Freelance Writing Jobs | Today's Articles | Sign In

Congenital Cytomegalovirus Infection

CMV is a Leading Cause of Childhood Disability

Apr 15, 2009 Stephen Allen Christensen

Most people are aware of the disability that can be caused by Down syndrome, fetal alcohol syndrome, or even neural tube defects, but many have never heard of CMV.

Cytomegalovirus (CMV) is the most common congenital infection (i.e., acquired in utero and present at birth) in the United States. 30,000 infants are born each year with CMV; another child is disabled by this virus every hour.

CMV is a herpesvirus, which is a family that includes herpes simplex virus (“cold sores” and genital herpes), varicella-zoster virus (chickenpox and shingles) and Epstein-Barr virus (infectious mononucleosis). CMV is found throughout the world but is more common in developing countries.

Between 50 and 80% of adults in the US have been infected with CMV by the time they are 40 years old; once CMV is acquired, it remains in the body for life. Most of these infections are asymptomatic, but infection in newborn babies or people with impaired immunity can be devastating.

Transmission of CMV occurs from close contact with bodily fluids (i.e., urine, saliva, blood, tears, breast milk, semen, and vaginal secretions), via transplanted organs, or, in the case of a fetus, through transfer of the virus across the placenta or during birth. The risk of becoming infected through casual contact is quite small.

The Risks and Impact of Congenital CMV

In some higher socioeconomic groups, up to 50% of young women lack antibody to CMV, making them susceptible to infection.
Up to 4% of previously uninfected women acquire their first infection during a pregnancy.
Approximately one-third of women who are infected for the first time during a pregnancy will pass the virus to their unborn infants.
Around 10% of infants with congenital CMV infection are symptomatic at birth; up to 30% of these children may die, and 70 to 90% of the survivors have some neurologic impairment.
10% of infected infants who have no symptoms at birth go on to develop neurologic disabilities.
One in 150 children is born with CMV infection, and approximately one in 750 (8,000 live births annually) suffers from permanent disability as a result.
Congenital CMV infection causes at least as much disability as Down syndrome, fetal alcohol syndrome, and neural tube defects.

Complications of Congenital CMV

Manifestations of intrauterine CMV infection include:

Intrauterine growth retardation
Microcephaly (abnormally small head and brain)
Periventricular calcifications (calcium deposits around the ventricles of the brain)
Jaundice
Chorioretinitis (inflammation of the inner eye)
Enlargement of the spleen and liver
Hepatitis
Pneumonitis or pneumonia
Prematurity
Hearing loss
Mental retardation
Seizures
Visual disturbances

Prevention of Congenital CMV

No immunization for CMV currently exists, although development of a vaccine is under investigation.
Pregnant women should be checked for immunity to CMV.
Pregnant women who are not immune to CMV should avoid day care centers or other places where they might be exposed to body fluids of potentially infected persons.
Young children, particularly those under three years of age, are most likely to be shedding CMV; many of these toddlers may not exhibit symptoms.
Pregnant women who have other children or who work in day care centers should practice scrupulous hand washing (30 seconds with soap and water) after any contact with secretions from a young child.
In areas that might be frequented by infected individuals, clean environmental surfaces with disinfectant, soap and water, or a 1:10 bleach solution.
Nonimmune pregnant women should not share food, drinks, or eating utensils, and they should avoid kissing any potentially infected persons on the lips.

Cytomegalovirus is a significant cause of disability and even death in newborns. Since no vaccine is currently available, pregnant women who are not immune to the virus should practice strict hygiene and infection control measures.

(From The Merck Manual, 18th Edition 2006:1605-06;2320-21 and Centers for Disease Control and Prevention: About Cytomegalovirus (CMV). November 3, 2008)

The copyright of the article Congenital Cytomegalovirus Infection in General Medicine is owned by Stephen Allen Christensen. Permission to republish Congenital Cytomegalovirus Infection in print or online must be granted by the author in writing.

What do you think about this article?

Comments

May 25, 2009 11:32 AM

Guest :

Please let me know if there is anything I can help you do to raise awareness of congenital CMV. My daugher died from complications of it in 2006. I am the parent rep for the Congenital CMV Foundation and a STOP CMV area rep. You can see my CMV work and my daughter's life at www.authorlisasaunders.com

1 Comment: