The effect of valacyclovir on secondary prevention of congenital cytomegalovirus infection, following primary maternal infection acquired periconceptionally or in the first trimester of pregnancy. An individual patient data meta-analysis

Prenatal Screening for CMV Primary Infection: A Cost-Utility Model

OBJECTIVE

Congenital cytomegalovirus (CMV) infection is a major cause of deafness and neurodevelopmental disability in children. Our objective was to assess the cost utility of first-trimester serological CMV screening, compared to screening of high-risk pregnancies and no serological screening.

DESIGN

A decision-analytic model was created to compare the cost utility of three strategies from a healthcare sector perspective: universal first-trimester serological screening, screening only of high-risk pregnant women (both including antiviral prophylaxis in cases of primary infection) and serological testing triggered by foetal morphological ultrasound (no CMV serological screening).

SETTING

Canada.

POPULATION

Hypothetical population of 80 000 pregnant women.

METHODS

Probability, expected values and cost estimates were derived from published literature and local hospital and national insurance data.

MAIN OUTCOME MEASURE

Cost per maternal and infant quality-adjusted life year (QALY) lost.

RESULTS

Universal serological screening was superior to both screening of high-risk women and no screening (utility of -0.42, -0.63 and - 0.87 QALY lost, respectively). Sensitivity analysis demonstrated that universal screening was the most cost-effective strategy regardless of the incidence of primary infection, the acceptability of amniocentesis and the efficacy of antiviral prophylaxis. In the Monte Carlo analyses, universal serological screening was the most cost-effective option in 96.36% of simulations. Universal serological screening would allow detection of 152 cases of primary maternal CMV infection and would prevent 29 cases of congenital CMV infection annually.

CONCLUSION

Our findings support the adoption of a population-based prenatal screening programme for the prevention of congenital CMV infection.

Awareness and knowledge of cytomegalovirus infection among pregnant women in French-speaking Switzerland

BACKGROUND

In Switzerland, cytomegalovirus (CMV) is the most common congenital infection, affecting more than 400 newborns per year. It is also the leading non-genetic cause of neurosensory impairment in children. The aims of this study were to assess the awareness, general knowledge and knowledge of hygiene measures related to CMV among pregnant women in French-speaking Switzerland, as well as identify baseline characteristics potentially associated with a better knowledge of CMV.

METHODS

A regional cross-sectionnal study carried out in French-speaking Switzerland between May and December 2022, using a 36-item questionnaire available through a QR code.

RESULTS

The majority of pregnant women surveyed, 61.6% (514/834), had already heard about CMV. Half the participants (50.4%, 375/743) knew how to protect themselves against this infection. Only 7.2% (60/834) were aware of all the consequences of congenital CMV infection in newborns, and only 1.2% (10/834) knew all the general facts about this virus (transmission, screening, treatment, fetal and maternal risks). An education above secondary level and having a high-risk profession (daycare of healthcare providers) appeared to be factors independently associated with greater awareness and knowledge of CMV, and of the hygiene measures to protect against it. Having been followed by a midwife (only or in addition to an obstetrician) was also associated with a greater knowledge of the virus, and age over 30 and being multiparous were also factors independently associated with a better knowledge of hygiene measures to adopt against CMV.

CONCLUSION

Awareness of CMV among pregnant women appears to have improved since a previous study conducted in Geneva in 2015. While knowledge of preventive measures among participants was insufficient to ensure comprehensive protection against CMV infection, it represents a significant improvement compared to previous studies. Further efforts are needed to enhance this knowledge to maximize its potential impact on prevention behaviors.

[Secondary Prevention of Fetal Cytomegalovirus Infection Through Valacyclovir Administration in Maternal Primary Infections During the Periconceptional Period and First Trimester of Pregnancy]

OBJECTIVES

Oral administration of valacyclovir at 8g/day significantly reduces the rate of vertical transmission of CMV in women with a primary CMV infection acquired during the periconceptional period or the first trimester. The aim of this study is to expand the findings of previously published studies by including all recent cohorts on the subject.

METHODS

The MEDLINE, Scopus, Cochrane Central Register of Controlled Trials (Central), and "clinical trial" registry (www.

