scholarly journals Impact of Maternal Immunity on Congenital Cytomegalovirus Birth Prevalence and Infant Outcomes: A Systematic Review

Vaccines ◽  
2019 ◽  
Vol 7 (4) ◽  
pp. 129 ◽  
Author(s):  
Coppola ◽  
Mangold ◽  
Cantrell ◽  
Permar
Keyword(s):  
Systematic Review ◽  
Primary Infection ◽  
Vaccine Development ◽  
Transmission Rate ◽  
Systemic Review ◽  
Maternal Infection ◽  
Chronic Infections ◽  
Congenital Cytomegalovirus ◽  
Birth Prevalence ◽  
Maternal Immunity

Congenital cytomegalovirus (cCMV) is the leading non-genetic cause of sensorineural hearing loss (SNHL), and efforts are geared towards prevention through vaccine development. Transmission rates following primary maternal infection occur at rates of 30–40%, however reported placental rates upon non-primary maternal infection is reported to be less than <4%. There is significant debate about whether this reduction in transmission rate is due to pre-existing maternal immunity, which could identify possible immunologic targets for vaccines. To address this question, we performed a systemic review of the literature using Preferred Reporting Items for Systematic Review and Analysis (PRISMA) guidelines. We identified cohort studies in high CMV seroprevalent (>80%) areas or in developing regions that examined a cohort of at least 50 infants for congenital CMV acquisition. We identified 19 articles that met criteria and were further categorized based on pre-conception serology, maternal seroprevalence, or previously known seroprevalence. Birth prevalence rates ranged from 0.4% to 6% (median 1.1%), with the studies reporting on clinical outcome (16/19 studies) noting the majority of infected infants as asymptomatic. We also utilized a recent study that differentiated primary maternal infections from chronic infections in a highly seropositive population to calculate a placental transmission rate in women with pre-existing immunity compared to that of no pre-existing immunity. This work confirms a low cCMV birth prevalence in highly seropositive populations, indicates via a calculated placental transmission rate that the CMV placental transmission rate is lower in non-primary infection than that of primary infection, and reveals gaps in data for further research aiming to identify targets for vaccine development.

scholarly journals Human Cytomegalovirus Congenital (cCMV) Infection Following Primary and Nonprimary Maternal Infection: Perspectives of Prevention through Vaccine Development

Vaccines ◽  
2020 ◽  
Vol 8 (2) ◽  
pp. 194
Author(s):  
Giuseppe Gerna ◽  
Daniele Lilleri
Keyword(s):  
Human Cytomegalovirus ◽  
Subunit Vaccine ◽  
Vaccine Development ◽  
Maternal Infection ◽  
Major Step ◽  
Congenital Cytomegalovirus ◽  
Partial Protection ◽  
Correlates Of Protection ◽  
Immune Correlates ◽  
Hyperimmune Globulin

Congenital cytomegalovirus (cCMV) might occur as a result of the human cytomegalovirus (HCMV) primary (PI) or nonprimary infection (NPI) in pregnant women. Immune correlates of protection against cCMV have been partly identified only for PI. Following either PI or NPI, HCMV strains undergo latency. From a diagnostic standpoint, while the serological criteria for the diagnosis of PI are well-established, those for the diagnosis of NPI are still incomplete. Thus far, a recombinant gB subunit vaccine has provided the best results in terms of partial protection. This partial efficacy was hypothetically attributed to the post-fusion instead of the pre-fusion conformation of the gB present in the vaccine. Future efforts should be addressed to verify whether a new recombinant gB pre-fusion vaccine would provide better results in terms of prevention of both PI and NPI. It is still a matter of debate whether human hyperimmune globulin are able to protect from HCMV vertical transmission. In conclusion, the development of an HCMV vaccine that would prevent a significant portion of PI would be a major step forward in the development of a vaccine for both PI and NPI.

FEATURES OF THE CONGENITAL CMV INFECTION IN THE UNBORN AND NEWBORN INFANT

2007 ◽  
Vol 18 (3) ◽  
pp. 181-199 ◽  
Author(s):  
G BENOIST ◽  
Y VILLE
Keyword(s):  
Primary Infection ◽  
Transmission Rate ◽  
Sensorineural Deafness ◽  
Recurrent Infection ◽  
Maternal Infection ◽  
Cmv Infection ◽  
Live Births ◽  
Vertical Transmission Rate ◽  
Fetal Infection ◽  
Congenital Cmv Infection

Cytomegalovirus (CMV) is the most frequent cause of congenital viral infection,1with a prevalence of 0.5 to 1% of all live births, and the leading infectious cause of sensorineural deafness and mental retardation.1As otherHerpesviridae, CMV fetal infection can develop following both primary and recurrent maternal infection. Vertical transmission rate is around 30% following primary infection and 2 to 3% following recurrent infection.2Effects on the unborn as well as on the newborn are widely variable. It is estimated that only 5 to 10% of infected newborns have symptoms at birth, whereas around 90% of congenitally infected infants are asymptomatic although 5–15% of these infants will develop some degree of sensorineural hearing loss.3

scholarly journals Local, non-systemic, and minimally invasive therapies for calcinosis cutis: a systematic review

2021 ◽  
Author(s):  
Joanna Nowaczyk ◽  
Michał Zawistowski ◽  
Piotr Fiedor
Keyword(s):  
Systematic Review ◽  
Complete Remission ◽  
Minimally Invasive ◽  
Subcutaneous Tissue ◽  
Sodium Thiosulfate ◽  
Common Adverse Event ◽  
Chronic Infections ◽  
Level Of Evidence ◽  
Calcinosis Cutis ◽  
Extracorporeal Shock Wave

AbstractCalcinosis cutis is a deposition of calcium in the skin and subcutaneous tissue, often accompanied by pain, reduced mobility, and chronic infections. Limited evidence is available about the feasibility and efficacy of therapies alternative to systemic treatment and surgical excision, both of which often lead to unsatisfactory results or complications. We conducted a systematic review to evaluate the efficacy and safety of topical and intralesional sodium thiosulfate, extracorporeal shock-wave lithotripsy (ESWL), and laser for calcinosis cutis. PubMed, Embase, and Web of Science were searched. Reports of calciphylaxis and treatment combined with systemic medications were excluded. A total of 40 studies including 136 patients were analysed. Partial or complete remission after monotherapy was observed in 64% to 81% of cases. Self-applied topical sodium thiosulfate required patient’s adherence (mean treatment duration, 4.9 months; range 2–24). Laser therapy enabled complete remission of microcalcifications after a single procedure (57%; 12/21). ESWL and intralesional sodium thiosulfate injections decreased calcinosis-associated pain (median reduction in VAS score, 3; range 0–9 and 1; range 0–5, respectively). The most common adverse event was scarring and hyperkeratosis, observed after CO2 laser (56%; 10/18). Intralesional sodium thiosulfate injections caused transient pain in over 11% of patients. Recurrences within the follow-up were rare (2%; 3/136). This study provides an overview of minimally invasive and local therapies that in selected cases might transcend conventional treatment. The limitation of this study is the poor level of evidence, which emerges mainly from non-randomized studies at high risk of bias.

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