported [5
]. Though more women who are in the child bearing ages are already seropositive, reinfection with a new strain of CMV can cause infections even in the presence of detectable IgG levels [10
]. This study showed a seropositive rate of 34.7% for the CMV specific IgM, thus indicating a higher prevalence in and around Varanasi. Therefore, it is necessary that behavioural and educational interventions for prevention are given and that an antenatal screening is routinely done.
Neonatal Herpes which can be acquired in utero from maternal infections, is quite severe and it is associated with a high morbidity and mortality [11
]. In this study, the prevalence rate of the anti HSV IgM antibodies against HSV-2, which is the most common component of TORCH, was detected to be 33.5%. An antenatal screening for HSV among the pregnant women is definitely required for carrying out effective interventions on the lifestyle practices.
In this study, the seroprevalence rates of the specific IgM antibodies for all the TORCH components showed a narrow range of a 95% confidence interval, thus denoting precision in the detected results.
This study showed that the seroprevalence of the anti TORCH complex IgM was notable amongst the pregnant women who resided in and around Varanasi, India. It has already been emphasized that knowing the epidemiology of the TORCH infections is an important aspect in the development of strategies for the prevention of congenital infections [1
]. Hence, it should be recommended that all the antenatal cases with BOH should be routinely screened for the TORCH complex to avoid adverse foetal outcomes. Moreover, similar studies as this one, which document the seroprevalence of the TORCH infections, should be done to create a baseline data in the country. In such a context, the development of a vaccine strategy against these infections, especially in the developing countries, should be considered.