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Beaulieu L, Bruce M, Tiedemann B, Chishti R, Iyiola I, Penny S, Leroux C, Nielssen I, Santana MJ, Castillo E. Perspectives of parents with lived experience of cytomegalovirus infection, on universal newborn screening for congenital cytomegalovirus (cCMV) in Canada: a patient-led qualitative study. BMJ Paediatr Open 2024; 8:e002851. [PMID: 39122481 PMCID: PMC11331962 DOI: 10.1136/bmjpo-2024-002851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2024] [Accepted: 07/23/2024] [Indexed: 08/12/2024] Open
Abstract
OBJECTIVE To understand parental perspectives regarding universal newborn screening (UNS) for congenital cytomegalovirus (cCMV) in Canada. DESIGN A qualitative, patient-led study using the Patient and Community Engagement Research approach consisting of online focus groups and in-depth individual interviews to understand parental preferences regarding UNS for cCMV. Data were analysed iteratively using inductive thematic analysis and narrative story analysis. SETTING Canada-wide study conducted via video conference from October to December 2023. PATIENTS 12 participants from five Canadian provinces who self-identified as 18 years of age or older and as having parental lived experience with cytomegalovirus (CMV) or cCMV participated in the study. RESULTS We identified three themes: (1) attitudes about UNS for cCMV, including participants' unanimous support for UNS and confirmation that parental anxiety is not a deterrent for screening, (2) cCMV diagnosis, including the importance of coupling cCMV diagnosis with access to treatment and medical support and (3) awareness of cCMV, where participants shared their frustration about the lack of public and pregnant people's awareness of cCMV. CONCLUSIONS Parental anxiety is not a deterrent for UNS for cCMV. Children with cCMV and their families deserve every opportunity to attain their best possible outcomes. UNS offers children with cCMV access to early intervention if they need it, and also helps to raise awareness and education to prevent future CMV infections.
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Affiliation(s)
- Laija Beaulieu
- Department of Continuing Education, University of Calgary, Calgary, Alberta, Canada
| | - Marcia Bruce
- Department of Continuing Education, University of Calgary, Calgary, Alberta, Canada
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Barbara Tiedemann
- Department of Continuing Education, University of Calgary, Calgary, Alberta, Canada
| | - Rabea Chishti
- Department of Continuing Education, University of Calgary, Calgary, Alberta, Canada
| | - Iqmat Iyiola
- Department of Continuing Education, University of Calgary, Calgary, Alberta, Canada
| | - Sarah Penny
- Department of Continuing Education, University of Calgary, Calgary, Alberta, Canada
| | - Caroline Leroux
- Department of Continuing Education, University of Calgary, Calgary, Alberta, Canada
| | - Ingrid Nielssen
- Department of Continuing Education, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Maria Jose Santana
- Departments of Paediatrics and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
| | - Eliana Castillo
- Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
- Departments of Medicine and Obstetrics & Gynaecology, University of Calgary, Calgary, Alberta, Canada
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Webb E, Hodgson J, Gillespie AN, Jones CA, Poulakis Z, Wong J, Sung V. Hearing Screening for Congenital CytoMegaloVirus-Exploring Parents' Experiences of Completing Targeted Congenital Cytomegalovirus Screening at the Time of Their Infants' Newborn Hearing Screening. J Clin Med 2024; 13:4367. [PMID: 39124634 PMCID: PMC11313214 DOI: 10.3390/jcm13154367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2024] [Revised: 07/16/2024] [Accepted: 07/23/2024] [Indexed: 08/12/2024] Open
Abstract
Background/Objectives: Congenital cytomegalovirus (cCMV) is the leading infectious cause of sensorineural hearing loss and neurodevelopmental disabilities, with prompt detection (<21 days of life) required to enable accurate diagnosis and anti-viral treatment where clinically appropriate. International guidelines recommend cCMV screening for infants who do not pass their Universal Newborn Hearing Screening (UNHS). This study aimed to explore parental experiences of targeted cCMV screening through the UNHS in Victoria, Australia between 2019 and 2020 (HearS-cCMV study). Methods: A qualitative study comprising 18 semi-structured interviews with parents who took saliva swabs from their infants who did not pass their UNHS. A maximum variation sampling strategy was used with data analysed using thematic analysis. Results: Four themes described 18 parents' experiences of cCMV screening: (1) parents' lack of CMV awareness prior to cCMV screening; (2) overall positive experience; (3) varied understanding of CMV post screening; and (4) parents were glad to screen their infant for cCMV. Enablers of targeted cCMV screening included the swab being simple and non-invasive, being easier to complete in the hospital than at home, and the screening being well delivered by the staff. Barriers included a potential increase in anxiety, especially with false positives, and the timing of cCMV screening coinciding with their infant not passing UNHS being difficult for some parents. Conclusions: Parent experiences of targeted cCMV screening were positive. Increasing public knowledge of cCMV and training staff members to complete the CMV swab would reduce the risk of false positives and associated parental anxiety. This would facilitate successful routine targeted cCMV screening.
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Affiliation(s)
- Emma Webb
- Murdoch Children’s Research Institute, Melbourne, VIC 3052, Australia; (E.W.)
- Department of Paediatrics, The University of Melbourne, Melbourne, VIC 3052, Australia
| | - Jan Hodgson
- Department of Paediatrics, The University of Melbourne, Melbourne, VIC 3052, Australia
| | - Alanna N. Gillespie
- Murdoch Children’s Research Institute, Melbourne, VIC 3052, Australia; (E.W.)
| | - Cheryl A. Jones
- Department of Paediatrics, The University of Melbourne, Melbourne, VIC 3052, Australia
- Medicine and Health, The University of New South Wales, Sydney, NSW 2050, Australia
- Sydney Children’s Hospital Network (Westmead), Sydney, NSW 2145, Australia
| | - Zeffie Poulakis
- Murdoch Children’s Research Institute, Melbourne, VIC 3052, Australia; (E.W.)
