Congenital Cytomegalovirus Infection and Disease in Sweden and the Relative Importance of Primary and Secondary Maternal Infections: Preliminary Findings from a Prospective Study

Abstract

In a prospective Swedish study started in 1977 and still in progress 10 328 newborn infants in an urban district were investigated for cytomegalovirus (CMV) excretion in the urine by the virus isolation test. Congenital infection was found in 50 cases (0.5%). Of 47 infected infants with known clinical status at birth 9 (19%) had hepatomegaly, splenomegaly, jaundice and/or petechiae. The symptoms were moderate or mild. Of the infants followed up, 2 (25%) of 8 neonatally symptomatic ones and 3 (9%) of 35 asymptomatic ones developed neurologic sequelae. Altogether 5 (12%) of 43 had permanent neurologic symptoms corresponding to 0.06% in the general population. The children ranged in age from 6 months to 4 yr at the last examination. 21 mothers of the 47 infants with known status at birth had a confirmed or presumed primary infection, 15 a confirmed or presumed secondary infection and 11 an undetermined type of infection. Of the 5 infants with neurologic sequelae, 1 with a grave psychomotor retardation and deafness was born to a mother with a primary infection in the 1st trimester; 1 infant with a moderate retardation and 3 deaf infants were all exposed to confirmed or presumed secondary maternal infections. Prospective serological studies of maternal sera in early pregnancy would have suspected only the gravely retarded infant to be at risk.

Congenital Cytomegalovirus Infection as a Cause of Sensorineural Hearing Loss in a Highly Immune Population

“…Similar to the findings from studies conducted in populations with different CMV seroprevalence rates in the U.S. and Europe, the results of our study indicated that symptomatic infants were significantly more likely to develop SNHL than those with asymptomatic infection 1–3 . Thus, the presence of CMV-related symptoms at birth is a strong predictor of hearing loss, even in populations with high maternal CMV seroprevalence rate.…”

“…Population based studies in Sweden 1 , Canada 2 and USA 3, 4 have reported that between 9.3% and 17% of infants with congenital CMV infection will have sensorineural hearing loss (SNHL). The rates of SNHL reported by these studies ranged between 22%–41% in children with clinically apparent or symptomatic infection and between 6–16% in those with subclinical or asymptomatic infection.…”

Congenital cytomegalovirus infection.

“…[6][7][8] Congenital infection may result from either primary or recurrent (due to reactivation of reinfection) infection in the mother. Although serious handicaps are more likely after primary rather than recurrent infection,219 neurological damage and bilateral hearing loss have occasionally been reported in children whose mothers undoubtedly had recurrent infection.2720 More data are required from large prospective studies before the risk associated with recurrent infection can be determined.…”

Surveillance of congenital cytomegalovirus in the UK and Ireland

“…Seroprevalence of CMV in women of childbearing age in the UK is around 50%, but varies by ethnicity, social class and parity 1. Congenital CMV infection can result from recurrent (reactivation of latent infection or reinfection with a new strain) or primary maternal infection in pregnancy 2 3. The birth prevalence of congenital CMV in resource-rich countries varies according to maternal seroprevalence, and in the UK is estimated to be around 3 per 1000 4 5.…”