National Cytomegalovirus (CMV) Awareness Month

CMV Test Tubes

The Facts about Cytomegalovirus (CMV)

Cytomegalovirus, or CMV, is a virus that is the most common infectious cause of birth defects to babies born in the U.S. Approximately 10% of babies diagnosed with congenital CMV infection have signs at birth. Almost 1 out of 200 babies is born with congenital CMV.

Approximately 1 out of 5 babies diagnosed with congenital CMV infection have birth defects or other long-term health problems, like hearing loss.  Hearing loss is common in babies with congenital CMV, even those without initial symptoms. Hearing loss may progress from mild to severe during baby’s first 2 years, a critical period for language learning and development. Over time, hearing loss can adversely affect communication, language, and social developmental skills of those children with congenital CMV.

In addition to babies, CMV may be present in small children. By the age of 5 years, 1 in 3 children has been infected with CMV, but usually without displaying symptoms. CMV can be present in a child’s body fluids for months after becoming infected.

CMV can affect adults, especially those in frequent contact with young children because young kids are a common CMV source. Over half of adults have been infected by CMV by age 40, with most showing no signs or symptoms.

CMV infection can compromise the health of those adults with weakened immunities, especially those who have had an organ, stem cell or bone marrow transplant or diagnosed with HIV and can even cause death.

Importantly, pregnant women infected with CMV can pass it to their developing baby, who may in turn develop congenital CMV, increasing baby’s susceptibility and risk to birth defects and long-term health problems. CMV may be transmitted via an infected mother’s breastmilk to her nursing baby.

Exposure to CMV is widespread and can infect almost anyone, making it important for women who are planning to conceive, pregnant women, parents, and caregivers to know its causes, reduce risk of exposure, understand symptoms and health problems associated with CMV infection, and know when to seek diagnosis and treatment.

June is designated National Cytomegalovirus Awareness Month and your local Capital Women’s Care practice wants to share important information about the different forms of CMV, including its causes, symptoms in babies and young children, plus diagnosis and available treatments if discovered early.

What is Cytomegalovirus?

Cytomegalovirus (CMV) is a common virus. Once infected, your body retains the virus for life. Most people are not aware they have CMV because it rarely causes problems in healthy people.

CMV is related to the viruses that cause chickenpox, herpes simplex and mononucleosis. CMV may cycle through times when it is dormant and then reactivates. If you are healthy, CMV primarily remains dormant.

When the virus is active in your body, you can pass the virus to other people. CMV is a virus that spreads from person to person through direct contact with body fluids of an infected person (blood, saliva, urine, semen, tears, vaginal fluids, and breast milk.)

Casual contact does not transmit CMV.

CMV can be transmitted by:

  • Touching your eyes or the inside of your nose or mouth after direct contact with an infected person’s body fluids.
  • Sexual contact with an infected person.
  • The breast milk of an infected mother.
  • Organ, bone marrow or stem cell transplantation or blood transfusions.
  • Birth. An infected mother can pass the virus to her baby before or during birth. The risk of transmitting the virus to your baby is higher if you become infected initially during pregnancy.

Pregnant women or anyone having a weakened immune system need to be aware of CMV and its potential consequence to their health and the health of their baby. Women who develop an active CMV infection during pregnancy can pass the virus to their babies, who might then experience symptoms. For people who have weakened immune systems, especially people who have had an organ, stem cell or bone marrow transplant, CMV infection can be fatal.

There is no cure, but medications are available to help treat CMV symptoms.

The greatest number CMV infections occur in newborns (congenital CMV), those infants of mothers with CMV (perinatal CMV) and adults with compromised immunities.

CMV Signs & Symptoms: Babies

Most babies who have congenital CMV often appear healthy at birth; a few babies who have congenital CMV who appear healthy at birth develop signs over time, sometimes not for months or years after birth. The most common of these late-occurring signs are hearing loss and developmental delay. A small number of babies may also develop vision problems.

These signs and symptoms are more common in babies with congenital CMV:

  • premature birth
  • low birth weight
  • yellow skin and eyes (jaundice)
  • enlarged, poorly functioning liver
  • purple skin splotches and/or rash
  • abnormally small head (microencephaly)
  • enlarged spleen
  • pneumonia
  • retinitis (damaged eye retina)
  • and seizures.

Long-term health problems afflicting those babies with congenital CMV may include:

  • hearing loss
  • intellectual disability or delay
  • vision loss
  • seizures
  • and lack of coordination or weakness.

Some babies with congenital CMV but without showing any signs at birth may still have or develop hearing loss, even in those babies who initially passed the newborn hearing test. Hearing loss may occur in one ear, with later loss developing in the other ear. In some instances, hearing loss worsens with age, with progression of hearing loss possibly occurring through adolescence.

Because congenital CMV greatly affects hearing ability, it is important to monitor babies and children for signs of hearing loss.

