Congenital Cytomegalovirus Infection: Review of the... : Obstetrical & Gynecological Survey (original) (raw)

CME PROGRAM: CATEGORY 1 CME REVIEW ARTICLES 10, 11, AND 12

Congenital Cytomegalovirus Infection: Review of the Epidemiology and Outcome

Gaytant, Michael A. MD, PhD*; Steegers, Eric A.P. MD, PhD†; Semmekrot, Ben A. MD, PhD‡; Merkus, Hans M.M.W. MD, PhD§; Galama, Jochem M.D. MD, PhD¶

*Trainee, Department of Internal Medicine, Slingerland Hospital Doetinchem, The Netherlands; †Associate Professor in Obstetrics, Department of Obstetrics and Gynecology, Erasmus University Medical Center, Rotterdam, The Netherlands; ‡Pediatrician and Neonatologist, Department of Pediatrics, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands; §Professor in Obstetrics, Department of Obstetrics and Gynecology, University Medical Center, St Radboud, The Netherlands; ¶Professor in Virology, Department of Medical Microbiology, Virology Section, University Medical Center, St Radboud, The Netherlands

Reprints requests to: JMD Galama, Department of Medical Microbiology, University Medical Centre, PO Box 9101, 6500 HB Nijmegen, the Netherlands. Email: [email protected]

The authors have disclosed no significant financial or other relationship with any commercial entity.

Abstract

Cytomegalovirus (CMV) is one of the most common viral causes of congenital infection. A future decision to lower its incidence by vaccination will depend on epidemiological conditions within a country and on the safety of the vaccine to be used, because a life vaccine may cause latency and subsequent reactivation that still may harm the fetus. The aim was to review the epidemiological studies published so far, with respect to factors that affect the incidence of congenital CMV infection, and factors that may influence its outcome, such as preexisting maternal immunity. The study included the data of 19 studies that were retrieved from a MEDLINE search during the period 1977 to 1997. The incidence of congenital CMV infection varied between 0.15% and 2.0% and seemed to correlate with the level of preexisting immunity in the population. Although preexisting maternal immunity was reported to strongly reduce transmission, the severity of congenital CMV infection (symptoms at birth and or sequelae later in life) was not significantly greater after virus transmission due to a primary infection of the mother as compared with recurrence or reinfection. The data indicate that preexisting immunity of the mother does not significantly mitigate the outcome of congenital infection. Moreover, life vaccines may bear a serious risk when transmittable to the fetus.

Target Audience: Obstetricians and Gynecologists, Family Physicians

Learning Objectives: After completion of this article, the reader will be able to describe the natural course of a CMV infection, to list the potential sequelae of a congenital CMV infection, to outline potential strategies to prevent transmission of CMV, and to summarize the diagnostic work up of a patient with a potential CMV infection.