CLINICALTRIALS

gov) were consulted. Randomized controlled trials and cohort studies administering oral valacyclovir at 8g/day to pregnant women with a primary CMV infection acquired during the periconceptional period or the first trimester were included. Cochrane's Risk of Bias 2 and ROBINS-I tools were used to assess the risk of bias. The result of the CMV PCR in the amniotic fluid was the primary outcome. A two-step individual patient data meta-analysis was conducted, and a subgroup analysis was performed, evaluating periconceptional and first-trimester infections separately.

RESULTS

Four studies (1 RCT and 3 cohorts) were included in the analysis (n=860 women). A significant reduction in the rate of the CMV vertical transmission was observed in the Valacyclovir group (aOR=0.39, 95% CI 0.25-0.59). This reduction was significant for both the periconceptional period (aOR=0.30, 95% CI 0.13-0.68) and the first trimester (aOR=0.47, 95% CI 0.28-0.78). Valacyclovir also reduced the rate of neonatal infections, aOR=0.45 (95% CI 0.25-0.83), for both periods considered (aOR=0.42, 95% CI 0.20-0.90, and aOR=0.54, 95% CI 0.29-0.99).

CONCLUSIONS

The current evidence suggests that oral valacyclovir (8g/day) is associated with reduction of the rate of vertical transmission of CMV following maternal primary infection acquired during the periconceptional period or the first trimester of pregnancy.

Quantification of maternal and fetal valaciclovir exposure in a pharmacokinetic study of cytomegalovirus-infected pregnant women treated to prevent vertical transmission

BACKGROUND

In cases of maternal primary infection with cytomegalovirus (CMV-MPI) maternal treatment with oral valaciclovir 8 g/day has been shown to reduce the risk of fetal infection. The pharmacological profile of this high dosage during pregnancy is not yet known.

OBJECTIVES

To quantify maternal-fetal exposure to valaciclovir 8 g/day in a population pharmacokinetic (popPK) study.

METHODS

Between October 2019 and April 2023, pregnant women referred for CMV-MPI were offered to participate following: (i) CMV-MPI <14 weeks of gestation; (ii) acceptance of valaciclovir 8 g/day; and (iii) consent for amniocentesis. Amniotic fluid was tested for (i) CMV PCR for prenatal diagnosis; and (ii) dosage of aciclovir concentration (the active form of valaciclovir). Maternal serum levels of aciclovir were also measured. Aciclovir assays in both compartments were used for popPK analysis. Pharmacokinetics were described using non-linear mixed-effect modelling.

RESULTS

We prospectively included 119 women with their 122 fetuses. CMV-MPI occurred at a median of 3.0 (range: -12; + 14) weeks of gestation. CMV-infected pregnant women were treated at a median of 12.3 (range: 4.6-21.4) weeks of gestation for a median duration of 35 days (range: 7-90 days). Median pharmacokinetic parameters (Cmin, Cmax and AUC0-24) were all successfully defined in both maternal blood and amniotic fluid compartments. No differences in aciclovir exposure were observed between infected (n = 12, 9.8%) and non-infected fetuses. Simulations showed that after a last maternal dose, aciclovir concentration would be undetectable in the amniotic fluid after 43-47 h.

CONCLUSIONS

In this popPK study, maternal and fetal pharmacokinetics were established using in vivo data. The results provide a better understanding of how this fetal therapy works.

Evaluation and Management of Congenital Cytomegalovirus Infection

The purpose of this review is to serve as an update on congenital cytomegalovirus (CMV) evaluation and management for obstetrician-gynecologists and to provide a framework for counseling birthing people at risk for or diagnosed with a primary CMV infection or reactivation or reinfection during pregnancy. A DNA virus, CMV is the most common congenital viral infection and the most common cause of nongenetic childhood hearing loss in the United States. The risk of congenital CMV infection from transplacental viral transfer depends on the gestational age at the time of maternal infection and whether the infection is primary or nonprimary. Although the risk of congenital CMV infection is lower with infection at earlier gestational ages, clinical sequelae are more severe with maternal infections earlier in gestation. At present, routine screening for maternal CMV infection is not recommended by U.S. guidelines. When maternal primary infection is confirmed in early pregnancy, emerging data support consideration of maternal antiviral therapy to prevent congenital CMV infection. When congenital CMV infection is confirmed, typically after an abnormal prenatal ultrasound result, there are more limited data on the utility of maternal antiviral therapy. Universal newborn screening for congenital CMV infection is not mandatory in most U.S. states at present. Newborns diagnosed with congenital CMV infection undergo an extensive evaluation to determine whether neurologic symptoms are present, which guides postnatal evaluation and management. In this review, we discuss the diagnosis and management of maternal CMV infection, the risk and diagnosis of congenital CMV infection, prevention and potential treatment of congenital CMV infection in utero, and neonatal congenital CMV infection diagnosis and management.