- Department of Paediatrics, The University of Melbourne, Melbourne, VIC 3052, Australia
- The Royal Children’s Hospital, Melbourne, VIC 3052, Australia
| | - Janis Wong
- Faculty of Medicine, The University of Melbourne, Melbourne, VIC 3052, Australia
| | - Valerie Sung
- Murdoch Children’s Research Institute, Melbourne, VIC 3052, Australia; (E.W.)
- Department of Paediatrics, The University of Melbourne, Melbourne, VIC 3052, Australia
- The Royal Children’s Hospital, Melbourne, VIC 3052, Australia
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3
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Gantt S. Newborn cytomegalovirus screening: is this the new standard? Curr Opin Otolaryngol Head Neck Surg 2023; 31:382-387. [PMID: 37820202 DOI: 10.1097/moo.0000000000000925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
PURPOSE OF REVIEW Congenital cytomegalovirus infection (cCMV) is a major cause of childhood hearing loss and neurodevelopmental delay. Early identification of cCMV allows for interventions that improve outcomes, particularly for cCMV-related hearing loss that develops in early childhood. Most cCMV is asymptomatic at birth and is rarely diagnosed without newborn screening. Therefore, various approaches to cCMV screening are increasingly being adopted. RECENT FINDINGS Both universal screening (testing all newborns) and targeted screening (testing triggered by failed hearing screening) for cCMV appear valuable, feasible and cost-effective, though universal screening is predicted to have greatest potential overall benefits. CMV PCR testing of newborn oral swabs is sensitive and practical and is therefore widely used in targeted screening programs. In contrast, PCR using dried-blood spots (DBS) is less sensitive but was adopted by current universal cCMV screening initiatives because DBS are already collected from all newborns in high-income countries, which circumvents large-scale oral swab collection. SUMMARY Targeted screening is widely recommended as standard of care, while universal screening is less common but is progressively considered as the optimal strategy for identification of children with cCMV. As with all screening programs, cCMV screening requires commitments to equitable and reliable testing, follow-up and services.
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Affiliation(s)
- Soren Gantt
- Sainte Justine University Hospital Research Centre and Department of Microbiology, Immunology and Infectious Diseases, University of Montreal, Montreal, Canada
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Del Valle Penella A, Miller J, Rochat R, Demmler-Harrison G. Utility of Dried Blood Spots for the Diagnosis of Congenital Cytomegaloviruses within the First 21 Days of Life in a Single Center. Int J Neonatal Screen 2023; 9:44. [PMID: 37606481 PMCID: PMC10443379 DOI: 10.3390/ijns9030044] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 06/26/2023] [Accepted: 07/14/2023] [Indexed: 08/23/2023] Open
Abstract
In this retrospective study, we aimed to evaluate the performance of dried-blood-spot (DBS) testing as a diagnostic method for the congenital cytomegalovirus (cCMV). We reviewed the medical records and DBS test results of 89 patients who had also undergone diagnostic cCMV testing within the first 21 days of life. The DBS test had a sensitivity of 83.9%, a specificity of 100%, a positive predictive value of 100%, and a negative predictive value of 73%. Patients with a true-positive DBS had a higher median level of CMV in blood according to PCR than those with a false-negative result. Additionally, all patients with cCMV and hearing loss had a positive DBS test, with higher median viremia levels observed in those with hearing loss compared to those without a CMV PCR blood test. These results suggest that DBS-based testing is useful in the diagnosis of cCMV, and its performance may be related to levels of CMV viremia. DBS testing accurately identified those patients with congenital/early onset hearing loss and those at risk of developing late-onset hearing loss.
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Affiliation(s)
| | | | | | - Gail Demmler-Harrison
- Department of Pediatrics, Division of Infectious Disease, Baylor College of Medicine, Houston, TX 77030, USA; (A.D.V.P.); (J.M.); (R.R.)
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Abstract
Over a century of research has focused on improving our understanding of congenital cytomegalovirus (cCMV), yet it remains the most common congenital infection in the United States, affecting 3 to 6 per 1000 live born infants each year. Pregnancies affected by cCMV are at a heightened risk of spontaneous abortion and intrauterine fetal demise. Neonates born with cCMV are also at substantial risk for long-term neurodevelopmental sequelae and disability, including sensorineural hearing loss, even those born without clinically apparent disease. Considerable progress has been made in recent years in study of the epidemiology and transmission of cCMV, developing better diagnostic strategies, implementing newborn screening programs, improving therapeutics, and launching vaccine trials. In this article, we review recent developments in the understanding of the virology and immunobiology of cytomegalovirus. We further discuss how this knowledge informs our understanding of the pathophysiology of cCMV and directs strategies aimed at improving outcomes and quality of life for congenitally infected children. We also provide an update on the epidemiology of cCMV in the United States, evolving scientific understanding of maternal-fetal transmission, enhanced screening approaches, and recognition of neonatal and long-term sequelae. Finally, we review the current landscape of pediatric cCMV research and provide recommendations for novel and high-priority areas for future investigation.
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Affiliation(s)
- Megan H Pesch
- Division of Developmental and Behavioral Pediatrics, Department of Pediatrics, University of Michigan Medical School, Ann Arbor, Michigan
| | - Mark R Schleiss
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota
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Family Perceptions of Newborn Cytomegalovirus Screening: A Qualitative Study. Int J Neonatal Screen 2021; 7:ijns7040080. [PMID: 34842613 PMCID: PMC8629002 DOI: 10.3390/ijns7040080] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 11/12/2021] [Accepted: 11/16/2021] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVES We sought to understand long-term retrospective parental perceptions of the utility of newborn screening in a context where many affected children never develop sequelae but where intensive support services and ongoing healthcare were provided. STUDY DESIGN Qualitative study. METHODS Focus groups and interviews among parents (N = 41) of children with congenital CMV who had been enrolled in a long-term follow-up study at a large medical college for a mean of 22 years following diagnosis. Groups included parents whose children were: symptomatic at birth; initially asymptomatic but later developed sensorineural hearing loss; and who remained asymptomatic into adulthood. RESULTS With proper follow-up support, newborn CMV screening was viewed positively by parents, who felt empowered by the knowledge, though parents often felt that they and healthcare providers needed more information on congenital CMV. Parents in all groups valued newborn CMV screening in the long term and believed it should be embedded within a comprehensive follow-up program. CONCLUSIONS Despite initial distress, parents of CMV-positive children felt newborn CMV screening was a net positive. Mandatory or opt-out screening for conditions with variable presentations and treatment outcomes may be valuable in contexts where follow-up and care are readily available.
