It’s time to talk about this silent virus

The silent transmission of cytomegalovirus (CMV) is a serious problem that requires attention.

About CMV

CMV is a common viral infection, infecting approximately 50% of the US population by age 40.1 CMV is in the herpes virus family along with human herpesviruses 6A, 6B and 7 and is similar to these viruses in that it may remain latent for years in infected people.1,2

Start a conversation to help
 stop transmission of CMV.

In the general population, primary CMV infections are usually asymptomatic or may cause a mild flu-like illness.1 Immunocompromised patients, such as transplant recipients, may develop more serious gastrointestinal, hepatic, neurologic, pulmonary, or ocular infections due to CMV.1,3 Congenital CMV (cCMV) infection, occurring through maternal transmission to the fetus, is the leading cause of severe birth defects in newborns in the United States.4

Despite its prevalence, awareness of CMV among women of child bearing age remains low.5 Whether your patients have children now or someday plan to, it is time to spread awareness and start a dialogue—because CMV is a virus all women should be informed about.

Approximately
30%
of women with primary CMV infection during pregnancy will deliver an infant with congenital CMV infection6

 

As few as
9%
of women have
heard of CMV5

The different clinical presentations
of CMV infection

CMV infections can be acquired in different settings. One commonality between all types of CMV
infection is how they are transmitted, which is through close person-to-person contact.1

1.
Primary CMV Infection7

Acute acquired CMV infection in which the majority of people will experience an inapparent infection.

2.
Reactivated CMV Infection1,8

Reactivation of an existing latent CMV infection in immunocompromised persons that can lead to severe illness.

3.
cCMV Infection1,9,10

Maternal transmission of
CMV to the fetus. This type of transmission almost always occurs with primary CMV infection during pregnancy or a reactivated CMV infection, being less common.

Signs and symptoms of primary CMV infection

Immunocompetent People

Immunocompetent people are generally able to control the infection. They may or may not experience one or more of the following symptoms:1

A graphic showing symptoms that immunocompetent people may or may not experience: fever, swollen glands, joint and muscle pain, mononucleosis-like fatigue, without presenting with a sore throat.
Immunocompromised People

Immunocompromised people, including those who recently had bone marrow or solid organ transplants, can develop serious consequences of a CMV infection including:3

A graphic showing possible consequences in immunocompromised people: encephalitis, CMV retinitis, hepatitis, gastrointestinal CMV.
Infants and Children

Newborns with cCMV infection may exhibit symptoms at birth including:11

A graphic showing symptom that newborns with CMV infection may exhibit at birth: microcephaly, jaundice, hearing loss, hepatosplenomegaly, petechiae.

Approximately 10%-15% of newborns with cCMV infection will have symptoms at birth or in early childhood. Although most infants with cCMV are asymptomatic at birth, they can go on to develop long-term neurodevelopmental disabilities.12

Long-term health conditions associated with cCMV:9

Hearing loss

Vision loss

Intellectual disabilities

Seizures

Lack of coordination/weakness

Immunocompetent people are generally able to control the infection. They may or may not experience one or more of the following symptoms:1

A graphic showing symptoms that immunocompetent people may or may not experience: fever, swollen glands, joint and muscle pain, mononucleosis-like fatigue, without presenting with a sore throat.

Immunocompromised people, including those who recently had bone marrow or solid organ transplants, can develop serious consequences of a CMV infection including:3

A graphic showing possible consequences in immunocompromised people: encephalitis, CMV retinitis, hepatitis, gastrointestinal CMV.

Newborns with cCMV infection may exhibit symptoms at birth including:11

A graphic showing symptom that newborns with CMV infection may exhibit at birth: microcephaly, jaundice, hearing loss, hepatosplenomegaly, petechiae.

Approximately 10%-15% of newborns with cCMV infection will have symptoms at birth or in early childhood. Although most infants with cCMV are asymptomatic at birth, they can go on to develop long-term neurodevelopmental disabilities.12

Long-term health conditions associated with cCMV:9

Hearing loss

Vision loss

Intellectual disabilities

Seizures

Lack of coordination/weakness

CMV diagnosis and management

Options for diagnosis vary based on clinical presentation.

  • Adults are diagnosed with IgG and IgM antibody tests3,15

  • Newborn babies are given saliva and urine tests1

Antivirals are the standard of care in patients who present with severe symptoms.

