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Izquierdo G, Guerra C, Reyes R, Araya L, Sepulveda B, Cabrera C, Medina P, Mardones E, Villavicencio L, Montecinos L, Tarque F, Acevedo W, Barraza M, Farfán M, Mendez J, Torres JP. Universal and Expanded Screening Strategy for Congenital Cytomegalovirus Infection: Is Pool Testing by a Rapid Molecular Test in Saliva a New Choice in Developing Countries? Viruses 2024; 16:772. [PMID: 38793653 PMCID: PMC11125597 DOI: 10.3390/v16050772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 05/08/2024] [Accepted: 05/10/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND Several screening strategies for identifying congenital CMV (cCMV) have been proposed; however, the optimal solution has yet to be determined. We aimed to determine the prevalence of cCMV by universal screening with saliva pool testing and to identify the clinical variables associated with a higher risk of cCMV to optimize an expanded screening strategy. METHODS We carried out a prospective universal cCMV screening (September/2022 to August/2023) of 2186 newborns, analyzing saliva samples in pools of five (Alethia-LAMP-CMV®) and then performed confirmatory urine CMV RT-PCR. Infants with risk factors (small for gestational age, failed hearing screening, HIV-exposed, born to immunosuppressed mothers, or <1000 g birth weight) underwent expanded screening. Multivariate analyses were used to assess the association with maternal/neonatal variables. RESULTS We identified 10 infants with cCMV (prevalence: 0.46%, 95% CI 0.22-0.84), with significantly higher rates (2.1%, 95% CI 0.58-5.3) in the high-risk group (p = 0.04). False positives occurred in 0.09% of cases. No significant differences in maternal/neonatal characteristics were observed, except for a higher prevalence among infants born to non-Chilean mothers (p = 0.034), notably those born to Haitian mothers (1.5%, 95% CI 0.31-4.34), who had higher odds of cCMV (OR 6.82, 95% CI 1.23-37.9, p = 0.04). Incorporating maternal nationality improved predictive accuracy (AUC: 0.65 to 0.83). CONCLUSIONS For low-prevalence diseases such as cCMV, universal screening with pool testing in saliva represents an optimal and cost-effective approach to enhance diagnosis in asymptomatic patients. An expanded screening strategy considering maternal nationality could be beneficial in resource-limited settings.
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Affiliation(s)
- Giannina Izquierdo
- Department of Pediatrics, Faculty of Medicine, University of Chile, Santiago 8820808, Chile
- Neonatal Intensive Care Unit, Hospital Barros Luco Trudeau, Santiago, Chile
- Centro de Investigación Clínica Avanzada (CICA), Hospital Exequiel González Cortés, Santiago, Chile
| | - Carolina Guerra
- Neonatal Intensive Care Unit, Hospital Barros Luco Trudeau, Santiago, Chile
| | - Roberto Reyes
- Neonatal Intensive Care Unit, Hospital Barros Luco Trudeau, Santiago, Chile
| | - Leslie Araya
- Department of Pediatrics, Faculty of Medicine, University of Chile, Santiago 8820808, Chile
- Neonatal Intensive Care Unit, Hospital Barros Luco Trudeau, Santiago, Chile
| | - Belén Sepulveda
- Neonatal Intensive Care Unit, Hospital Barros Luco Trudeau, Santiago, Chile
| | - Camila Cabrera
- Neonatal Intensive Care Unit, Hospital Barros Luco Trudeau, Santiago, Chile
| | - Pamela Medina
- Neonatal Intensive Care Unit, Hospital Barros Luco Trudeau, Santiago, Chile
| | - Eledier Mardones
- Neonatal Intensive Care Unit, Hospital Barros Luco Trudeau, Santiago, Chile
| | | | - Luisa Montecinos
- Molecular Biology Laboratory, Hospital Lucio Córdova, Santiago, Chile
| | - Felipe Tarque
- Molecular Biology Laboratory, Hospital Lucio Córdova, Santiago, Chile
| | - William Acevedo
- Molecular Biology Laboratory, Hospital Lucio Córdova, Santiago, Chile
| | - Marlon Barraza
- Pharmacy Unit Santiago, Hospital Luis Calvo Mackenna, Santiago, Chile;
| | - Mauricio Farfán
- Molecular Biology Laboratory, Hospital Luis Calvo Mackenna, Santiago, Chile
| | - Jocelyn Mendez
- Molecular Biology Laboratory, Hospital Luis Calvo Mackenna, Santiago, Chile
| | - Juan Pablo Torres
- Department of Pediatrics, Faculty of Medicine, University of Chile, Santiago 8820808, Chile
- Division of Pediatric Infectious Diseases, Hospital Luis Calvo Mackenna, Santiago, Chile