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7
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Jenks CM, Hoff SR, Mithal LB. Congenital Cytomegalovirus Infection: Epidemiology, Timely Diagnosis, and Management. Neoreviews 2021; 22:e606-e613. [PMID: 34470762 DOI: 10.1542/neo.22-9-e606] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Congenital cytomegalovirus (cCMV) infection is common because of the ubiquitous nature of the virus and the lack of an effective prevention strategy during pregnancy. Most infants with cCMV are asymptomatic, although a notable subset can have sequelae including, most commonly, sensorineural hearing loss and neurodevelopmental disability, which may not be present at birth. Timely screening for cytomegalovirus in the first weeks after birth is critical to appropriately diagnose congenital infection, evaluate affected infants, and determine the treatment course. Antiviral therapy with valganciclovir can optimize end hearing and neurodevelopmental outcomes in symptomatic infants. This review discusses the epidemiology and clinical manifestations of cCMV, targeted and universal screening approaches, and treatment and monitoring of infants with cCMV.
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Affiliation(s)
- Carolyn M Jenks
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine; Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Stephen R Hoff
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine; Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Leena B Mithal
- Division of Infectious Diseases, Department of Pediatrics, Northwestern University Feinberg School of Medicine; Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
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Qiao L, Martelli CMT, Raja AI, Sanchez Clemente N, de Araùjo TVB, Ximenes RADA, Miranda-Filho DDB, Ramond A, Brickley EB. Epidemic preparedness: Prenatal Zika virus screening during the next epidemic. BMJ Glob Health 2021; 6:bmjgh-2021-005332. [PMID: 34117012 PMCID: PMC8202108 DOI: 10.1136/bmjgh-2021-005332] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 05/10/2021] [Indexed: 12/29/2022] Open
Abstract
Zika virus (ZIKV) is a vectorborne infectious agent of global public health significance due to its potential to cause severe teratogenic outcomes. The question of whether health systems should consider adopting screening programmes for ZIKV infections during pregnancy warrants consideration. In this analysis, we apply the Wilson-Jungner framework to appraise the potential utility of a prenatal ZIKV screening programme, outline potential screening strategies within the case-finding pathway, and consider other epidemiological factors that may influence the planning of such a screening programme. Our evaluation of a potential prenatal ZIKV screening programme highlights factors affirming its usefulness, including the importance of Congenital Zika Syndrome as a public health problem and the existence of analogous congenital prenatal screening programmes for STORCH agents (syphilis, toxoplasmosis, others (eg, human immunodeficiency virus, varicella-zoster virus, parvovirus B19), rubella, cytomegalovirus, and herpes simplex virus). However, our assessment also reveals key barriers to implementation, such as the need for more accurate diagnostic tests, effective antiviral treatments, increased social service capacity, and surveillance. Given that the reemergence of ZIKV is likely, we provide a guiding framework for policymakers and public health leaders that can be further elaborated and adapted to different contexts in order to reduce the burden of adverse ZIKV-related birth outcomes during future outbreaks.
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Affiliation(s)
- Luxi Qiao
- Health Equity Action Lab, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK.,School of Medicine, Washington University in St Louis, St Louis, Missouri, USA
| | | | - Amber I Raja
- Health Equity Action Lab, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Nuria Sanchez Clemente
- Health Equity Action Lab, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Ricardo Arraes de Alencar Ximenes
- Departamento de Medicina Tropical, Universidade Federal de Pernambuco, Recife, Pernambuco, Brasil.,Departamento de Medicina Interna, Universidade de Pernambuco, Recife, Pernambuco, Brasil
| | | | - Anna Ramond
- Health Equity Action Lab, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Elizabeth B Brickley
- Health Equity Action Lab, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
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9
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Carlton J, Griffiths HJ, Horwood AM, Mazzone PP, Walker R, Simonsz HJ. Acceptability of childhood screening: a systematic narrative review. Public Health 2021; 193:126-138. [PMID: 33831694 PMCID: PMC8128098 DOI: 10.1016/j.puhe.2021.02.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 02/05/2021] [Accepted: 02/09/2021] [Indexed: 12/22/2022]
Abstract
Objectives A systematic narrative literature review was undertaken to assess the acceptability of childhood screening interventions to identify factors to consider when planning or modifying childhood screening programs to maximize participation and uptake. Study design This is a systematic narrative literature review. Methods Electronic databases were searched (MEDLINE, EMBASE, PsycINFO via Ovid, CINAHL, and Cochrane Library) to identify primary research studies that assessed screening acceptability. Studies were categorized using an existing theoretical framework of acceptability consisting of seven constructs: affective attitude, burden, ethicality, intervention coherence, opportunity costs, perceived effectiveness, and self-efficacy. A protocol was developed and registered with PROSPERO (registration no. CRD42018099763) Results The search identified 4529 studies, and 46 studies met the inclusion criteria. Most studies involved neonatal screening. Programs identified included newborn blood spot screening (n = 22), neonatal hearing screening (n = 13), Duchenne muscular dystrophy screening (n = 4), cystic fibrosis screening (n = 3), screening for congenital heart defects (n = 2), and others (n = 2). Most studies assessed more than one construct of acceptability. The most common constructs identified were affective attitude (how a parent feels about the program) and intervention coherence (parental understanding of the program, and/or the potential consequences of a confirmed diagnosis). Conclusions The main acceptability component identified related to parental knowledge and understanding of the screening process, the testing procedure(s), and consent. The emotional impact of childhood screening mostly explored maternal anxiety. Further studies are needed to examine the acceptability of childhood screening across the wider family unit. When planning new (or refining existing) childhood screening programs, it is important to assess acceptability before implementation. This should include assessment of important issues such as information needs, timing of information, and when and where the screening should occur.