Signs of hearing loss in babies:

  • does not startle at loud noises
  • does not turn toward the source of sound after age 6 months
  • does not say single words like “dada” or “mama” by age 1 year
  • turns head when baby sees you but not if you call out baby’s name
  • seems to hear some sounds but not others

Signs of hearing loss in young children:

  • delayed speech
  • unclear speech
  • does not follow directions (a potential result of a partial or complete hearing loss)
  • turns the TV volume up too high

If your child has hearing loss, there are many services like speech and occupational therapies to help ensure your child develops important communication, language, and social skills. Children facing hearing loss also benefit from learning to communicate through sign language and use devices like hearing aids and cochlear implants. The earlier children affected by hearing loss start receiving services, the more likely they are to reach their full potential.

CMV Signs & Symptoms: Immunocompromised Adults

Immunocompromised adults with CMV can face serious problems affecting the following:

  • eyes
  • lungs
  • liver
  • esophagus
  • stomach
  • intestines
  • and brain.

Complications of CMV infection in immunocompromised adults can include:

  • vision loss, due to inflammation of the light-sensing layer of the eye (retinitis)
  • digestive system problems, including inflammation of the colon (colitis), esophagus (esophagitis) and liver (hepatitis)
  • nervous system problems, including brain inflammation (encephalitis)
  • pneumonia

CMV Signs & Symptoms: Healthy Adults

Those otherwise healthy adults with CMV exhibit few, if any, symptoms. When initially infected with CMV, some adults may experience symptoms like those of infectious mononucleosis, including:

  • fatigue
  • fever
  • sore throat
  • muscle aches

CMV rarely causes mononucleosis in otherwise healthy infected adults. Additional rare complications for healthy adults include problems with the digestive system, liver, brain, and nervous system.

CMV Prevention

Careful hygiene is the best prevention against CMV. You can take these precautions to guard against infection:

  • Wash hands often. Use soap and water for 15 to 20 seconds, especially if you have contact with young children or their diapers, saliva, or other oral secretions. This is especially important if the children attend childcare.
  • Avoid contact with tears and saliva when kissing a child.  This is especially important if you are pregnant.
  • Avoid sharing food or drinking from the same glass as others. Sharing glasses and kitchen utensils can spread CMV.
  • Take care with disposable items. When disposing diapers, tissues and other items that have been contaminated with bodily fluids, wash hands thoroughly with soap and water before touching your face.
  • Clean toys and countertops. Clean any surfaces that have direct contact with children's urine or saliva.
  • Practice safe sex. Wear a condom during sexual contact to prevent spreading CMV through semen and vaginal fluids.

CMV Diagnosis

Laboratory tests, including tests of blood and other body fluids or tests of tissue samples, can detect CMV. Saliva and urine are usually tested in newborns to determine CMV infection.

If you are pregnant, testing to determine whether you have ever been infected with CMV can be important. Pregnant women with already developed CMV antibodies have a very small chance of a CMV reactivation infecting their unborn children.

If your doctor detects a new CMV infection during your pregnancy, a prenatal test (amniocentesis) can determine whether your baby is infected. In this test, your doctor takes and examines an amniotic fluid sample. Amniocentesis is generally recommended when abnormalities that might be caused by CMV are seen by your doctor during ultrasound.

If your doctor suspects your baby has congenital CMV, it is important to test the baby within the first three weeks of birth. If your baby has CMV, your doctor likely will recommend additional tests to check the health of the baby's organs, including the liver and kidneys.

A recent study shows accuracy of dried blood spot testing for detection of CMV infection in newborns.

Testing for CMV can also be important if you have a weakened immune system. For example, if you have HIV or AIDS, or if you have undergone an organ transplant, your doctor may want to monitor you regularly.

CMV Treatment

Treatment generally is not required for healthy children and adults. Healthy adults who develop CMV mononucleosis generally recover without medication.

Newborns and people who have weakened immunity need treatment when experiencing CMV infection symptoms. The type of treatment depends on the signs and symptoms and their severity.

Antiviral medications are the most common type of CMV treatment. They can slow reproduction of the virus but cannot eliminate it.

If you have weakened immunity, you may benefit from taking antiviral medication to prevent becoming infected with CMV.

Researchers are studying new medications and vaccines to treat and prevent CMV.

Experimental vaccines are being tested for women of childbearing age. These vaccines may be useful in preventing CMV infection in mothers and infants, reducing the chance that babies born to women who are infected while pregnant will develop disabilities.

Your local Capital Women’s Care family of healthcare professionals is here for you should you have any questions or concerns regarding CMV or any other aspect of you or your family’s health. Our top priority is to offer you quality, comprehensive health care and treatment so that you and your family achieve and enjoy optimal health.

Sources:

www.cdc.gov/cmv/overview.html
https://www.cdc.gov/cmv/resources/pregnant-women-parents.html
https://www.cdc.gov/cmv/fact-sheets/parents-pregnant-women.html
https://www.cdc.gov/cmv/congenital-infection.html
https://www.cdc.gov/cmv/hearing-loss.html
https://www.mayoclinic.org/diseases-conditions/cmv/symptoms-causes/syc-2...
https://www.ninds.nih.gov/Disorders/All-Disorders/Neurological-Consequen...
https://www.nationalcmv.org/overview/cmv-transmission
https://www.womenshealth.gov/pregnancy/youre-pregnant-now-what/pregnancy...
https://www.news-medical.net/news/20210202/Study-shows-accuracy-of-dried...

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