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Merav L, Ofek Shlomai N, Oiknine-Djian E, Caplan O, Livneh A, Sido T, Peri A, Shtoyer A, Amir E, Ben Meir K, Daitch Y, Rivkin M, Kripper E, Fogel I, Horowitz H, Greenberger S, Cohen M, Geal-Dor M, Gordon O, Averbuch D, Ergaz-Shaltiel Z, Eventov Friedman S, Wolf DG, Yassour M. Implementation of pooled saliva tests for universal screening of cCMV infection. Nat Med 2024; 30:1111-1117. [PMID: 38459181 PMCID: PMC11031397 DOI: 10.1038/s41591-024-02873-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 02/14/2024] [Indexed: 03/10/2024]
Abstract
Congenital cytomegalovirus (cCMV) is the most common intrauterine infection, leading to neurodevelopmental disabilities. Universal newborn infant screening of cCMV has been increasingly advocated. In the absence of a high-throughput screening test, which can identify all infected newborn infants, the development of an accurate and efficient testing strategy has remained an ongoing challenge. Here we assessed the implementation of pooled saliva polymerase chain reaction (PCR) tests for universal screening of cCMV, in two hospitals of Jerusalem from April 2022 through April 2023. During the 13-month study period, 15,805 infants (93.6% of all live newborn infants) were screened for cCMV using the pooled approach that has since become our routine screening method. The empirical efficiency of the pooling was six (number of tested newborn infants per test), thereby sparing 83% of the saliva tests. Only a minor 3.05 PCR cycle loss of sensitivity was observed for the pooled testing, in accordance with the theoretical prediction for an eight-sample pool. cCMV was identified in 54 newborn infants, with a birth prevalence of 3.4 per 1,000; 55.6% of infants identified with cCMV were asymptomatic at birth and would not have been otherwise targeted for screening. The study demonstrates the wide feasibility and benefits of pooled saliva testing as an efficient, cost-sparing and sensitive approach for universal screening of cCMV.
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Affiliation(s)
- Lior Merav
- School of Computer Science and Engineering, The Hebrew University of Jerusalem, Jerusalem, Israel
- Department of Microbiology and Molecular Genetics, IMRIC, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
- Clinical Virology Unit, Department of Clinical Microbiology and Infectious Diseases, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Noa Ofek Shlomai
- Department of Neonatology, Hadassah and Hebrew University Medical Center, Jerusalem, Israel
- Hebrew University Faculty of Medicine, Jerusalem, Israel
| | - Esther Oiknine-Djian
- Clinical Virology Unit, Department of Clinical Microbiology and Infectious Diseases, Hadassah Hebrew University Medical Center, Jerusalem, Israel
- Hebrew University Faculty of Medicine, Jerusalem, Israel
- Lautenberg Center for General and Tumor Immunology, Jerusalem, Israel
| | - Orit Caplan
- Clinical Virology Unit, Department of Clinical Microbiology and Infectious Diseases, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Ayala Livneh
- Clinical Virology Unit, Department of Clinical Microbiology and Infectious Diseases, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Tal Sido
- Clinical Virology Unit, Department of Clinical Microbiology and Infectious Diseases, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Amir Peri
- Computing Department of Laboratories and Institutes, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Aviad Shtoyer
- Computing Department of Laboratories and Institutes, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Eden Amir
- Clinical Virology Unit, Department of Clinical Microbiology and Infectious Diseases, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Kerem Ben Meir
- Clinical Virology Unit, Department of Clinical Microbiology and Infectious Diseases, Hadassah Hebrew University Medical Center, Jerusalem, Israel
- Hebrew University Faculty of Medicine, Jerusalem, Israel
- Lautenberg Center for General and Tumor Immunology, Jerusalem, Israel
| | - Yutti Daitch
- Clinical Virology Unit, Department of Clinical Microbiology and Infectious Diseases, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Mila Rivkin
- Clinical Virology Unit, Department of Clinical Microbiology and Infectious Diseases, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Esther Kripper
- Clinical Virology Unit, Department of Clinical Microbiology and Infectious Diseases, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Irit Fogel
- Clinical Virology Unit, Department of Clinical Microbiology and Infectious Diseases, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Hadar Horowitz
- Clinical Virology Unit, Department of Clinical Microbiology and Infectious Diseases, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Sraya Greenberger