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Affiliation(s)
- J Carlton
- School of Health and Related Research (ScHARR), Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK.
| | - H J Griffiths
- Academic Unit of Ophthalmology and Orthoptics, The Medical School, University of Sheffield, Health Sciences School, Beech Hill Road, Sheffield, S10 2RX, UK.
| | - A M Horwood
- Infant Vision Laboratory, School of Psychology and Clinical Language Sciences, University of Reading, Infant Vision Laboratory, Earley Gate, Reading, RG6 6AL, UK.
| | - P P Mazzone
- School of Health and Related Research (ScHARR), Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK.
| | - R Walker
- School of Health and Related Research (ScHARR), Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK.
| | - H J Simonsz
- Department of Ophthalmology, Erasmus Medical Center, P.O. Box 2040, NL-3000CA, Rotterdam, the Netherlands.
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Dollard SC, Dreon M, Hernandez-Alvarado N, Amin MM, Wong P, Lanzieri TM, Osterholm EA, Sidebottom A, Rosendahl S, McCann MT, Schleiss MR. Sensitivity of Dried Blood Spot Testing for Detection of Congenital Cytomegalovirus Infection. JAMA Pediatr 2021; 175:e205441. [PMID: 33523119 PMCID: PMC7851756 DOI: 10.1001/jamapediatrics.2020.5441] [Citation(s) in RCA: 70] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
IMPORTANCE The sensitivity of dried blood spots (DBS) to identify newborns with congenital cytomegalovirus (cCMV) infection has not been evaluated in screening studies using the current, higher-sensitivity methods for DBS processing. OBJECTIVE To assess the sensitivity of DBS polymerase chain reaction (PCR) for newborn screening for cCMV infection using saliva as the reference standard for screening, followed by collection of a urine sample for confirmation of congenital infection. DESIGN, SETTING, AND PARTICIPANTS This population-based cohort study took place at 5 newborn nurseries and 3 neonatal intensive care units in the Minneapolis/Saint Paul area in Minnesota from April 2016 to June 2019. Newborns enrolled with parental consent were screened for cCMV using DBS obtained for routine newborn screening and saliva collected 1 to 2 days after birth. Dried blood spots were tested for CMV DNA by PCR at both the University of Minnesota (UMN) and the US Centers for Disease Control and Prevention (CDC). Saliva swabs were tested by CMV DNA PCR at the UMN laboratory only. Newborns who screened positive by saliva or DBS had a diagnostic urine sample obtained by primary care professionals, tested by PCR within 3 weeks of birth. Analysis began July 2019. EXPOSURES Detection of CMV from a saliva swab using a PCR assay. MAIN OUTCOMES AND MEASURES Number of children with urine-confirmed cCMV and the proportion of them who were CMV positive through DBS screening. RESULTS Of 12 554 individuals enrolled through June 2019 (of 25 000 projected enrollment), 56 newborns were confirmed to have cCMV (4.5 per 1000 [95% CI, 3.3-5.7]). Combined DBS results from either UMN or CDC had a sensitivity of 85.7% (48 of 56; 95% CI, 74.3%-92.6%), specificity of 100.0% (95% CI, 100.0%-100.0%), positive predictive value (PPV) of 98.0% (95% CI, 89.3%-99.6%), and negative predictive value (NPV) of 99.9% (95% CI, 99.9%-100.0%). Dried blood spot results from UMN had a sensitivity of 73.2% (95% CI, 60.4%-83.0%), specificity of 100.0% (100.0%-100.0%), PPV of 100.0% (95% CI, 91.4%-100.0%), and NPV of 99.9% (95% CI, 99.8%-99.9%). Dried blood spot results from CDC had a sensitivity of 76.8% (95% CI, 64.2%-85.9%), specificity of 100.0% (95% CI, 100.0%-100.0%), PPV of 97.7% (95% CI, 88.2%-99.6%), and NPV of 99.9% (95% CI, 99.8%-99.9%). Saliva swab results had a sensitivity of 92.9% (52 of 56; 95% CI, 83.0%-97.2%), specificity of 99.9% (95% CI, 99.9%-100.0%), PPV of 86.7% (95% CI, 75.8%-93.1%), and NPV of 100.0% (95% CI, 99.9%-100.0%). CONCLUSIONS AND RELEVANCE This study demonstrates relatively high analytical sensitivity for DBS compared with previous studies that performed population-based screening. As more sensitive DNA extraction and PCR methods continue to emerge, DBS-based testing should remain under investigation as a potential low-cost, high-throughput option for cCMV screening.