Diagnosis and management of congenital Cytomegalovirus: Critical Appraisal of Clinical Practice Guidelines

OBJECTIVES

To review the currently available Clinical Practice Guidelines regarding the diagnosis and management of Cytomegalovirus (CMV) infection in pregnancy.

METHODS

Medline, Turning Research into Practice (TRIP), Web of Science databases and scientific societies' websites were searched electronically up to April 2024. We included national and international Clinical Practice Guidelines regarding diagnosis, treatment and follow-up of CMV infection in pregnancy, published in English language. Quality assessment of the included guidelines was performed using the Appraisal of Guidelines for Research and Evaluation (AGREE) II tool.

RESULTS

Ten Clinical Practice Guidelines and two expert consensus statements were included. The review showed agreement among national and international guidelines about the diagnostic criteria for primary maternal CMV infection and about the gold standard for confirmation of fetal infection. Regarding treatment, only two societies recommended routine administration of Valaciclovir in case of primary infection in the clinical practing setting. Fetal surveillance including ultrasound and magnetic resonance imaging (MRI) in case of confirmed infection was found to be heterogeneous among the recommendations.

CONCLUSIONS

Although consensus was obtained regarding the diagnostic criteria for primary CMV infection in pregnancy, there was heterogeneity among Clinical Practice Guidelines with regards to other aspects of clinical management of CMV in pregnancy. In addition, some topics where not addressed in the current guidelines, including the treatment of non-confirmed fetal infection and the management of non-primary maternal infection. Recommendations regarding prevention of congenital CMV are rapidly evolving based on the new available evidence.

Universal screening and valacyclovir for first trimester primary cytomegalovirus: a cost-effectiveness analysis

BACKGROUND

Universal prenatal screening for cytomegalovirus is not currently recommended in the United States, as no effective interventions have previously been available. With growing evidence that treating maternal first trimester primary cytomegalovirus infections with valacyclovir reduces vertical transmission, universal screening may become an important tool in congenital cytomegalovirus prevention.

OBJECTIVE

This study examined the cost-effectiveness of a universal screening approach for maternal cytomegalovirus in the first trimester of pregnancy followed by valacyclovir treatment in positive cases for prevention of the sequelae of congenital cytomegalovirus.

STUDY DESIGN

A decision-analytic model was constructed to compare outcomes of universal screening and subsequent valacyclovir treatment in a theoretical cohort of 2,869,141 individuals, the estimated number of pregnant people in the United States who receive prenatal care by the first trimester. Individuals found to be immunoglobulin G positive, immunoglobulin M positive, and to have low immunoglobulin G avidity were considered to have primary cytomegalovirus infection and received valacyclovir. Outcomes included cases of vertical cytomegalovirus transmission, abortions, stillbirths, neonatal deaths, cases of hearing loss, cases of neurodevelopmental disabilities, costs, and quality-adjusted life years. Model inputs were derived from literature. Sensitivity analyses were performed via tornado analysis, univariable sensitivity analysis, and multivariable sensitivity analysis with Monte Carlo simulation.

RESULTS

In our study, universal screening in the first trimester for primary cytomegalovirus and subsequent treatment with valacyclovir in positive cases decreased adverse outcomes by preventing 2898 vertical transmissions, 94 abortions, 19 stillbirths, 11 neonatal deaths, 460 cases of hearing loss, and 263 cases of neurodevelopmental disability. Universal screening and subsequent treatment was the dominant strategy as it saved 242.2 million dollars and led to 3437 additional quality-adjusted life years. Tornado analysis demonstrated that there were no threshold values which would change the model results, when all variables were varied across a predetermined range. Univariable sensitivity analyses demonstrated that even with decreasing specificity of screening tests, decreasing maternal utility of neonatal hearing loss, and increasing the price of screening up to 17 times the current cost, universal screening remained the cost-effective strategy. Monte Carlo analysis demonstrated that the screening strategy remained cost-saving in 100% of trials.