- Clinical Virology Unit, Department of Clinical Microbiology and Infectious Diseases, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Mevaseret Cohen
- Clinical Virology Unit, Department of Clinical Microbiology and Infectious Diseases, Hadassah Hebrew University Medical Center, Jerusalem, Israel
- Hebrew University Faculty of Medicine, Jerusalem, Israel
- Lautenberg Center for General and Tumor Immunology, Jerusalem, Israel
| | - Miriam Geal-Dor
- Speech and Hearing Center, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
- Department of Communication Disorders, Hadassah Academic College, Jerusalem, Israel
| | - Oren Gordon
- Hebrew University Faculty of Medicine, Jerusalem, Israel
- Pediatric Infectious Diseases, Pediatric Division, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Diana Averbuch
- Hebrew University Faculty of Medicine, Jerusalem, Israel
- Pediatric Infectious Diseases, Pediatric Division, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Zivanit Ergaz-Shaltiel
- Department of Neonatology, Hadassah and Hebrew University Medical Center, Jerusalem, Israel
- Hebrew University Faculty of Medicine, Jerusalem, Israel
| | - Smadar Eventov Friedman
- Department of Neonatology, Hadassah and Hebrew University Medical Center, Jerusalem, Israel
- Hebrew University Faculty of Medicine, Jerusalem, Israel
| | - Dana G Wolf
- Clinical Virology Unit, Department of Clinical Microbiology and Infectious Diseases, Hadassah Hebrew University Medical Center, Jerusalem, Israel.
- Hebrew University Faculty of Medicine, Jerusalem, Israel.
- Lautenberg Center for General and Tumor Immunology, Jerusalem, Israel.
| | - Moran Yassour
- School of Computer Science and Engineering, The Hebrew University of Jerusalem, Jerusalem, Israel.
- Department of Microbiology and Molecular Genetics, IMRIC, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel.
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Izquierdo G, Farfan MJ, Villavicencio L, Montecinos L, Tarque F, Acevedo W, Reyes R, Guerra C, Araya L, Sepúlveda B, Cabrera C, Medina P, Mendez J, Mardones E, Torres JP. Optimizing congenital cytomegalovirus detection by pool testing in saliva by a rapid molecular test. Eur J Pediatr 2023; 182:5131-5136. [PMID: 37684486 PMCID: PMC10640427 DOI: 10.1007/s00431-023-05183-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 08/24/2023] [Accepted: 08/28/2023] [Indexed: 09/10/2023]
Abstract
Universal congenital cytomegalovirus (cCMV) screening in saliva is increasingly recommended. The aim of our study was to correlate the performance of a point-of-care rapid molecular test with CMV real time PCR (CMV RT-PCR) detection, using saliva pool-testing in newborns under a universal screening strategy. Saliva swabs were prospectively collected from newborns < 21 days old and tested by Alethia-LAMP-CMV assay in pools of 5 samples. In positive pools, subjects were tested individually and by saliva and urine CMV RT-PCR. A subset of negative pools were studied with both techniques and viral loads in whole blood were determined in positive patients. From 1,642 newborns included in 328 pools, 8 were confirmed by urine CMV RT-PCR, (cCMV prevalence 0,49%). The PPA and NNA of the pooled saliva Alethia-LAMP-CMV testing were 87,5% and 99,8% with a negative and positive predictive value of 99,9% and 77,7%, respectively. Two false positives were detected (0,12%). A subset of 17 negative pools (85 samples), studied by saliva CMV RT-PCR, showed 100% concordance. Conclusion: CMV pool-testing using a rapid molecular test in saliva proved feasible when compared to PCR gold standards. This strategy could improve cost-effectiveness for cCMV universal neonatal screening, based on the low prevalence of the infection and could be a more affordable approach in less developed regions with reduced detection capacity. What is Known: • cCMV is the most frequent congenital infection and a leading nongenetic cause of sensorineural hearing loss and brain disease. • Universal screening could allow early detection of congenitally infected infants, improving clinical outcome. • Saliva PCR is the preferred and non-invasive test for newborn cCMV screening. What is New: • The feasibility of a universal cCMV screening by pool-testing in saliva using a rapid test in pools of 5 samples. • PPA and NPA were 87,5 and 99,8% compared to CMV PCR in urine. • This strategy could be relevant specially in LMIC where detection capacity is reduced and could improve cost-effectiveness. • cCMV prevalence in our center was 0,49%.