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Affiliation(s)
| | - Maggie Dreon
- Public Health Laboratory, Newborn Screening, Minnesota Department of Health, Saint Paul
| | - Nelmary Hernandez-Alvarado
- Division of Pediatric Infectious Diseases and Immunology, University of Minnesota Medical School, Minneapolis
| | - Minal M. Amin
- US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Phili Wong
- US Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Erin A. Osterholm
- Division of Neonatology, University of Minnesota Medical School, Minneapolis
| | | | - Sondra Rosendahl
- Public Health Laboratory, Newborn Screening, Minnesota Department of Health, Saint Paul
| | - Mark T. McCann
- Public Health Laboratory, Newborn Screening, Minnesota Department of Health, Saint Paul
| | - Mark R. Schleiss
- Division of Pediatric Infectious Diseases and Immunology, University of Minnesota Medical School, Minneapolis
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11
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Demmler Harrison GJ. Newborn Screening for Congenital Cytomegalovirus Infection…It Is Time. Clin Infect Dis 2020; 70:1385-1387. [PMID: 31107963 DOI: 10.1093/cid/ciz415] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 05/19/2019] [Indexed: 12/13/2022] Open
Affiliation(s)
- Gail J Demmler Harrison
- Department of Pediatrics, Section Infectious Diseases, Baylor College of Medicine, Texas Children's Hospital, Houston.,Infectious Diseases Service, Texas Children's Hospital, Houston
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12
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Haller T, Shoup A, Park A. Should hearing targeted screening for congenital cytomegalovirus infection Be implemented? Int J Pediatr Otorhinolaryngol 2020; 134:110055. [PMID: 32361556 PMCID: PMC7293539 DOI: 10.1016/j.ijporl.2020.110055] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 04/17/2020] [Accepted: 04/17/2020] [Indexed: 12/18/2022]
Abstract
Since 2013, after Utah became the first state to implement hearing targeted early CMV screening, a national debate has been percolating about whether this approach should be introduced nationally. Currently Utah, Iowa, Connecticut, and New York have passed legislation mandating early CMV screening, and over 100 birth hospitals across the United States have voluntarily implemented early CMV screening programs as part of their standard of care. We reviewed the evidence related to this approach and used the Wilson and Jungner (1968) criteria to evaluate this method of screening. Based on these criteria, there is substantial rationale and evidence to support a hearing targeted approach to screen for congenital CMV. Given this evidence, we currently recommend that infants who fail newborn hearing screen should undergo CMV screening.
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Affiliation(s)
- Travis Haller
- Division of Otolaryngology- Head and Neck Surgery, University of Utah
| | - Angela Shoup
- Division of Communicative and Vestibular Disorders, Department of Otolaryngology University of Texas Southwestern Medical Center at Dallas
| | - Albert Park
- Division of Otolaryngology- Head and Neck Surgery, University of Utah
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13
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Andronaco DW. Congenital Cytomegalovirus and Hearing Loss. J Obstet Gynecol Neonatal Nurs 2020; 49:293-304. [DOI: 10.1016/j.jogn.2020.02.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2020] [Indexed: 11/26/2022] Open
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14
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A Cross-Sectional Study of Caregiver Perceptions of Congenital Cytomegalovirus Infection: Knowledge and Attitudes about Screening. J Pediatr 2020; 218:151-156.e2. [PMID: 31952844 DOI: 10.1016/j.jpeds.2019.12.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 11/27/2019] [Accepted: 12/03/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVES To understand caregiver knowledge of and attitudes toward congenital cytomegalovirus (cCMV) testing in Utah. STUDY DESIGN We surveyed 365 caregivers whose children were being seen in an otolaryngology clinic at a tertiary pediatric hospital about their knowledge of and attitudes toward cCMV and cCMV screening. Descriptive statistics and cluster analysis were used to examine their responses. RESULTS The majority of caregivers were unsure how cCMV was spread, the symptoms of cCMV, and why cCMV screening of infants was important. Most caregivers did not know that cCMV screening was required by law in Utah if an infant is referred after newborn hearing screening. A majority wanted to know if their child had cCMV even if asymptomatic and were willing to pay $20 for cCMV screening. Caregivers of children who had been tested for cCMV were significantly more likely to be strongly in favor of cCMV screening than expected by chance. Caregivers in the highly knowledgeable cluster were more likely to be strongly in favor of cCMV screening. CONCLUSIONS Caregivers frequently were unaware of cCMV and its implications. Attitudes toward cCMV screening generally were positive. Education on epidemiology and impact of cCMV may benefit both prevention of infection and attitudes toward screening.
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Tastad KJ, Schleiss MR, Lammert SM, Basta NE. Awareness of congenital cytomegalovirus and acceptance of maternal and newborn screening. PLoS One 2019; 14:e0221725. [PMID: 31449545 PMCID: PMC6709948 DOI: 10.1371/journal.pone.0221725] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Accepted: 08/13/2019] [Indexed: 01/06/2023] Open
Abstract
Objectives To assess awareness of cytomegalovirus (CMV); attitudes towards screening; and frequency of behaviors that could increase the risk of prenatal infection. Methods We conducted a survey among 726 women at the 2017 Minnesota State Fair. Minnesota residents aged 18–44 were eligible if they had never been pregnant or had been pregnant within the past 10 years. We compared responses between never-pregnant and recently-pregnant women. Results Only 20% of study participants had previously heard of CMV. Remarkably, recently-pregnant women were no more likely to be aware of CMV than never-pregnant women after adjusting for potential confounders. After receiving information about CMV, nearly all participants indicated they believed prenatal (96%) or newborn (96%) screening should be offered. Conclusions Although baseline awareness of CMV was low (even among recently-pregnant women), after learning more about the risks, women supported screening. Several states have passed or proposed legislation promoting CMV education and/or screening programs. We identified important gaps in knowledge about CMV among women who may benefit from education about how to reduce their risk of exposure and who may need to decide whether they would be willing to screen for CMV in the future.