CONCLUSION

Our results demonstrate that screening for first trimester primary cytomegalovirus may be a cost-saving intervention, as identification of cases allows for the provision of treatment, which in turn reduces vertical cytomegalovirus transmission and costly sequelae.

Emerging concepts of CMV in transplantation

Cytomegalovirus (CMV) infections continue to be associated with significant morbidity and mortality following solid organ transplantation and haemopoietic stem cell transplantation. Advances in understanding the biology of CMV in the immunosuppressed host will translate into improved management approaches and better clinical outcomes. Updated definitions of resistant and refractory CMV infections will lead to more consistent reporting of CMV outcomes, better inform appropriate antiviral strategies and influence clinical trial design. Improved knowledge of the immunological control of CMV in the immunosuppressed host has led to novel diagnostics, emerging therapeutic cellular therapies and the development of an informed rationale for prophylactic and pre-emptive strategies. As the boundaries of transplantation are extended, new patterns of CMV infection are being recognised. Finally, recent studies support the use of novel antiviral therapies in transplant recipients in the appropriate clinical setting. In this review, we provide an update on important new and emerging concepts in the management of CMV in immunosuppressed transplant recipients.

Screening frequency for congenital cytomegalovirus in Flanders, Belgium - a multicentre retrospective study

OBJECTIVE

This study investigates the screening practices for congenital cytomegalovirus (cCMV) in Flanders, Belgium, with the aim of determining the frequency of neonatal screening and the number of diagnoses resulting from it.

METHODS

Flemish hospitals with maternity facilities were asked for data on the number of infants screened for cCMV (PCR-CMV on saliva or urine), and diagnosed with cCMV (positive PCR-CMV on urine before the age of 3 weeks). Screening and diagnosis rates were compared across geographic regions and screening policies. We defined that at least 3% of neonates should be screened, given the prevalence of common screening indications (i.e. microcephaly and IUGR), and evaluated whether the empirical incidence of cCMV (0.5%) was approached.

RESULTS

Fifty of 57 eligible hospitals participated. Overall, 1.65% of infants were screened and 0.12% were diagnosed with cCMV. Few hospitals screened 3% or more of infants (14/50), and measured an incidence of 0.5% or more (6/50). Hospitals using targeted screening policies conducted fewer screenings (median 1.5% vs 94.2%, p < 0.001) and diagnosed fewer infants (median 0.10% vs 0.54%, p < 0.001) compared to hospitals that screened universally.

CONCLUSION

There was important variability in cCMV screening practices across Flanders. Most hospitals screened fewer than 3% of infants, i.e. lower than the prevalence of microcephaly, a clinical feature that warrants testing for cCMV. Failure to diagnose cCMV in a timely manner limits the opportunities for early treatment with valganciclovir (secondary prevention) and morbidities such as hearing loss (tertiary prevention). There is a pressing need to enhance the knowledge and vigilance of perinatal healthcare professionals in Flanders, ensuring infants at risk of cCMV are appropriately identified and receive timely care.

Prenatal and postnatal antiviral therapies for the prevention and treatment of congenital cytomegalovirus infections

PURPOSE OF REVIEW

Congenital cytomegalovirus infection (cCMV) is the leading infectious cause of sensorineural hearing loss and lifelong neurodevelopmental disabilities. Studies suggest antiviral therapy can prevent fetal infection after maternal primary infection, as well as halt the progression of hearing loss and neurodevelopmental disabilities in newborns with symptomatic cCMV. With growing worldwide momentum on early detection and diagnosis of cCMV, this review describes the exciting recent advances in antiviral therapies in CMV infected pregnant mothers and babies, as well as emerging evidence on anti-CMV vaccines.

RECENT FINDINGS

New opportunities for prenatal and neonatal interventions have driven a rising interest in screening and identification of asymptomatic CMV infection. Routine screening of pregnant women to identify primary infection in first trimester is now advocated in Western Europe but has yet to be examined from a public health perspective in other regions. Evidence is emerging for maternal valaciclovir therapy to prevent fetal infection after a maternal primary CMV infection in the first trimester of pregnancy. For those infants who are born with symptomatic cCMV, a 6-month course of valganciclovir, started within the first 4 weeks of life, and possibly up to 13 weeks of life, is the current recommended therapy. However, there is unclear evidence for the benefit of treatment for asymptomatic cCMV and cCMV with isolated hearing loss. Research to identify more effective antivirals and an effective CMV vaccine continues.

