Risk factors for early childhood infection of human herpesvirus-8 in zambian children: The role of early childhood feeding practices

Background: Human herpesvirus-8 (HHV-8) infection in early childhood is common throughout sub- Saharan Africa with prevalence increasing throughout childhood. Specific routes of transmission have not been clearly delineated, though HHV-8 is present in high concentrations in saliva. Methods: To understand the horizontal transmission of HHV-8 within households to children, we enrolled for cross-sectional analysis, 251 households including 254 children, age two and under, in Lusaka, Zambia. For all children, plasma was screened for HHV-8 and HIV type I (HIV-1) and health and behavioral questionnaires were completed. Multilevel logistic regression analysis was conducted to assess independent factors for HHV- 8 infection in children. Results: Risk factors for HHV-8 infection included increasing number of HHV-8-positive household members [OR 1/4 2.5; 95% confidence interval (CI), 1.9-3.3; P < 0.01] and having a primary caregiver who tested the temperature of food with their tongue before feeding the child (OR1/4 2.4; 95% CI, 1.93-3.30; P1/4 0.01). Breastfeeding was protective against infection with HHV-8 for children (OR 1/4 0.3; 95% CI, 0.16-0.72; P < 0.01). Conclusions: These results indicate that exposure to HHV-8 in the household increases risk for early childhood infection, with specific feeding behaviors likely playing a role in transmission. Impact: Interventions to protect children from infection should emphasize the possibility of infection through sharing of foods.