Symptomatic Congenital Cytomegalovirus Infection Is Underdiagnosed in British Columbia

Sorichetti, Brendan; Goshen, Oran; Pauwels, Julie; Kozak, Frederick K.; Tilley, Peter; Krajden, Mel; Gantt, Soren

doi:10.1016/j.jpeds.2015.10.069

Cited by 36 publications

(44 citation statements)

References 11 publications

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“…To our knowledge, no awareness studies have been performed in Norway. However, there is no reason to believe that awareness in Norway is much different from other comparable countries where studies report a low awareness in the population and underreporting of cCMV at birth . Given a “true” prevalence for cCMV of 0.5%, only one‐third of the symptomatic infections and none of the initially asymptomatic infections would have been diagnosed with the P.35.1 code in Norway, according to NPR numbers.…”

Section: Discussionmentioning

confidence: 95%

“…This corresponds relatively well to the number of children registered with the P35.1 code in the NPR given a prevalence of 0.22. During the study period, there were no screening for cCMV at birth in Norway, which suggests that only the most clinically overt cases are diagnosed and registered with the ICD‐10 code at birth . To our knowledge, no awareness studies have been performed in Norway.…”

Section: Discussionmentioning

confidence: 99%

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Maternal and congenital cytomegalovirus infections in a population‐based pregnancy cohort study

Barlinn

Trogstad

Gibory

et al. 2018

APMIS

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CMV is the most common cause of congenital infection. During the past few decades, there has been a change in behaviour that possibly has affected the CMV infection rate of mother and child. We investigated 1350 randomly selected pregnant women from the Norwegian Mother and Child Cohort Study using an algorithm for detection of maternal and congenital CMV (cCMV) infection including both serology and nucleic acid amplification assay. The CMV IgG seroprevalence was 54% and 23 (3.7%) mothers seroconverted. Three (0.22%) children had a positive CMV PCR in the umbilical cord blood. The transmission rate was lower than reported in previous studies, probably due to lower sensitivity in plasma compared to saliva and urine. The prevalence of cCMV in the present study was compared with the number registered with the ICD‐10 code P.35.1‐congenital CMV infection in the Norwegian Patient Register. The number registered was lower than the number of estimated infections. Factors like lower level of education and parity were associated with higher CMV IgG seroprevalence, but no significant difference could be linked to age. In conclusion, in this cohort of pregnant women, a high CMV IgG seroconversion rate was found, while the vertical transmission rate was low.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Maternal and congenital cytomegalovirus infections in a population‐based pregnancy cohort study

Barlinn

Trogstad

Gibory

et al. 2018

APMIS

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“…We observed a prevalence of symptomatic congenital CMV disease that was between one-half and one-third of the expected 5.0–7.5 per 10,000 prevalence in the United States 2 . One study by Diener et al 19 found that the proportion of diagnosed symptomatic congenital CMV cases may be as high as 30%, though other studies have found this proportion to be much lower, with <10% of symptomatic cases diagnosed 17, 18, 20 .…”

Section: Discussionmentioning

confidence: 99%

Valganciclovir Use Among Commercially and Medicaid-insured Infants With Congenital CMV Infection in the United States, 2009–2015

Leung

Dollard

Grosse

et al. 2018

Clinical Therapeutics

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Purpose To assess clinical characteristics and trends in valganciclovir use among infants diagnosed with congenital cytomegalovirus (CMV) disease in the United States. Methods We analyzed 2009–2015 medical claims from Truven Health MarketScan® Commercial Claims and Encounters and Medicaid databases. We identified infants with a live birth code in the first claim who were enrolled for at least 45 days. Among infants diagnosed with congenital CMV disease, identified by an ICD-9-CM or ICD-10-CM code of congenital CMV infection or CMV disease within 45 days of birth, we assessed codes for CMV-associated clinical condition within the same period, and hearing loss and valganciclovir claims within the first 180 days. Findings In the commercial and Medicaid databases, we identified 257 (2.5/10,000) and 445 (3.3/10,000) infants diagnosed with congenital CMV disease, respectively, among whom 135 (53%) and 282 (63%) had ≥1 CMV-associated condition, 30 (12%) and 32 (7%) had hearing loss, and 41 (16%) and 78 (18%) had valganciclovir claims. Among infants with congenital CMV disease who had valganciclovir claims, 37 (90%) among commercially-insured infants and 68 (87%) among Medicaid-insured infants had ≥1 CMV-associated condition and/or hearing loss. From 2009 to 2015, the proportion with valganciclovir claims increased from 0% to 29% among commercially-insured infants and from 4% to 37% among Medicaid-insured infants (p<0.0001). Implications During 2009–2015, there was a strong upward trend in valganciclovir claims among insured infants who were diagnosed with congenital CMV disease, the majority of whom had CMV-associated conditions and/or hearing loss.

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“…However, only a small proportion of symptomatic cCMV infections (and essentially none of the asymptomatic ones) are diagnosed using this approach. [9][10][11][12][13][14] All infants with cCMV infection, symptomatic or asymptomatic, may benefit from early diagnosis for anticipatory guidance, early identification of lateonset hearing impairment, and appropriate support. 3 Treatment of newborns with symptomatic cCMV infection with the antiviral drug valganciclovir hydrochloride for 6 months also results in improved hearing and developmental outcomes.…”

mentioning

confidence: 99%

Cost-effectiveness of Universal and Targeted Newborn Screening for Congenital Cytomegalovirus Infection

et al. 2016

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IMPORTANCE Congenital cytomegalovirus (cCMV) infection is a major cause of childhood deafness. Most cCMV infections are not diagnosed without newborn screening, resulting in missed opportunities for directed care.OBJECTIVE To estimate the cost-effectiveness of universal and targeted newborn cCMV screening programs compared with no cCMV screening. DESIGN, SETTING, AND PARTICIPANTS Models were constructed using rates and outcomes from prospective cohort studies of newborn cCMV screening in US postpartum care and early hearing programs. Costs of laboratory testing, treatment, and hearing loss were drawn from Medicaid data and published estimates. The benefits of cCMV screening were assumed to come from antiviral therapy for affected newborns to reduce hearing loss and from earlier identification of hearing loss with postnatal onset. Analyses were performed from July 2014 to March 2016.INTERVENTIONS Models compared universal or targeted cCMV screening of newborns with a failed hearing screen, with standard care for cCMV infection. MAIN OUTCOMES AND MEASURESThe incremental costs of identifying 1 cCMV infection, identifying 1 case of cCMV-related hearing loss, and preventing 1 cochlear implant; the incremental reduction in cases of severe to profound hearing loss; and the differences in costs per infant screened by universal or targeted strategies under different assumptions about the effectiveness of antiviral treatment.

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Symptomatic Congenital Cytomegalovirus Infection Is Underdiagnosed in British Columbia

Cited by 36 publications

References 11 publications

Maternal and congenital cytomegalovirus infections in a population‐based pregnancy cohort study

Maternal and congenital cytomegalovirus infections in a population‐based pregnancy cohort study

Valganciclovir Use Among Commercially and Medicaid-insured Infants With Congenital CMV Infection in the United States, 2009–2015

Cost-effectiveness of Universal and Targeted Newborn Screening for Congenital Cytomegalovirus Infection

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