Как лечить цитомегаловирус у детей: Е. Комаровский: Цитомегаловирус у ребенка

Цитомегаловирус у детей: симптомы, лечение, диагностика

Цитомегалия считается распространенной инфекционной болезнью. Несмотря на это, большинство родителей не понимают, как нужно лечить цитомегаловирус у детей. ЦМВ встречается у 50% всех детей, да и родители, перенеся инфекцию, являются ее носителями. Попав в организм, вирус остается в нем навсегда, поэтому важно понимать, что такое цитомегаловирусная инфекция.

Причины появления

Цитомегаловирус — вирус герпеса 5 типа, который передается только от человека к человеку. Никто из других живых существ не является его носителем. Причин, вызывающих развитие ЦМВ у детей несколько:

• Внутриутробное инфицирование — основная причина. Заражение свершается в период беременности (до нее) в результате заболевания женщины.
• Большой риск заражения вирусом возникает в процессе родовой деятельности и при кормлении грудью.

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Пути заражения

Цитомегаловирусная инфекция имеется в моче, грудном молоке, кровяной жидкости, в слюне, мужском семени и женских выделениях.

Механизм проникновения вируса в организм и возраст малыша играют не последнюю роль в развитии заболевания. Цитомегаловирус у ребенка бывает врожденным и приобретенным, в связи с этим выделяют 3 направления попадания инфекции в организм ребенка, приведенные в таблице:

Вид поражения	Путь передачи	Особенности
Врожденный	Антенатальный	Отклонение приносит самые непредвиденные последствия
		Сосредоточение вируса в околоплодных водах способствует его проникновению в жизненно важные органы малыша
		Иногда беременность заканчивается выкидышем
Приобретенный	Интранатальный	Риск заражения инфекцией даже при активной форме заболевания у мамы составляет около 5%
	Постнатальный	На передачу инфекции при грудном вскармливании отводится от 30 до 70% всех случаев
		Заражение происходит через поцелуи и телесные контакты, что связано с активным общением ребенка с посторонними людьми

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Симптомы развития ЦМВ у детей

Вирус передается плоду через плаценту.

От момента попадания инфекции в организм до появления признаков заболевания может пройти от 15 дней до 3 месяцев. Нормальный иммунитет ребенка справится с вирусом, и цитомегалия себя никак не проявит. На активизацию вируса влияет иммунитет, возраст, а также наличие сопутствующих заболеваний:

• Врожденный цитомегаловирус у детей проявляется следующими симптомами:
  • печень и селезенка увеличены;
  • желтушность;
  • поражения слуховой и зрительной функции;
  • задержка развития;
  • количество тромбоцитов в крови снижено.
• При инфицировании посредством грудного кормления признаки цитомегаловируса отличаются:
  • появляется сыпь;
  • беспричинное воспаление легких;
  • кашель;
  • развивается воспаление печени.
• Цитомегаловирусная инфекция у годовалого ребенка и старшего возраста в острой фазе сопровождается симптомами, как при ОРВИ и мононуклеозном синдроме, как при вирусе Эпштейна Барра:
  • повышение температуры;
  • воспаление слюнных желез;
  • выкручивание суставов;
  • головные боли;
  • насморк;
  • отсутствие аппетита;
  • быстрая утомляемость.

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Особенности вируса для грудного ребенка

У новорожденных вирус поражает печень.

Врожденная цитомегаловирусная инфекция или приобретенная в первые месяцы жизни, влияют на развитие малыша, грозят инвалидностью и опасны для жизни. Для первых дней жизни после рождения характерно проявление симптомов поражения печени (желтушность глаз и кожи). У здоровых малышей послеродовая желтушка проходит за месяц, у детей с вирусом сохраняется до полугода.

ЦМВИ — причина поражения кроветворной функции и воспалительных процессов в мозговой ткани. У грудного ребенка в связи с снижением количества тромбоцитов появляются на теле синяки, кровоточит и не заживает пупок. А воспалительный процесс провоцирует потерю сознания, судороги, нарушения центральной и периферической нервной системы.

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Вирус у детей с иммунодефицитом

Цитомегаловирусная инфекция у детей с дефицитом иммунной системы по-настоящему несет опасность для их жизни. Согласно статистике количество патологий при ЦМВ, ведущих к летальному исходу, больше всего у детей с иммунодефицитом. Терапия заболевания в таком случае должна быть интенсивной и начинаться незамедлительно. Важно понимать индивидуальность каждого случая, поэтому определением терапевтических методов должен заниматься только специалист.

