International consensus guidelines recommend a targeted cCMV screening approach for newborns who do not pass their universal newborn hearing screen by saliva polymerase chain reaction (PCR). To accurately diagnose cCMV infection, urine or saliva samples must be taken from the newborn within the first 21 days of life, because samples taken after that time period may indicate post-natal CMV infection, which does not cause hearing loss or neurodisability. The potential effectiveness of early antiviral therapy in reducing cCMV-related hearing loss progression and neurodevelopmental disabilities has led to a worldwide push to implement early screening for cCMV.
A case-by-case discussion between families and clinicians is required in these instances and the decision whether to commence treatment is dependent on when the diagnosis occurs and the severity of hearing loss or neurodisability, in order to weigh up potential benefits and side effects such as neutropenia.
The International Congenital Cytomegalovirus Recommendations Group in 2015 recommended that infants who are moderately to severely affected by cCMV be offered oral valganciclovir for management, and it is not currently recommended as routine practice for infants with isolated sensorineural hearing loss or mild symptoms. Further research is needed to clarify this. However, as this study only enrolled symptomatic infants, we do not yet know whether antiviral medication benefits cCMV-infected newborns who have isolated hearing loss or no symptoms at birth. Research in 2015 demonstrated prolonged (6-month) antiviral medication with oral valganciclovir, if commenced within the first month of life for babies with symptoms from cCMV infection as newborns, resulted in improved hearing and neurodevelopmental outcomes in many infants beyond a year of life. Worldwide race to implement early cCMV screening Of these initially asymptomatic infants, around 14% go on to develop hearing loss or neurodevelopmental disabilities. A minority of babies born with cCMV infection can be unwell at birth, but most (about 90%) are born without any clinically apparent symptoms ( here and here). The most risk of transmission to an unborn baby is when CMV primary infection occurs in the first trimester of pregnancy of a non-immune mother. CMV is generally spread by direct contact through bodily fluids such as saliva, nasal mucous, or urine, for example, through kissing children on the lips, sharing food, handling children’s toys or changing nappies without washing hands.ĬMV can be problematic for pregnant women if caught for the first time (primary infection) or reactivated from its latent state. The infection is common but silent, affecting around 83% of adults, with most remaining asymptomatic. Once a person is infected, the virus remains viable but usually inactive (dormant/latent) in the body. As Professor Demmler-Harrison accurately states, it is “the elephant in our living room”.ĬMV is a virus in the herpesvirus family. While there has been a shift in the understanding of viruses and infection prevention and control, adequate infection prevention of CMV for expecting mothers is low ( here and here). There is no effective vaccine for the prevention of cCMV infection. Despite this, the public, and even health professionals, have little awareness of cCMV.
The most common sequelae of cCMV are sensorineural (permanent) hearing loss affecting around 13% of infants, vision loss, cerebral palsy, intellectual impairment and neurodevelopmental disability ( here, here and here). Approximately 400 infants in Australia are either born with or develop cCMV-related issues in Australia per year. CONGENITAL cytomegalovirus (cCMV) infection is the most common, and potentially preventable, infectious cause of permanent hearing loss and child neurodevelopmental disabilities such as cerebral palsy.