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Affiliation(s)
- Katie J. Tastad
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, United States of America
| | - Mark R. Schleiss
- Division of Pediatric Infectious Diseases and Immunology, School of Medicine, University of Minnesota, Minneapolis, MN, United States of America
| | - Sara M. Lammert
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, United States of America
| | - Nicole E. Basta
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, United States of America
- * E-mail:
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Viswanathan R, Bafna S, Mergu R, Deshpande G, Gunjikar R, Gaikwad S, Mullick J. Direct Saliva Real-time Polymerase Chain Reaction Assay Shows Low Birth Prevalence of Congenital Cytomegalovirus Infection in Urban Western India. Pediatr Infect Dis J 2019; 38:e65-e68. [PMID: 30882739 DOI: 10.1097/inf.0000000000002094] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Congenital cytomegalovirus (cCMV) infection is the leading infectious cause of mental retardation, developmental delay and sensorineural deafness. Nonprimary infection plays a major role in transmission of this infection in countries with high maternal seroprevalence. Noninvasive sampling and testing is a useful alternative to traditional methods of laboratory detection of congenital CMV infection. The present study was conducted to understand birth prevalence of cCMV infection using molecular techniques, in an urban setting of a developing country with evidence of high maternal seroprevalence. METHODS Universal newborn screening for cCMV was performed for 750 infants born at a tertiary care center in Western India. Real-time polymerase chain reaction was directly carried out on saliva samples. Follow-up laboratory testing of saliva, urine and blood was performed for neonates identified as positive. Sequential clinical follow-up was offered to the affected infants. RESULTS A birth prevalence of 0.4% (95% CI: 0.13-1.2) was observed with 3 of 750 babies confirmed to be positive for cCMV infection. All 3 babies were born to seropositive mothers (anti-CMV immunoglobulin G positive). One of the babies detected was symptomatic with sepsis like features. All of them survived and did not develop any sequelae up to 1 year of age. CONCLUSION The use of direct real-time polymerase chain reaction of saliva samples can be considered as a feasible option for newborn screening of congenital CMV infection in developing countries. Relatively low birth prevalence of cCMV infection was observed in our study, which needs to be corroborated through further studies.
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Affiliation(s)
| | - Sanjay Bafna
- Department of Pediatric Medicine, Jehangir Hospital, Pune, India
| | - Ravikanth Mergu
- Department of Pediatric Medicine, Jehangir Hospital, Pune, India
| | - Gururajrao Deshpande
- From the Diagnostic Virology Group, ICMR-National Institute of Virology, Pune, India
| | - Rashmi Gunjikar
- From the Diagnostic Virology Group, ICMR-National Institute of Virology, Pune, India
| | - Shivshankar Gaikwad
- From the Diagnostic Virology Group, ICMR-National Institute of Virology, Pune, India
| | - Jayati Mullick
- Avian Influenza Group, ICMR-National Institute of Virology, Pune, India
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Lu CY, Tsao PN, Ke YY, Lin YH, Lin YH, Hung CC, Su YN, Hsu WC, Hsieh WS, Huang LM, Wu CC, Hsu CJ. Concurrent Hearing, Genetic, and Cytomegalovirus Screening in Newborns, Taiwan. J Pediatr 2018; 199:144-150.e1. [PMID: 29681450 DOI: 10.1016/j.jpeds.2018.02.064] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 02/13/2018] [Accepted: 02/27/2018] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To evaluate the feasibility and potential benefits of incorporating genetic and cytomegalovirus (CMV) screenings into the current newborn hearing screening (NHS) programs. STUDY DESIGN Newborns were recruited prospectively from a tertiary hospital and a maternity clinic between May 2016 and December 2016 and were subjected to hearing screening, CMV screening, and genetic screening for 4 common mutations in deafness genes (p.V37I and c.235delC of GJB2 gene, c.919-2A>G of SLC26A4 gene, and the mitochondrial m.1555A>G). Infants with homozygous nuclear mutations or homoplasmic/heteroplasmic mitochondrial mutation (referred to as "conclusively positive genotypes") and those who tested positive for CMV received diagnostic audiologic evaluations. RESULTS Of the total 1716 newborns enrolled, we identified 20 (1.2%) newborns with conclusively positive genotypes on genetic screening, comprising 15 newborns (0.9%) with GJB2 p.V37I/p.V37I and 5 newborns (0.3%) with m.1555A>G. Three (0.2%) newborns tested positive on CMV screening. Twelve of the 20 newborns (60%) with conclusively positive genotypes and all 3 newborns who tested positive for CMV (100%) passed NHS at birth. Diagnostic audiologic evaluations conducted at 3 months confirmed hearing impairment in 6 of the 20 infants (30%) with conclusively positive genotypes. CONCLUSIONS This study confirms the feasibility of performing hearing, genetic, and CMV screenings concurrently in newborns and provides evidence that the incorporation of these screening tests could potentially identify an additional subgroup of infants with impaired hearing that might not be detected by the NHS programs.
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Affiliation(s)
- Chun-Yi Lu
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | - Po-Nien Tsao
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | - Ying-Ying Ke
- Graduate Institute of Molecular Medicine, National Taiwan University College of Medicine, Taipei, Taiwan; Sofiva Genomics Co, Ltd, Taipei, Taiwan
| | - Yi-Hsin Lin
- Graduate Institute of Molecular Medicine, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan
| | - Yin-Hung Lin
- Graduate Institute of Molecular Medicine, National Taiwan University College of Medicine, Taipei, Taiwan; Graduate Institute of Medical Genomics and Proteomics, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Medical Genetics, National Taiwan University Hospital, Taipei, Taiwan
| | | | - Yi-Ning Su
- Sofiva Genomics Co, Ltd, Taipei, Taiwan; Department of Gynecology and Maternity, Dianthus Maternal Fetal Medicine Clinic, Taipei, Taiwan; Department of Obstetrics and Gynecology, School of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Wei-Chung Hsu
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan
| | - Wu-Shiun Hsieh
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan; Department of Pediatrics, Cathay General Hospital, Taipei, Taiwan
| | - Li-Min Huang
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | - Chen-Chi Wu
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan; Department of Medical Genetics, National Taiwan University Hospital, Taipei, Taiwan.