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Последствия инфицирования

Цитомегаловирус провоцирует развития гепатита.

Неверно считать цитомегаловирусную инфекцию неопасной для детского здоровья. Хотя она может не проявляться на протяжении длительного периода времени, снижение иммунной защиты вызывает ее быстрое развитие. Внутриутробная цитомегаловирусная инфекция у новорожденных провоцирует следующие осложнения:

• воспаление мозговой оболочки;
• патологии зрительных нервов;
• скопление жидкости в головном мозге;
• отсутствие слуха;
• нарушается работа слюнных желез и надпочечников.

В случае ослабления защитных сил организма ЦМВИ проникает в жизненно важные органы, провоцируя развитие патологий:

• воспаление спинного мозга;
• пневмония;
• гепатит;
• воспаление толстой кишки;
• нейропатия;
• воспаление сетчатки глаза.

Самым опасным считается бессимптомный детский цитомегаловирус, заражение которым произошло во внутриутробном периоде, во время родов или кормлении грудью. В таком случае цитомегаловирус у новорожденного опасен тяжелыми последствиями:

• У 20% новорожденных через некоторое время наблюдается деформация костей черепа, расстройство двигательных функций, судороги и внешне заметный недобор массы тела.
• Через несколько лет становится заметна задержка развития, нарушение речи, появляются сердечно-сосудистые патологии.

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Диагностика

Лабораторные исследования определят наличие вирусной инфекции.

Если ЦМВИ обнаружили у мамы, грудничка сразу ставят на контроль для наблюдения за возможными изменениями состояния здоровья. Врач 1 раз в 3 месяца назначает необходимые обследования, позволяющие отслеживать активацию вируса. Кроме этого, понадобятся ежегодные консультации окулиста, невролога, отоларинголога, которые позволят вовремя обнаружить развитие осложнений.

В случае подозрений, поскольку характерные признаки инфекции отсутствуют, поставить правильный диагноз можно только после проведения специальных лабораторных исследований. Если в крови или тканях обнаружили вирус или наличие антител к нему в крови, диагноз подтверждается. Кроме этого наличие вируса можно обнаружить в моче и слюне.

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Какой анализ сдавать?

Острый и хронический процесс развития вирусной инфекции у детей до года и старше определяется путем сдачи анализов:

• Лабораторное исследование крови на определение или отсутствие антител IgG. Если мама инфицирована, определяют показатели специфических антител g (M) через пуповинную кровь. Исследование может показать неточность результатов, особенно в первые 14 дней после инфицирования, у детей до 2 лет.
• Для определения уровня активности вируса необходимо делать бактериологический посев биологической массы.
• Проводят цитологическое исследование слюны, мочи на определение клеток вируса.
• Метод ПЦР позволяет подтвердить или опровергнуть наличие клеток ДНК цитомегаловируса в биологических материалах: крови, слюне, слизи, околоплодной жидкости, выделениях.

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Лечение вируса

Болезнь требует систематического врачебного контроля.

Полностью вылечить вирус невозможно. Лечить цитомегалию у детей — это значит уменьшить его активность и не допустить возможных осложнений. Как правило, лечение проводят противовирусными препаратами, но если инфекция распространилась на внутренние органы, подключают дополнительные медикаменты. Если признаки вируса у ребенка не проявляются и он здоров, в специфическом лечении нет никакой необходимости. Лечение ЦМВИ у детей начинают при врожденном инфицировании или при сложных формах патологии, ведущих к осложнениям.

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Методы профилактики

У детей месячного возраста и старше с сильным иммунитетом цитомегаловирус проходит с отсутствием ярких признаков и без осложнений. Чтобы не спровоцировать развитие цитомегалии и не допустить патологий, родителям необходимо укреплять организм малыша, соблюдать правила гигиены и контролировать любые изменения здоровья. При появлении непонятной сыпи, беспричинном подъеме температуры или росте лимфоузлов обязательна консультация врача. Родители должны помнить, что самолечение навредит ребенку и исказит проявление вируса.

How to Treat Cytomegalovirus Retinitis

Written By: Bradley T. Smith, MD, and Carl D. Regillo, MD
Edited By Ingrid U. Scott, MD, MPH, and Sharon Fekrat, MD

This article is from October 2005 and may contain outdated material.