  • Healthy people diagnosed with CMV do not usually require treatment. Continue to monitor them for symptoms1

  • Newborn babies and the immunocompromised are treated with antivirals9

Investigational CMV vaccines that
are in clinical trials

Currently, there is no vaccine available to prevent CMV. However, many experts believe
that a vaccine to prevent congenital CMV infection may have an impact on child health.
CMV vaccines are currently being researched and developed right now.15-17

It is important to continue to raise awareness and help educate your patients on the risks of CMV and encourage that people follow proper hand hygiene guidelines to help prevent the spread of CMV.16

Additional resources

The following organizations offer additional information on CMV that may help you diagnose the infection
when you see it (and even when you do not).

CMV is always a cause for conversation with your patients. Now is the time to help break the silence.

Learn more about investigational Moderna CMV vaccines and clinical trials.

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References
1. 

About cytomegalovirus and congenital cmv infection. cdc.gov. Updated August 18, 2020. Accessed December 7, 2020. https://www.cdc.gov/cmv/overview.html

2. Dioverti MV, Razonable RR. Cytomegalovirus. Microbiol Spectr. 2016;4(4). doi: 10.1128/microbiolspec.DMIH2-0022-2015 PMID: 27726793.

3. Luscalov S, Loga L, Dican L, Junie LM. Cytomegalovirus infection in immunosuppressed patients after kidney transplantation. Clujul Med. 2016;89(3):343-346.

4. van Zuylen WJ, Hamilton ST, Naing Z, Hall B, Shand A, Rawlinson WD. Congenital cytomegalovirus infection: Clinical presentation, epidemiology, diagnosis and prevention. Obstet Med. 2014;7(4):140-146. doi:10.1177/1753495X14552719

5. Doutre SM, Barrett TS, Greenlee J, White KR. Losing ground: awareness of congenital cytomegalovirus in the United States. J Early Hear Detect Interv. 2016;1(2):39–48. doi: 10.15142/T32G62

6. Kenneson A, Cannon MJ. Review and meta-analysis of the epidemiology of congenital cytomegalovirus (CMV) infections. Rev Med Virol. 2007;17:253–276.

7. Davis NL, King CC, Kourtis AP. Cytomegalovirus infection in pregnancy. Birth Defects Res. 2017;109(5):336–346. doi: 10.1002/bdra.23601 PMID: 28398680.

8. Effros RB. The silent war of CMV in aging and HIV infection. Mech Ageing Dev. 2016;158:46–52. doi: 10.1016/j.mad.2015.09.003 Epub 2015 Sep 25. PMID: 26404009; PMCID: PMC4808485.

9. CMV fact sheet for pregnant women and parents. cdc.org. Updated September 2018. Accessed December 7, 2020. https://www.cdc.gov/cmv/fact-sheets/parents-pregnant-women.html

10. Babies Born with Congenital Cytomegalovirus (CMV). cdc.gov. Updated August 18, 2020. Accessed December 29, 2020. https://www.cdc.gov/cmv/congenital-infection.html

11. Demmler-Harrison GJ. Congenital cytomegalovirus infection: clinical features and diagnosis. In: UpToDate, Armsby C (ED), UpToDate, Waltham, MA, 2020.

12. James SH, Kimberlin DW. Advances in the prevention and treatment of congenital cytomegalovirus infection. Curr Opin Pediatr. 2016;28(1):81-85. doi: 10.1097/MOP.0000000000000305

13. Pass R, Anderson B. Mother-to-child transmission of cytomegalovirus and prevention of congenital infection. J Pediatric Infect Dis Soc. 2014;3(Suppl 1):S2-S6. doi:10.1093/jpids/piu069

14. CMV clinical features for healthcare professionals. cdc.gov. Updated August 18, 2929. Accessed December 7, 2020. https://www.cdc.gov/cmv/index.html

15. Bardanzellu F, Fanos V, Reali A. Human breast milk-acquired cytomegalovirus infection: certainties, doubts and perspectives. Curr Pediatr Rev. 2019;15(1):30-41.

16. Cannon MJ, Davis, KF. Washing our hands of the congenital cytomegalovirus disease Epidemic. BMC Public Health. 2005;5:70 doi:10.1186/1471-2458-5-70

17. Plotkin SA, Boppana SB. Vaccination against the human cytomegalovirus. Vaccine. 2019;(37):7437-7442.