SUMMARY

More research is needed to determine the region-specific applicability of the new European recommendations for routine CMV screening in pregnancy. Areas of uncertainty in postnatal management include timing of initiation, duration of treatment and identifying pediatric subgroups that benefit from modification of the standard treatment recommendations.

Auditory and Vestibular Involvement in Congenital Cytomegalovirus Infection

Congenital cytomegalovirus infection (cCMV) is a frequent cause of non-hereditary sensorineural hearing loss (SNHL) and developmental disabilities. The contribution of cCMV to childhood hearing loss has been estimated to be about 25% of all hearing loss in children at 4 years of age. Although the vestibular insufficiency (VI) in cCMV has not been well-characterized and therefore, underestimated, recent studies suggest that VI is also frequent in children with cCMV and can lead to adverse neurodevelopmental outcomes. The pathogenesis of SNHL and VI in children with cCMV has been thought to be from direct viral cytopathic effects as well as local inflammatory responses playing a role. Hearing loss in cCMV can be of varying degrees of severity, unilateral or bilateral, present at birth or develop later (late-onset), and can progress or fluctuate in early childhood. Therefore, newborn hearing screening fails to identify a significant number of children with CMV-related SNHL. Although the natural history of cCMV-associated VI has not been well characterized, recent data suggests that it is likely that VI also varies considerably with respect to the laterality, timing of onset, degree of the deficit, and continued deterioration during early childhood. This article summarizes the current understanding of the natural history and pathogenesis of auditory and vestibular disorders in children with cCMV.

Progress and Challenges in the Management of Congenital Cytomegalovirus Infection

Congenital cytomegalovirus (CMV) infection is the most common intrauterine viral infection with a significant impact on the foetus and newborn. Current diagnostic practice includes serological testing for specific antibodies, but there are no global screening protocols. Maternal CMV screening is often performed in conjunction with antenatal ultrasound. While most infections are asymptomatic, severe cases can lead to long-term disability or death. Antiviral therapies, mainly ganciclovir and valganciclovir, are reserved for symptomatic patients, especially those with central nervous system involvement. Although effective, these treatments are associated with significant side effects such as neutropenia and hepatotoxicity. Foscarnet and cidofovir are used as alternatives, but their efficacy and safety require further study in paediatric patient populations. The effectiveness of passive prophylaxis is still uncertain. The lack of universally accepted guidelines for diagnosis, treatment, and prevention and the risk of serious side effects highlight the need for continued research. This review evaluates current therapeutic strategies, discusses their efficacy and associated risks, and highlights the need for innovative approaches to improve outcomes for affected neonates.

Proceedings of the Conference "CMV Vaccine Development-How Close Are We?" (27-28 September 2023)

Congenital cytomegalovirus (cCMV) is the most common infectious cause of disability in children, including sensorineural hearing loss. There is interest in developing a pre-conception vaccine that could confer protective immunity on a woman of child-bearing age, hence resulting in a reduced cCMV disease burden. Other populations, including solid organ transplant (SOT) and hematopoietic stem cell transplant (HSCT) patients, could also benefit from CMV vaccination. To review and discuss vaccines that are in clinical development, a workshop, sponsored by the National Institutes of Health (NIH) and the National Institute of Allergy and Infectious Diseases (NIAID), was empaneled. At this workshop, correlates of protective immunity against CMV, epidemiologic features of CMV transmission, and vaccine platforms in development were reviewed. Representatives from academia, pharma, and the NIH engaged in discussion on the current state-of-the-art in CMV vaccinology. A summary of the presentations from this is provided in this report.

Congenital Cytomegalovirus Severity Definitions and Treatment Decisions around the World: A Systematic Scoping Review of the Literature