Cytomegalovirus retinitis usually results from reactivation of a latent CMV infection secondary to immunodeficiency and accounts for 90 percent of the infectious retinopathies in AIDS patients.Before the introduction of highly active antiretroviral therapy, 30 percent of patients with AIDS developed CMV retinitis. Fortunately, HAART has reduced that incidence by three-quarters. However, CMV retinitis remains a concern for HIV-infected individuals who are not in treatment or who have failed anti-HIV therapy, whose CD4 lymphocytes have fallen below 50 / mm³, who have a plasma HIV-1 RNA level greater than 100,000 copies / mL or who have been previously diagnosed with opportunistic infections.

Clinical Findings

Patients with CMV retinitis may be asymptomatic, or they may complain of floaters, photopsia and / or scotomata. The retinal lesions usually consist of perivascular infiltration with associated retinal hemorrhage and vascular sheathing. Vitritis is not a common finding given the immunocompromised state of these patients, but it may occur with immune recovery. The two forms of CMV retinitis are:

• The indolent form, limited to the periphery and appearing more granular with less hemorrhage than
• The fulminant form, which can involve the macula, having a more intense retinal infiltration with a greater degree of intraretinal hemorrhage.

Diagnosis

Ophthalmoscopy revealing the characteristic appearance of CMV retinitis is diagnostic.

However, it is important to consider other causes. These include acute retinal necrosis, progressive outer retinal necrosis, toxoplasmosis, syphilis, HIV retinitis as well as other bacterial and fungal infections. Consider immunoglobulin G levels or polymerase chain reaction analysis (PCR) for CMV in problematic instances such as the patient with a vitreous hemorrhage precluding a fundus view.Diagnostic vitrectomy with tissue biopsy looking for inclusion bodies may also be helpful.

Treatment

HAART is by far the most important weapon in the treatment of CMV retinitis. Sustained immune reconstitution (maintaining CD4 cells above 100 / mm³) may allow discontinuation of anti-CMV treatment that otherwise must be continued indefinitely to suppress the virus. ¹

Specific anti-CMV treatment should be individualized based on the location and severity of the retinitis, level of underlying immune suppression, concomitant medications and ability to comply with treatment.Therapy is induced at high doses for two to three weeks or until the retinitis stabilizes. (See the table below for current options and dosing regimens.)

Treatment Options and Dosing Regimens SYSTEMIC Intravenous ganciclovir Induction: 5 mg / kg twice daily for two weeks Maintenance: 5 mg / kg / day Oral ganciclovir Induction: not recommended Maintenance: 1 g three times a day Oral valganciclovir Induction: 900 mg twice daily for two weeks Maintenance: 900 mg / day Intravenous foscarnet Induction: 60 mg / kg every eight hours for 14 days Maintenance: 90 mg / kg / day Intravenous cidofovir Induction: 5 mg / kg weekly for two weeks Maintenance: 3 mg / kg every two weeks Give probenecid 2 g orally three hours before and an additional 1 g at two and eight hours after each infusion OCULAR Intravitreal ganciclovir Induction: 2 mg twice weekly for three weeks Maintenance: 2 mg weekly Ganciclovir implant Induction: 4.5 mg implant Maintenance: replace every six to eight months Intravitreal foscarnet Induction: 2.4 mg twice weekly for three weeks Maintenance: 2.4 mg weekly Intravitreal cidofovir Induction: 20 μg Maintenance: repeat every five to six weeks Intravitreal fomivirsen Induction: 300 μg every two weeks for four weeks Maintenance: 300 μg every four weeks Note: The manufacturer’s instructions regarding dosage, administration and monitoring should be followed precisely.

Systemic Treatment

Ganciclovir is administered intravenously, and the dose must be adjusted in patients with renal insufficiency. Ganciclovir undergoes phosphorylation to the active form after uptake by CMV-infected cells, making it susceptible to resistance when the UL97 mutation is present. Oral ganciclovir is not as effective in delaying disease progression as is IV ganciclovir. However, it causes less neutropenia and does not carry the risks associated with indwelling catheters.It may be appropriate as prophylactic therapy or as treatment in those patients with early, stable, peripheral CMV retinitis that is not immediately sight threatening. Note that if immune recovery is sufficient on HAART, reimplantation of a ganciclovir device (see below) or continuation of specific anti-CMV therapy may not be necessary.

