Neonatal screening for congenital cytomegalovirus infections
Department of Neonatology, Academisch Ziekenhuis, Free University of Brussels, Belgium. Journal of Perinatal Medicine
(Impact Factor: 1.36).
02/1999; 27(2):116-21. DOI: 10.1515/JPM.1999.015
We evaluated a screening program for the detection of congenital cytomegalovirus in 3075 unselected pregnant women. From each live-born child urine for CMV culture was collected within 7 days after birth. Each fetus expelled after a spontaneous second trimester abortion and each stillborn infant were also evaluated for a possible congenital CMV infection. For each congenital infection stored maternal sera were analysed to determine whether maternal infection was primary or recurrent. Fifteen out of the 3075 pregnancies studied resulted in a congenitally infected infant (0.49%). Nine maternal CMV infections were primary infections; five were recurrent infections, and in one case the type of infection could not be determined. Three congenital infections resulted in severe sequelae, leading to the termination of pregnancy in two instances and to neonatal death in one case. One of these severe fetal infections was due to a recurrent maternal infection. Follow-up of the other 12 neonates demonstrated hearing disorders in two children. One was born after a primary maternal infection and one after a recurrent maternal infection. We conclude that congenital CMV infections occurs in 0.49% of all pregnancies in the population studied. Twenty percent of the congenitally infected infants present severe sequelae at birth or during pregnancy, and an additional 17% have audiological deficits at 1 year of age. Severe sequelae may occur after both primary and recurrent maternal CMV infection.
Available from: Michel Segondy
- "These disorders are thought to be related to evolutive infraclinic encephalitis. Cases of severe pathology in neonates born to mothers who were seropositive before their pregnancy were regarded as exceptional (Ahlfors et al., 1981; Rutter et al., 1985); however, three recent American, Swedish and Belgian studies report that respectively 17, 26 and 40% of symptomatic congenital infections result from initially IgG seropositive (IgG + ) mothers (Boppana et al., 1999; Ahlfors et al., 1999; Casteels et al., 1999). The rareness of reinfection compared with reactivation is now put into question. "
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ABSTRACT: The hypothetical responsibility of sperm donation in cytomegalovirus (CMV) transmission to recipients and precautions to prevent this transmission are widely discussed. The aim of this French CECOS Federation study was to evaluate both the reality and the importance of the CMV risk due to donor sperm and the relevance of measures used to screen it.
We conducted a prospective multicentric study. CMV was detected by rapid and conventional cultures and by PCR in the frozen sperm of donors who met the normal criteria required of semen donors, irrespective of their CMV serological status.
635 samples from 231 donors (39.4% IgG(+)) were obtained and tested by culture; 551 samples from 197 donors were also tested by PCR. From those samples, 0.78% were culture(+), 1.57% culture(+) and/or PCR(+); 3.3% of seropositive donors and 0.72% of initially seronegative donors were culture(+), but in the latter seroconversion occurred during the quarantine period; of the 197 PCR-tested donors, 3.5% (6.2/1.7) were PCR(+), 3.3% (5.3/1.45) culture(+) and/or PCR(+). PCR(+) samples can be culture(-) and vice versa. The most strongly positive sample corresponded to an initially seronegative donor.
The best strategy to prevent potential CMV risk is to test donors for CMV IgG and IgM antibody at the outset and after a 6 month period of quarantine and to reject initially IgM seropositive donors or donors who seroconvert during the quarantine period.
Available from: humrep.oxfordjournals.org
- "Three recent studies attempted to evaluate the natural risk of symptomatic congenital disease and sequelae in newborns of CMV seropositive mothers. Although serological investigations in pregnant women were retrospective and a part of the maternal serological data was not available, respectively 17% of symptomatic congenital CMV infection in a US study (Boppana et al., 1999), 40% in a Belgian study (Casteels et al., 1999), and 26% in a Swedish study (Ahlfors et al., 1999) were attributed to a secondary infection of their mothers (mothers with pre-existing CMV IgG antibodies). Knowing the CMV seroprevalence, the incidence of congenital CMV infection and the percentage of symptomatic congenital infection attributed to secondary maternal infection in these populations , we could estimate the risk of symptomatic congenital CMV infection linked to a secondary CMV infection of the mother at being between 0.45 and 1.25/1000 seropositive woman/pregnancy. "
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ABSTRACT: The British Andrology Society recently recommended the exclusion of all cytomegalovirus (CMV) seropositive semen donors to
prevent the risk of congenital CMV infection. The recommendation is based on the results of recent studies that identified
a high percentage of symptomatic congenital CMV infections in newborns of women with CMV seropositivity pre-existing to pregnancy
and on the fact that CMV can be detected in semen of CMV seropositive men. These are not new data. CMV seropositive women
can infect their fetuses with their own latent CMV strain that can reactivate, or with an exogeneous strain that can be transmitted
to them by a sexual partner, but also by contacts, for example with an excreting child. The efficiency of these various ways
of transmission to the fetus and the factors that could influence this transmission are for the moment completely unknown.
An infectious virus is recovered by culture in the semen of <5% of CMV seropositive men. Exclusion of a large population of
donors on the sole criteria of a positive CMV serology introduces the general message that this part of the male population
is also not suitable as possible partners in couples who have no fertility problems. The problem of congenital infection in
neonates of CMV seropositive women is a complex one that has just begun to be investigated. No data exists concerning this
risk in the setting of assisted reproduction. We think that alternatives to the drastic BAS recommendation exist and should
be more deeply discussed.
Available from: w210.ub.uni-tuebingen.de
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