Congenital cytomegalovirus (cCMV) is the most common cause of congenital infection and the leading cause of non-genetic sensorineural hearing loss in childhood. While treatment trials have been conducted in symptomatic children, defining asymptomatic infection can be complex. We performed a scoping review to understand how infection severity is defined and treated globally, as well as the various indications for initiating treatment. We conducted an electronic search of MEDLINE, EMBASE, Scopus, and the Cochrane Library, using combinations of the following terms: "newborn", "baby", "child", "ganciclovir", "valganciclovir", and "cytomegalovirus" or "CMV". We included eligible prospective and retrospective studies, case series, and randomized clinical trials (RCTs) published up to May 2024. A total of 26 studies were included, of which only 5 were RCTs. There was significant heterogeneity between studies. The most commonly considered criteria for symptomatic infection were microcephaly (23/24 studies), abnormal neuroimaging (22/24 studies), chorioretinitis/ocular impairment (21/24 studies), and hearing impairment (20/24 studies). Two studies also included asymptomatic newborns in their treatment protocols. Outcome measures varied widely, focusing either on different hearing assessments or neurocognitive issues. Our literature analysis revealed significant variability and heterogeneity in the definition of symptomatic cCMV infection and, consequently, in treatment approaches. A consensus on core outcomes and well-conducted RCTs are needed to establish treatment protocols for specific groups of newborns with varying manifestations of cCMV.

Is valacyclovir being used for cytomegalovirus infection during pregnancy?

Valacyclovir use in 10% of pregnancies with cytomegalovirus infection in this US cohort was likely for genital herpes treatment.

In utero treatment of congenital cytomegalovirus infection with valganciclovir: an observational study on safety and effectiveness

BACKGROUND

The treatment of congenital cytomegalovirus (CMV) infection is usually administered to neonates after birth; however, it can be anticipated during the prenatal period by treating pregnant women in order to reduce the severity of the congenital disease. The most commonly used treatment for CMV during pregnancy is valaciclovir; however, valganciclovir has a higher potency against CMV and is the first choice for neonates with congenital CMV disease.

OBJECTIVES

We investigated neonatal and maternal safety of tertiary prevention in infected fetuses showing ultrasound features of infection using valganciclovir.

METHODS

Retrospective cohort study of pregnant women and their symptomatic infected fetuses taking valganciclovir, 3 × 450 mg per day. All fetuses presented at least one prenatal feature on ultrasound. We assessed fetal/neonatal and maternal safety, as well as neonatal efficacy of treatment. The main outcome was neutropenia. Secondary outcomes included other haematological side effects, symptoms at birth and neonatal CMV-PCR was positive.

RESULTS

Seventeen women with singleton pregnancies received valganciclovir from a median (IQR) of 27.1 (26.0-30.3) to 11.6 (6.5-12.9) weeks of gestation. No neonatal neutropenia was reported. One pregnancy was terminated for severe features. Three newborns (18%) were asymptomatic at birth, including one with negative CMV-PCR from blood and saliva. CMV-PCR was positive for 12/13 symptomatic newborns, with a median (IQR) log10 viral load of 3.36 (3.30-4.20), 4.03 (1.75-4.27) and 3.04 (0.00-3.40) log10 copies/mL in blood, urine and saliva, respectively.

CONCLUSIONS

Tertiary prevention by valganciclovir appears to be well tolerated for both fetus and mother. However, more extensive trials accompanied by long-term follow-up are needed.

Burden of Congenital CMV Infection: A Narrative Review and Implications for Public Health Interventions

Cytomegalovirus causes the most common congenital infection worldwide. With most infants asymptomatic at birth, the few affected may present with variable clinical scenarios, from isolated hearing loss to severe neurologic impairment. Public health interventions include all actions at the health system, community, and individual levels that aim at reducing the burden of congenital Cytomegalovirus. This review examines the literature on maternal and neonatal screening programs in light of current evidence for treatment and the development of vaccines against Cytomegalovirus. Potential biases and benefits of these interventions are outlined, with the objective of increasing awareness about the problem and providing readers with data and critical tools to participate in this ongoing debate.

[Implementation of screening for cytomegalovirus congenital infection in a French type 3 maternity]

OBJECTIVES

Congenital cytomegalovirus (CMV) infection is the most common congenital infection and the leading cause of infectious neurosensorial disability in newborns. We wanted to organize the management of women from the beginning of pregnancy allowing access to antenatal treatment with valaciclovir, recognized since 2020 as limiting materno-fetal transmission. To this end, we set up and evaluated the interest of systematic screening for CMV infection in our maternity. We wanted to organize care for women from the very start of pregnancy.

METHODS

Retrospective and comparative descriptive study carried out at the CHRU de Limoges from July 2017 to December 2019 (targeted screening), then from January 2020 to June 2022, during which period we implemented systematized screening by iterative serologies at the 3rd, 6th, 8th months and before delivery. Our main evaluation criteria were the seroprevalence of CMV infection and the rate of congenital infection. We then described our cases of infection (primary or secondary) during pregnancy.