Valganciclovir is an oral prodrug of ganciclovir and has been shown to be equally efficacious. ² Bone marrow suppression can occur with either drug, so blood counts should be measured twice weekly during induction and weekly during maintenance therapy.If neutropenia occurs, a colony-stimulating factor should be added and other drugs with myelosuppressive effects (including some antiretrovirals) should be discontinued, or an alternative anti-CMV drug substituted.

Foscarnet does not require intracellular phosphorylation to inhibit DNA polymerase and so it is effective against many resistant strains of CMV. Induction requires a large fluid infusion. Maintenance therapy requires an indwelling catheter and a daily two-hour infusion.Renal toxicity is common, but appropriate dose calculation based on creatinine clearance and adequate hydration can help prevent this side effect. Renal function and electrolytes should be evaluated twice weekly with appropriate dose adjustment based on creatinine levels. Foscarnet was shown to provide a greater survival advantage than ganciclovir in the Study of the Ocular Complications of AIDS trial, ³ but this advantage has waned in the HAART era. Combination therapy with ganciclovir and foscarnet is effective, but quality of life suffers greatly given the time required for the infusions.

Cidofovir is also effective against many resistant strains of CMV since it does not require immediate phosphorylation. However, renal toxicity is even more common with this drug and so should be avoided in patients already taking a nephrotoxic medication or in those with a history of renal insufficiency. Urine protein and creatinine levels should be checked 48 hours before injection and the dose adjusted accordingly. Its less frequent dosing schedule compared with foscarnet makes an indwelling catheter unnecessary and so may be more attractive for those interested in maximizing quality of life.Its toxicity may be reduced by a saline bolus and adequate hydration, plus concomitant use of probenecid (beware in patients with allergy to sulfa) to inhibit renal uptake.

Intraocular Treatment

Intraocular anti-CMV therapy provides higher targeted concentrations of drug compared with systemic therapy. However, the patient is not then protected systemically (e.g., against CMV esophagitis or colitis) and the fellow eye remains vulnerable to reactivated CMV infection.

The ganciclovir implant has demonstrated effective local control of CMV retinitis for up to six to eight months before replacement is required. ⁴ It is especially useful when sight is immediately threatened or when systemic therapy is not adequate. However, risks of vitreous hemorrhage, retinal detachment and endophthalmitis require a more judicious use of implants. Because of these risks, it is recommended that efficacy first be established with several injections of intravitreal ganciclovir.

Intravitreal foscarnet, like ganciclovir, requires weekly injections, making it intolerable to some patients.

Intravitreal cidofovir injections can result in hypotony and uveitis even in the fellow eye. Both of these injectable drugs also carry a risk of complications such as retinal detachment and endophthalmitis, although those occur less often than with the ganciclovir implant.

Intravitreal fomivirsen is a synthetic antisense oligonucleotide that binds specifically to viral mRNA to inhibit protein expression. It has recently been proven effective in the treatment of patients with newly diagnosed CMV retinitis and for those in whom CMV retinitis has reactivated or persisted despite previous treatment.Like other intravitreal antivirals, it is considered a second-line agent, given the bimonthly induction injections followed by monthly maintenance doses.

Resistance and Relapse

It is impossible to totally eradicate CMV since all patients harbor a resistant colony. Resistance is defined as persistent active retinitis despite six weeks of induction therapy and occurs in 25 to 35 percent of patients by nine months of therapy. Resistance increases with longer-term therapy, and the UL97 mutation is the culprit in most cases.Management includes combining therapies such as foscarnet with ganciclovir, or adding an implant or intravitreal injection to systemic therapy. In some cases it may be prudent to switch therapies altogether.

Almost all patients with a CD4 count less than 100 will relapse. This can be subtle clinically, so comparison of serial photos is necessary. Relapse is defined as a quiescent CMV retinitis that becomes active. It may be that the intravitreal drug concentration is subtherapeutic, so do not assume resistance.Consider PCR sequencing for detection of the UL97 mutation if the patient has clearly relapsed. In the meantime, the current therapy should be continued at the induction schedule. The most important factor in treating resistance and relapse is to ensure HAART compliance.