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Affiliation(s)
- Giannina Izquierdo
- Faculty of Medicine, Universidad de Chile, Department of Pediatrics, Santiago, Chile
- Hospital Barros Luco Trudeau, Neonatal Intensive Care Unit, Santiago, Chile
- Hospital Exequiel González Cortés, Division of Pediatric Infectious Diseases, Santiago, Chile
| | - Mauricio J Farfan
- Faculty of Medicine, Universidad de Chile, Department of Pediatrics, Santiago, Chile
- Hospital Luis Calvo Mackenna, Molecular Biology Laboratory and Department of Pediatrics, Santiago, Chile
| | | | - Luisa Montecinos
- Hospital Lucio Cordova, Molecular Biology Laboratory, Santiago, Chile
| | - Felipe Tarque
- Hospital Lucio Cordova, Molecular Biology Laboratory, Santiago, Chile
| | - William Acevedo
- Hospital Lucio Cordova, Molecular Biology Laboratory, Santiago, Chile
| | - Roberto Reyes
- Hospital Barros Luco Trudeau, Neonatal Intensive Care Unit, Santiago, Chile
| | - Carolina Guerra
- Hospital Barros Luco Trudeau, Neonatal Intensive Care Unit, Santiago, Chile
| | - Leslie Araya
- Faculty of Medicine, Universidad de Chile, Department of Pediatrics, Santiago, Chile
- Hospital Barros Luco Trudeau, Neonatal Intensive Care Unit, Santiago, Chile
| | - Belén Sepúlveda
- Hospital Exequiel González Cortés, Division of Pediatric Infectious Diseases, Santiago, Chile
| | - Camila Cabrera
- Hospital Barros Luco Trudeau, Neonatal Intensive Care Unit, Santiago, Chile
| | - Pamela Medina
- Hospital Barros Luco Trudeau, Neonatal Intensive Care Unit, Santiago, Chile
| | - Jocelyn Mendez
- Hospital Luis Calvo Mackenna, Molecular Biology Laboratory and Department of Pediatrics, Santiago, Chile
| | - Elieder Mardones
- Hospital Barros Luco Trudeau, Neonatal Intensive Care Unit, Santiago, Chile
| | - Juan P Torres
- Faculty of Medicine, Universidad de Chile, Department of Pediatrics, Santiago, Chile.
- Hospital Luis Calvo Mackenna, Molecular Biology Laboratory and Department of Pediatrics, Santiago, Chile.
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Jenks CM, Hoff SR, Mithal LB. Congenital Cytomegalovirus Infection: Epidemiology, Timely Diagnosis, and Management. Neoreviews 2021; 22:e606-e613. [PMID: 34470762 DOI: 10.1542/neo.22-9-e606] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Congenital cytomegalovirus (cCMV) infection is common because of the ubiquitous nature of the virus and the lack of an effective prevention strategy during pregnancy. Most infants with cCMV are asymptomatic, although a notable subset can have sequelae including, most commonly, sensorineural hearing loss and neurodevelopmental disability, which may not be present at birth. Timely screening for cytomegalovirus in the first weeks after birth is critical to appropriately diagnose congenital infection, evaluate affected infants, and determine the treatment course. Antiviral therapy with valganciclovir can optimize end hearing and neurodevelopmental outcomes in symptomatic infants. This review discusses the epidemiology and clinical manifestations of cCMV, targeted and universal screening approaches, and treatment and monitoring of infants with cCMV.
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Affiliation(s)
- Carolyn M Jenks
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine; Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Stephen R Hoff
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine; Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Leena B Mithal
- Division of Infectious Diseases, Department of Pediatrics, Northwestern University Feinberg School of Medicine; Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
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