| | - Chuan-Jen Hsu
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan; Department of Otolaryngology, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan
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Hosseinzadeh Adli A, Karami C, Baghban Rahimi S, Mirarab A, Tabarraei A. What family doctors know about congenital CMV: a regional survey in Iran. Ital J Pediatr 2018; 44:31. [PMID: 29490704 PMCID: PMC5831851 DOI: 10.1186/s13052-018-0470-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 02/23/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Since there is no effective treatment or vaccine against the congenital cytomegalovirus (cCMV) infection, knowledge and awareness of medical doctor's (MDs) especially family doctors are essential for preventive strategies and it also seems to be usually ignored by healthcare providers. Aim of this study was to investigate awareness of MDs about cCMV infection in Iran. METHODS A single page questionnaire was randomly distributed among 450 MDs including general practitioners, pediatricians, gynecologists, internal and other medical specialists concerning of their knowledge in clinical presentation, diagnosis, prevention, prognosis, epidemiology, transmission, and management of cCMV infection. All statistical analyses were performed using SPSS version 16. RESULTS More than half of questionnaire recipients refused to take part in any of the questionnaire items. The most of the respondents were agreed for newborn CMV screening tests and mandatory CMV test for women trying to get pregnant, which, are not routinely tested. The knowledge of general practitioners about cCMV was less than usual. The field of expertise had a profound effect in this survey, but age and gender did not. CONCLUSIONS Our results indicated that the knowledge of cCMV infection, especially among family doctors contains several gaps. Urgent action is required to improve family doctor's knowledge of CMV infection. Surveys to evaluate CMV awareness among MDs, healthcare professionals and women of childbearing age are proposed.
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Affiliation(s)
| | - Chiman Karami
- Department of Virology, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Sanaz Baghban Rahimi
- Department of Microbiology, Golestan University of Medical Sciences, Gorgan, Iran
| | - Azam Mirarab
- Department of Microbiology, Golestan University of Medical Sciences, Gorgan, Iran
| | - Alijan Tabarraei
- Infectious Diseases Research Center, Golestan University of Medical Sciences, Gorgan, Iran.
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Park AH, Shoup AG. Should infants who fail their newborn hearing screen undergo cytomegalovirus testing? Laryngoscope 2017; 128:295-296. [PMID: 28815627 DOI: 10.1002/lary.26819] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2017] [Indexed: 11/08/2022]
Affiliation(s)
- Albert H Park
- Division of Otolaryngology-Head and Neck Surgery, University of Utah, Salt Lake City, Utah, U.S.A
| | - Angela G Shoup
- Division of Communicative and Vestibular Disorders, Department of Otolaryngology, University of Texas Southwestern Medical Center, Dallas, Texas, U.S.A
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Kumar P, Iyengar H, Kumar P. Public Views on Pulse Oximetry Screening for Critical Congenital Heart Disease. World J Pediatr Congenit Heart Surg 2017; 8:130-134. [DOI: 10.1177/2150135116674468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives: To understand public views on pulse oximetry screening for critical congenital heart disease. Methods: Two hundred thirteen adults read a brief vignette describing the importance of early detection of critical congenital heart disease and then answered five questions on a five-point scale of how likely or unlikely they were to support pulse oximetry screening. Responses were tabulated and analyzed using a Fisher exact test, and logistic regression was used to estimate odds ratios for adjusted associations using generalized estimating equations. Results: Almost 90% of all participants expressed support for routine pulse oximetry screening. The possibility of false positives leading to a delay in discharge, and the potential need for transfer to another facility lowered support but did not reach a statistical significance. The overall support for pulse oximetry screening was strong and consistent between different participant demographics. Conclusion: A large majority of participants in this study support pulse oximetry screening for the early detection of critical congenital heart disease.
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Affiliation(s)
- Praveen Kumar
- Departments of Pediatrics, Northwestern Memorial Hospital, Chicago, IL, USA
- Department of Pediatrics, Children’s Hospital of Illinois, University of Illinois, Peoria, IL, USA
| | - Hari Iyengar
- Departments of Pediatrics, Northwestern Memorial Hospital, Chicago, IL, USA
| | - Prerna Kumar
- Departments of Pediatrics, Children’s Hospital Colorado, Aurora, CO, USA
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Lenticulostriate Vasculopathy in Brain Ultrasonography is Associated with Cytomegalovirus Infection in Newborns. Pediatr Neonatol 2015; 56:408-14. [PMID: 26073370 DOI: 10.1016/j.pedneo.2015.04.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Revised: 03/25/2015] [Accepted: 04/16/2015] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Lenticulostriate vasculopathy is associated with various disorders, in particular cytomegalovirus infection, which can cause neurological consequences. We wanted to evaluate the association of lenticulostriate vasculopathy and cytomegalovirus infection. We retrospectively collected data on lenticulostriate vasculopathy from 858 neonatal ultrasonography scans. METHODS Fifty-five patients with lenticulostriate vasculopathy were diagnosed. Lenticulostriate vasculopathy was classified as severe and mild according to the ultrasonographic findings. We analyzed gender, unilateral and bilateral lenticulostriate vasculopathy, mild and severe lenticulostriate vasculopathy, intrauterine growth retardation, and lenticulostriate vasculopathy associated with other brain malformations to determine whether they were correlated with cytomegalovirus infection. RESULTS Neonatal cytomegalovirus infections correlated primarily with lenticulostriate vasculopathy that was associated with brain structure anomalies p < 0.0001, followed by severe lenticulostriate vasculopathy (p = 0.029). Cytomegalovirus urine polymerase chain reaction ratios were 69% for severe and 23% for mild lenticulostriate vasculopathy (p = 0.002; odds ratio = 7.33). Of 72 newborns with intrauterine growth retardation without lenticulostriate vasculopathy, 33 were analyzed for cytomegalovirus, of whom only one was positive, which was significantly different from the newborns with lenticulostriate vasculopathy (p = 0.003; odds ratio = 11.64). CONCLUSION Lenticulostriate vasculopathy on neonatal ultrasonography is useful for predicting cytomegalovirus infection, particularly in severe lenticulostriate vasculopathy. When severe lenticulostriate vasculopathy is associated with a brain structure anomaly, cytomegalovirus infection should be considered. The outcomes for the cases in which cytomegalovirus infection was associated with other brain structure anomalies were significantly worse than the outcomes in cases associated with lenticulostriate vasculopathy only.
