Congenital cytomegalovirus infection management; what is new?
Congenital Cytomegalovirus (CMV) infection is one of major public health concerns and one of the most frequent congenital infections worldwide. Congenital CMV infection is under-diagnosed in the majority of asymptomatic pregnant women due to its self-limited non-specific symptoms and unimplemented screening program. It also can go undetected at birth because in affected newborns are often asymptomatic; however, they manifest serious morbidities later in life. Primary CMV infections are associated with the highest in-utero transmission with estimated rates of 30–35% . Transmission occurs less frequently in secondary maternal infections at approximately 1.1–1.7%. There are growing evidences that early treatment with the antiviral therapy in newborns with congenital CMV infection can reduce sensorineural hearing loss (SNHL) and the substantial long-term neurodevelopmental disabilities. There is increased interest in establishing a prophylactic CMV vaccines that can protect seronegative mothers from primary infection and also to augment the immune response in seropositive women in order to prevent reactivation or re-infection. Saliva PCR assay can be used to screen newborns within the first 3 weeks of age instead of Dried blood spots (DBS), liquid-saliva PCR assay sensitivity is “100%” higher than DBS sensitivity “35%-100%" as not all infants have detectable viraemia at birth. Suggestive strategies to reduce the burden of congenital CMV disease and ensure better outcomes are; establishing a screening programme for pregnant mothers, developing prophylactic CMV vaccines, early therapeutic intervention in pregnant women and newborns and to replace DBS with Saliva PCR assay in screening newborns.