The “Silent” Global Burden of Congenital Cytomegalovirus
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TLDR
The global epidemiology of congenital CMV and the implications of growing knowledge in areas of prevention, diagnosis, prognosis, and management for both low (50 to 70%)- and high (>70%)-seroprevalence settings are highlighted.Abstract:
Human cytomegalovirus (CMV) is a leading cause of congenital infections worldwide. In the developed world, following the virtual elimination of circulating rubella, it is the commonest nongenetic cause of childhood hearing loss and an important cause of neurodevelopmental delay. The seroprevalence of CMV in adults and the incidence of congenital CMV infection are highest in developing countries (1 to 5% of births) and are most likely driven by nonprimary maternal infections. However, reliable estimates of prevalence and outcome from developing countries are not available. This is largely due to the dogma that maternal preexisting seroimmunity virtually eliminates the risk for sequelae. However, recent data demonstrating similar rates of sequelae, especially hearing loss, following primary and nonprimary maternal infection have underscored the importance of congenital CMV infection in resource-poor settings. Although a significant proportion of congenital CMV infections are attributable to maternal primary infection in well-resourced settings, the absence of specific interventions for seronegative mothers and uncertainty about fetal prognosis have discouraged routine maternal antibody screening. Despite these challenges, encouraging results from prototype vaccines have been reported, and the first randomized phase III trials of prenatal interventions and prolonged postnatal antiviral therapy are under way. Successful implementation of strategies to prevent or reduce the burden of congenital CMV infection will require heightened global awareness among clinicians and the general population. In this review, we highlight the global epidemiology of congenital CMV and the implications of growing knowledge in areas of prevention, diagnosis, prognosis, and management for both low (50 to 70%)- and high (>70%)-seroprevalence settings.read more
Citations
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David W. Kimberlin,Penelope Jester,Pablo J. Sánchez,Amina Ahmed,Ravit Arav-Boger,Marian G. Michaels,Negar Ashouri,Janet A. Englund,Benjamin Estrada,Richard F. Jacobs,Jose R. Romero,Sunil K. Sood,M. S. Whitworth,Mark J. Abzug,Mary T. Caserta,Sandra L. Fowler,Jorge Lujan-Zilbermann,Gregory A. Storch,Roberta L. DeBiasi,Jin Young Han,April Palmer,Leonard B. Weiner,Joseph A. Bocchini,Penelope H. Dennehy,Adam Finn,Paul D. Griffiths,Suzanne Luck,Kathleen Gutierrez,Natasha B. Halasa,James Homans,Andi L. Shane,Mike Sharland,Kari A. Simonsen,John A. Vanchiere,Charles R. Woods,Diane L. Sabo,Inmaculada Aban,Hui-Chien Kuo,Scott H. James,Mark N. Prichard,Jill Griffin,Dusty Giles,Edward P. Acosta,Richard J. Whitley +43 more
TL;DR: Treating symptomatic congenital CMV disease with valganciclovir for 6 months, as compared with 6 weeks, did not improve hearing in the short term but appeared to improve hearing and developmental outcomes modestly in the longer term.
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References
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Journal ArticleDOI
Review and meta‐analysis of the epidemiology of congenital cytomegalovirus (CMV) infection
TL;DR: CMV is a common congenital infection worldwide that can lead to permanent disabilities and there is an urgent need for interventions that can reduce the substantial burden of this often overlooked disease.
Journal ArticleDOI
Newborn Hearing Screening — A Silent Revolution
TL;DR: The implementation of universal screening programs to detect hearing defects in newborns has dramatically increased the identification of hearing loss in infants, and further improvement in these programs can readily be achieved.
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Broadly targeted human cytomegalovirus-specific CD4+ and CD8+ T cells dominate the memory compartments of exposed subjects
Andrew W. Sylwester,Bridget L. Mitchell,John B. Edgar,Cara Taormina,Christian Pelte,Franziska Ruchti,Paul R. Sleath,Kenneth H. Grabstein,Nancy Ann Hosken,Florian Kern,Jay A. Nelson,Louis J. Picker +11 more
TL;DR: The first glimpse of the total human T cell response to a complex infectious agent is provided and insight into the rules governing immunodominance and cross-reactivity in complex viral infections of humans is provided.
Journal ArticleDOI
Review of cytomegalovirus seroprevalence and demographic characteristics associated with infection.
TL;DR: Despite high seroprevalences in some populations, a substantial percentage of women of reproductive age are CMV seronegative and thus at risk of primary CMV infection during pregnancy, and future vaccine or educational campaigns to prevent primary infection in pregnant women may need to be tailored to suit the needs of different populations.
Journal ArticleDOI
New estimates of the prevalence of neurological and sensory sequelae and mortality associated with congenital cytomegalovirus infection.
TL;DR: The estimates of permanent sequelae associated with congenital CMV presented here are likely underestimates and future studies should extend follow‐up of CMV‐infected children identified through universal screening and include the evaluation of visual impairment.
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