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Harrison GJ. Current controversies in diagnosis, management, and prevention of congenital cytomegalovirus: updates for the pediatric practitioner. Pediatr Ann 2015; 44:e115-25. [PMID: 25996198 DOI: 10.3928/00904481-20150512-11] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Congenital cytomegalovirus (CMV) infection has been called "the elephant in our living room" because it is a major public health problem that for decades has been unrecognized and unaddressed. Congenital CMV infection is a common cause of sensorineural hearing loss, vision loss, neurodevelopment disabilities, liver disease, and growth failure. Diagnostic tests are now widely available to identify newborns with congenital CMV infection, congenitally infected newborns now can be easily assessed for evidence of organ involvement, and there are now antiviral treatments and other interventions available to improve the outcome in children with congenital CMV disease. A licensed vaccine to prevent CMV infection is not yet available; however, a "CMV knowledge vaccine," composed of "an ounce of CMV awareness and three simple precautions" and that is endorsed by the Centers for Disease Control and Prevention is available for pregnant women who wish to reduce their contact with potentially CMV-infected secretions and therefore reduce their risk of acquiring CMV during pregnancy. Medical experts in the field of congenital CMV have been called upon for a consensus statement for diagnosis and treatment, and nonprofit organizations of families affected by congenital CMV from around the world have formed a collaborative coalition to facilitate the spread of CMV knowledge and awareness.
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Cannon MJ, Griffiths PD, Aston V, Rawlinson WD. Universal newborn screening for congenital CMV infection: what is the evidence of potential benefit? Rev Med Virol 2014; 24:291-307. [PMID: 24760655 PMCID: PMC4494732 DOI: 10.1002/rmv.1790] [Citation(s) in RCA: 163] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Revised: 02/21/2014] [Accepted: 02/24/2014] [Indexed: 11/11/2022]
Abstract
Congenital CMV infection is a leading cause of childhood disability. Many children born with congenital CMV infection are asymptomatic or have nonspecific symptoms and therefore are typically not diagnosed. A strategy of newborn CMV screening could allow for early detection and intervention to improve clinical outcomes. Interventions might include antiviral drugs or nonpharmaceutical therapies such as speech-language therapy or cochlear implants. Using published data from developed countries, we analyzed existing evidence of potential benefit that could result from newborn CMV screening. We first estimated the numbers of children with the most important CMV-related disabilities (i.e. hearing loss, cognitive deficit, and vision impairment), including the age at which the disabilities occur. Then, for each of the disabilities, we examined the existing evidence for the effectiveness of various interventions. We concluded that there is good evidence of potential benefit from nonpharmaceutical interventions for children with delayed hearing loss that occurs by 9 months of age. Similarly, we concluded that there is fair evidence of potential benefit from antiviral therapy for children with hearing loss at birth and from nonpharmaceutical interventions for children with delayed hearing loss occurring between 9 and 24 months of age and for children with CMV-related cognitive deficits. We found poor evidence of potential benefit for children with delayed hearing loss occurring after 24 months of age and for children with vision impairment. Overall, we estimated that in the United States, several thousand children with congenital CMV could benefit each year from newborn CMV screening, early detection, and interventions.
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Affiliation(s)
- Michael J. Cannon
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | - William D. Rawlinson
- BABS, SOMS and ACPS University of NSW, Sydney, NSW, Australia
- Virology Division, SEALS Microbiology, SESLHD, Sydney, NSW, Australia
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Williams EJ, Kadambari S, Berrington JE, Luck S, Atkinson C, Walter S, Embleton ND, James P, Griffiths P, Davis A, Sharland M, Clark JE. Feasibility and acceptability of targeted screening for congenital CMV-related hearing loss. Arch Dis Child Fetal Neonatal Ed 2014; 99:F230-6. [PMID: 24596404 DOI: 10.1136/archdischild-2013-305276] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Congenital cytomegalovirus (cCMV) is the most common non-genetic cause of sensorineural hearing loss (SNHL) in children. Ganciclovir has been shown to prevent the continued deterioration in hearing of children with symptomatic cCMV, but some children with cCMV-related SNHL are unidentified in the neonatal treatment period. Neonatal cCMV screening provides an opportunity to identify infants with cCMV-related SNHL who might benefit from early treatment. OBJECTIVES To assess the feasibility (ability to take samples before 3 weeks of age and clinical assessment by 30 days of age) and acceptability (maternal anxiety) of targeted CMV testing of infants who are 'referred' for further audiological testing after routine newborn hearing screening programme (NHSP). METHODS Parents of infants who have 'no clear responses' on routine NHSP before 22 days of life in London and North East England were approached. Salivary and urine samples were tested by CMV PCR. At recruitment and 3 months, the short form Spielberger State-Trait Anxiety Inventory measured maternal anxiety. RESULTS 411 infants were recruited. 99% (407/411) returned a sample; 98% (404/411) successfully yielded a CMV result, 6 had cCMV, all diagnosed on salivary samples taken <22 days of age (1.5%; 95% CI 0.6% to 3.2%). Only 50% returned urine samples compared with 99% returning salivary samples (p<0.001). Using saliva swabs 98% were successfully screened for CMV within 3 weeks. All positive screening CMV results were known by day 23, and 5/6 infants with cCMV were assessed within 31 days. Anxiety was not increased in mothers of infants screened for cCMV. CONCLUSIONS Targeted salivary screening for cCMV within the NHSP is feasible, acceptable and detects infants with cCMV-related SNHL who could benefit from early treatment.
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Affiliation(s)
- Eleri J Williams
- Department of Paediatric Immunology and Infectious Diseases, Great North Childrens Hospital, Royal Victoria Hospital, , Newcastle-upon-Tyne, UK
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Álvarez Domínguez E, Figueras Aloy J, Botet Mussons F, Marcos Maeso M, Pérez Fernández J. Cribado de la infección por citomegalovirus en recién nacidos de muy bajo peso. An Pediatr (Barc) 2013; 79:3-9. [DOI: 10.1016/j.anpedi.2012.09.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2012] [Revised: 09/26/2012] [Accepted: 09/27/2012] [Indexed: 11/25/2022] Open
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