2023-06-27 17:43:11
Why is this important?
With approximately 1% of births affected, congenital cytomegalovirus infection is the most common infection in pregnant women worldwide. A literature review provides an update on the primary, secondary and tertiary prevention strategies already available that might mitigate the immediate and long-term consequences of this congenital infection.
Cytomegalovirus (CMV) is a DNA herpes virus of the Human Herpes virus 5 family. maternal age is advanced. In France, CMV infection affects 2.3% of pregnant women. When present, the main symptoms are similar to those of the flu or mononucleosis (mild fever, rhinitis, pharyngitis, headache, fatigue and liver problems). Congenital CMV is the leading cause of non-genetic sensorineural impairments in children, contributing to 10% of all cases of cerebral palsy in children. Overall 85% to 90% of infected newborns are asymptomatic. But 5% to 15% of them will develop late neurodevelopmental disorders or hearing loss. In the United States, 8,600 children per year are born infected with CMV with potential long-term complications compared to 1,000 for toxoplasmosis and 4,000 for trisomy 21.
Principle results
The main preventive strategy involves improving the knowledge of health professionals to better educate pregnant women. It is essential to increase the information and awareness of women of childbearing age regarding CMV and the risks of complications. Three studies carried out in France, Switzerland and Italy have shown that knowledge of CMV by pregnant women remains insufficient and lower than that which they may have concerning other congenital infections. For this, it is necessary to support the training of health professionals on the subject.
The following points are important to know:
Infection occurs mainly through sexual intercourse and close contact with young children. Transmission occurs through semen, cervical or vaginal secretions, saliva, urine, blood products. The risk of primary infection is greater for women expecting a second child or seronegative in their first pregnancy (20 times greater risk). The maternal-fetal transmission rate following reinfection is often described as low; for example, more than 70% of the Brazilian population would be positive, while the prevalence of congenital CMV infection would be only 1.1%. Hygiene measures remain the most effective prevention strategy, reducing by 4 or 5 the risk of primary infection during pregnancy: washing your hands following changing a baby’s dirty diaper, not sharing the same glass , the same spoon and fork with a child under 5 years old, do not kiss on the lips and avoid contact with nasal secretions or tears. Clinical diagnosis of maternal CMV infection is unreliable because subjects are symptomatic in only 8-10% of cases. Elisa tests are available to look for anti-CMV IgG and IgM. The specificity of the prediction of a recent primary infection is low (15-40%) which can easily lead to misinterpretation of the results. Serology makes it possible to specify the serological status of the mother or to reinforce the suspicion of a recent infection (<3 months). However, it remains difficult to establish a diagnosis of secondary infection. Recent technical improvements have increased the quality of serological tests, which is a strong argument for early universal screening in pregnant women or women planning a pregnancy. Estimation of the prognosis of the infected fetus and the proposal of prenatal treatment with valaciclovir might increase the chances of the fetus being asymptomatic at birth in the event of mild to moderate infection. The efficacy and safety of treatments currently available (valaciclovir) or to come (letermovir) as well as different types of vaccines that are in development must continue to be investigated. 1687889011 #remember #cytomegalovirus #pregnant #women