Surveillance of congenital cytomegalovirus in the UK and Ireland

Abstract

Objective To explore the presentation and management of congenital cytomegalovirus (CMV) identifi ed through routine clinical investigations, and ascertain outcome in early childhood. Design Active population-based surveillance. Setting UK and Ireland. Methods Infants born in 2001-2002 with confi rmed or suspected congenital CMV infection were reported through the British Paediatric Surveillance Unit, and clinicians completed questionnaires on presentation, diagnosis, management and subsequent outcome. Results 86 confi rmed and 70 possible cases of congenital CMV infection were reported. Over a third (27/72) of singleton infants with confi rmed and 44% (27/61) with possible congenital infection were preterm (<37 weeks gestation). Among confi rmed cases, 75% (64/85) presented with neonatal manifestations compatible with congenital CMV, over half (34/64) of whom had neurological signs; 17 infants were treated with gancyclovir. Among confi rmed cases with information on outcome, 31% (24/78) were developing normally, 18% (14/78) had mild, 24% (19/78) moderate and 14% (11/78) severe sequelae, and 13% (10/78) had died. Median age at follow-up among survivors was 18 months (IQR 15-22 months). Children with neonatal CMV manifestations were signifi cantly more likely than those without to have moderate or severe outcomes (including death) (60%, 36/60, vs 22%, 4/18, p=0.001). 27% of survivors (17/63) had bilateral hearing loss. Conclusions The number of confi rmed cases of diagnosed congenital CMV reported in this study was lower than expected, highlighting the need for early and appropriate investigations when congenital infection is suspected. Due to the unexpectedly high proportion of preterm infants, resulting from differential case ascertainment, it was diffi cult to distinguish prematurity and CMV-related symptoms.

Evaluating the feasibility of integrating salivary testing for congenital CMV into the Newborn Hearing Screening Programme in the UK

“…The majority of these newborns were on NICUs where the initial hearing screen is only performed from a corrected gestational age of 34 weeks onwards. cCMV may be more prevalent in this population [10]. Twenty percent of parents refused to take part in the study, most often because they did not want their newborn to take part in a research study.…”

Seroprevalence of Cytomegalovirus, Epstein Barr Virus and Varicella Zoster Virus among Pregnant Women in Bradford: A Cohort Study

“…Cytomegalovirus is the most common congenital infection in the UK affecting around 3 per 1000 births [1] and can cause neurological impairment such as hearing loss [2]. In utero transmission of CMV can occur following primary maternal infection during pregnancy but can also occur in women with natural immunity, either because they reactivate latent virus or become reinfected with a different strain [3].…”

Congenital Cytomegalovirus-related Hospitalizations in Infants <1 Year of Age, United States, 1997–2009

“…2,12,14,15 The annual number of deaths among infants <1 month and <1 year of age in the United States due to cCMV were estimated in our study to be 18 and 31, respectively. Extrapolating data from a population-based study of cCMV mortality in the United States by taking the total number of deaths for each age group in that study and dividing by the 17-year study period 16 yields similar numbers of deaths, 19 and 33 among infants <1 month and <1 year of age, respectively.…”