RESULTS

CMV seroprevalence in our pregnant women increased significantly from 52.7% (779/1478 women screened) to 58.4% (3852/6599 women screened) between the 2 study periods (P=0.04). We diagnosed 11 infections during the first part of the study vs. 27 during the second, with a significant increase in primary infections from 0.14% (9/6524 births) to 0.37% (24/6426 births) (P=0.008). Only 3 secondary infections were diagnosed during the second study period. The rate of congenital infections remained stable between the 2 study periods (6 children/6524=0.09% vs. 8 children/6426=0.12%; P=0.57).

CONCLUSION

Our results confirmed the interest of screening for CMV infection, while modifying the screening strategy we had initiated.

Consensus recommendation for prenatal, neonatal and postnatal management of congenital cytomegalovirus infection from the European congenital infection initiative (ECCI)

Congenital cytomegalovirus (cCMV) infection carries a significant burden with a 0.64% global prevalence and a 17-20% chance of serious long-term effects in children. Since the last guidelines, our understanding, particularly regarding primary maternal infections, has improved. A cCMV guidelines group was convened under the patronage of the European Society of Clinical Virology in April 2023 to refine these insights. The quality and validity of selected studies were assessed for potential biases and the GRADE framework was employed to evaluate quality of evidence across key domains. The resulting recommendations address managing cCMV, spanning prevention to postnatal care. Emphasizing early and accurate maternal diagnosis through serological tests enhances risk management and prevention strategies, including using valaciclovir to prevent vertical transmission. The guidelines also strive to refine personalized postnatal care based on risk assessments, ensuring targeted interventions for affected families.

Awareness of Pregnant Patients about Congenital Cytomegalovirus Infection-A Semi-Systematic Review

Background: Cytomegalovirus (CMV) infection represents a major issue worldwide, since it constitutes the most common viral congenital infection, with a prevalence of 0.58% and 1-5% in developed and developing countries, respectively. According to recent studies, prenatal treatment significantly decreases the risk of vertical CMV transmission, and early intervention may even prevent the termination of pregnancy. This study aimed to investigate the level of awareness of CMV among pregnant patients through a semi-systematic review. Methods: We included all of the original articles investigating knowledge and awareness about CMV infection among pregnant women. Our research included the PubMed database. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement, the Covidence system automatically guided us to screen the titles and/or abstracts, and then full-texts, followed by data extraction from the eligible studies. Results: We screened 764 studies altogether, with 13 studies included in this analysis. Knowledge about the existence of CMV infection risk varied between the articles, ranging from 11.4% in a study performed in Ireland to 60% reported in a study on the French population. Studies analyzing the impact of educational interventions on patients' knowledge about preventive measures reported significant improvement compared to their level of awareness before the intervention. Conclusions: Patients' awareness and knowledge about CMV seemed to be generally low or very low during the last decade before the development of effective secondary prevention methods. Educational interventions seem to be effective, and therefore their wide use could be of potential benefit. In the era of available secondary prevention of vertical transmission, it is crucial to concentrate the efforts of different stakeholders to increase the awareness of cCMV among pregnant women.

Performance of eight commercial immunoassays for the detection of cytomegalovirus-specific IgM antibodies in pregnancy - no test fits all needs

Detection of cytomegalovirus (CMV)-specific immunoglobulin M (IgM) antibodies as first-line serologic diagnosis plays an important role in identifying CMV primary infection during pregnancy. The performance characteristics of eight commercially available CMV IgM assays were compared. Sensitivity and IgM antibody kinetics were assessed using 100 acute phase and follow-up sera from 39 pregnant women with a well-defined onset of CMV primary infection. Specificity was analyzed using 50 well-characterized serum samples from pregnant women not infected or latently infected with CMV and from patients with other acute infections. Until 12 weeks after the onset of primary infection, four assays showed sensitivities of 100%, whereas the others had individual gaps to detect all primary infections in this time period. All assays showed a time-dependent decrease of IgM levels. More than 12 weeks after the onset of infection, the IgM-positive rates varied considerably between tests. The specificity was between 92% and 98% in all but one assay. The observed differences in the performance characteristics must be taken into account in CMV screening and diagnosis of primary infection during pregnancy.