An effective and feasible approach to prevention of primary cytomegalovirus infection in pregnancy

Abstract

In the absence of a cytomegalovirus (CMV) vaccine, other strategies for prevention of primary infection in pregnancy should be considered. Behavioural interventions have been reported to significantly decrease seroconversion rate among seronegative pregnant women. We report here on a recently completed controlled study in which seronegative women at high risk of infection because of close contacts with children <36 months, were identified and informed about risky and protective behaviours. Informed women seroconverted at a significantly lower rate than non-informed women.When in 1974 Elek and Stern published their paper with the committing title 'Development of a vaccine against mental retardation caused by cytomegalovirus infection in utero' 1 they could not imagine that 40 years later the CMV vaccine would still be an elusive target, and the hope that '. . . the use of such a vaccine in adolescent girls would reduce the incidence of primary cytomegalovirus infection in pregnancy and thus eliminate fetal brain damage due to this cause' would remain unmet. Although considered top priority 2 and highly desirable 3 , the availability of a CMV vaccine is not foreseen for the near future. Sadly, nowadays, seronegative pregnant women are at the same risk of acquiring a primary CMV infection as they were decades ago. Congenital CMV is perpetuated by the lack of public awareness, serologic screening, unavailability of an effective vaccine and of effective therapeutic treatments.On the other hand, our knowledge about the epidemiology of the virus and its ways of transmission, together with the availability of reliable serology assays have the potential, when properly used, to markedly reduce the incidence of primary infection in pregnant women and, ultimately, of congenital infection.In two small studies conducted in Virginia, US, in 1996 and 2004 the group of S. Adler reported that: (1) behavioural interventions such as frequent hand washing and avoiding close contacts with young children had the potential of reducing the risk of primary CMV infection; and (2) pregnant women were more motivated to follow behavioural interventions than were nonpregnant women 4,5 . In other words, four conditions had to be satisfied for hygiene recommendations to be effective, namely the woman had: (1) to be pregnant; (2) to

What family doctors know about congenital CMV: a regional survey in Iran

“…Since there is no effective vaccine against the cCMV infection yet, simple hygienic precautions remain the only successful strategy to prevent of cCMV infection. The rate of vertical transmission of CMV infection from mother to fetus is dependent on the time of mother’s infection [ 8 – 10 ]. Previous studies suggest that there is a limited awareness or knowledge about cCMV and prevention strategies among women who have educated by Family Practice Physicians and also it has been shown that delivery of prevention counseling to the pregnant women by healthcare providers were highly effective at raising awareness among pregnant women [ 11 , 12 ].…”