Congenital Cytomegalovirus Conference - Congenital CMV ...

Epidemiology
O-01 Recent epidemiologic results that impact awareness, prevention, and treatment.
Michael J. Cannon, Centers for Disease Control and Prevention, Atlanta, GA.
Epidemiologic studies of CMV infection and congenital disease can highlight the need for awareness, inform
prevention research, and focus treatment efforts. This presentation will describe three areas of recent
epidemiologic study at the Centers for Disease Control and Prevention: 1) Surveys of CMV awareness
among women and obstetrician/gynecologists; 2) Analyses of CMV seroprevalence data from the U.S.
National Health and Nutrition Examination Survey (NHANES) to understand transmission modes on a
population level; and 3) Literature reviews of the overall burden of congenital CMV infection and disease
and the particular burden due to permanent, bilateral hearing loss. These studies are intended to identify
women at high risk for giving birth to children with congenital CMV, clarify what messages need to be
communicated about congenital CMV prevention, measure the extent of the disease burden, and establish
who is likely to need antiviral treatments or other interventions.
O-02 Building passive and active surveillance systems for congenital CMV infection
Karen B. Fowler, UAB Department of Pediatrics, Birmingham, AB.
Congenital CMV infection remains the most common intrauterine infection in the United States resulting
in serious disability in infected newborns. CMV however, is not included in any state’s recommended
or mandated newborn screening tests. The lack of an easy, rapid, inexpensive testing method for CMV,
the need for a vaccine or effective treatment to prevent infection, and the absence of advocacy and policy
groups for CMV has diminished enthusiasm in the larger scientific community for developing surveillance
programs for congenital CMV infection. Additionally, there has been little public awareness about
CMV and the possible adverse outcomes following congenital CMV infection. In recent years, new developments
in testing for and treating CMV infections, as well as an emerging interest from the newborn
hearing screening community for identification of CMV-related hearing loss, has resulted in a need to reconsider
surveillance or screening programs for congenital CMV infection. This presentation will include
a discussion of the components that are needed for building passive and active surveillance systems for
congenital CMV infection. Also, a review of factors that contribute to varying rates of congenital CMV
infection in infant populations will be included and how these population variations could impact the development
of a surveillance system. Other challenges for developing surveillance systems for congenital
CMV infection will also be discussed.
O-03 Creating CMV-related treatment registries of pregnant women and infants
Suzanne Luck, Royal Free and University College Medical School, Londond, UK.
The role of antiviral treatment for congenital CMV (cCMV) is currently under debate. Only one randomised
controlled trial exists to date documenting the efficacy of intravenous (IV) ganciclovir in preventing
hearing deterioration in babies with central nervous system symptoms of disease. The availability
of oral valganciclovir has seen case reports of the use of antiviral treatment in babies with less severe disease
and for prolonged treatment courses emerging in the literature. Nucleoside analogues are not without
their risks in this age group, with acute effects on bone marrow being frequently documented and the
theoretical risk of carcinogenicity and decreased spermatogenesis in the longer term. While the results of
properly conducted RCT are awaited there is a need to monitor treatment trends, toxicity and establish
measures of treatment efficacy in these babies and to have the potential for long-term monitoring in the
future. In the UK registries are well established for HIV during pregnancy and the monitoring of their offspring.
This has provided valuable epidemiological and treatment-related data on which to base national
guidelines. Registries of CMV-infected children have been successfully established in the US and Canada
and given much an invaluable insight into the course of CMV disease. Changes in legal and regulatory
procedures both in the UK and elsewhere have raised new challenges. We discuss the rationale, challenges,
and progress in establishing such databases in 21st century Europe.
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