Complications

As a patient’s immune system recovers, it recognizes CMV antigens as foreign. Immune recovery uveitis (IRU) can occur months to years after a patient begins treatment with HAART. IRU represents the leading cause of new visual loss in patients with AIDS through mechanisms such as cystoid macular edema, epiretinal membranes and cataracts.The treatment of IRU is one of the few indications for corticosteroids in an AIDS patient, and a depot injection of steroid should be considered before cataract extraction. The diagnosis of IRU should only be made when the retinitis is inactive, the CD4 cell counts have increased, and there is no evidence of an additional infectious etiology.

It is estimated that 18 to 26 percent of eyes with CMV retinitis develop a rhegmatogenous retinal detachment due to multiple necrotic holes. Methods of repairing detachments depend on the status of the macula and activity of the retinitis.Pars plana vitrectomy with silicone oil tamponade is useful for macula-off retinal detachments in the setting of an active retinitis. The oil should remain in the eye until the immune system has recovered and the retinitis is quiescent. Vitrectomy with SF ₆ gas tamponade may be used if the retinitis is not active. Laser demarcation is useful for preventing detachment of the macula only when the retinitis is inactive and the area of ​​prior retinitis and associated rhegmatogenous retinal detachment are relatively limited.Adjunct scleral buckling procedures which require many sutures are often not necessary.

Minimizing intraoperative suturing will help to reduce the risk of needle sticks. Retinal detachments in HIV patients with a history of CMV retinitis are rarely complicated by proliferative vitreoretinopathy.

Follow-Up

In general anti-CMV therapy should be maintained until patients have been compliant with HAART for at least 18 months, there are documented CD4 counts greater than 100 for at least three months, and the retinitis is quiescent with prolonged relapse-free intervals.Treatment success is suggested by reaction of the retinal pigment epithelium, no advancement of the linear border, and no expansion of any area of ​​retinitis or atrophy by greater than 750 micrometers on serial fundus photographs.

CMV retinitis is the most common ocular infection in people with AIDS. Those with CD4 counts less than 50 should have a dilated exam every three months since many patients with active retinitis may be asymptomatic. Patients should be instructed on the importance of strict adherence to HAART and any specific anti-CMV treatment.Any change in vision or ocular symptoms should be reported promptly.

_______________________________

1 Whitcup, S. M. et al. JAMA 1999; 282: 1633-1637.

2 Martin, D. F. et al. N Engl J Med 2002; 346: 1119-1126.

3 Jabs, D. A. et al. N Engl J Med 1992; 326 (4): 213-220.

4 Martin, D. F. et al. Arch Oph thalmol 1994; 112 (12): 1531-1539.

_______________________________

Dr.Smith is a senior ophthalmology resident and Dr. Regillo is a professor of ophthalmology. Both are at Wills Eye Hospital in Philadelphia.

AAO Annual Meeting: Chicago 2005 Two related posters will be presented in Chicago: Poster # 343 «Ocular Lesions in HIV-Infected Patients in the Era of Highly Active Anti-Retroviral Therapy in Western India» is to be presented by Alay S. Banker, MD , on Monday, Oct.17, from 11 a.m. to 12:30 p.m. in Hall A. Poster # 378 «Pathologic Findings of Choroidal Melanoma in Patients With HIV» is to be presented by Scott R. Witherspoon, MD, on Monday, Oct. 17, from 11 a.m. to 12:30 p.m. in Hall A.

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Medical Conditions | Children Cytomegalovirus

What is CMV in newborns?

CMV is a herpes virus. It is very common. It affects people of all ages and parts of the U.S. Most of the time, CMV causes mild or no symptoms. But, it can cause serious problems in a fetus or newborn.

What causes CMV in newborns?

CMV is a virus that is spread from a person with the virus to someone else. The virus can spread:

• To the fetus during pregnancy (congenital CMV)
• To the newborn during delivery or through breastmilk (perinatal CMV)
• In households with young children and in daycare centers
• By contact with infected saliva, urine, vaginal fluid, or semen

What are the symptoms of CMV in newborns?

Most babies with CMV present at birth (congenital) do not have symptoms.Symptoms may include:

• Hearing loss. It may be found during regular newborn hearing screening.
• Small size, including small head size
• Enlarged liver and spleen
• Yellow color to skin (jaundice)
• Small broken blood vessels under the skin
• Eye problems

Babies with perinatal CMV may not have symptoms. Signs and symptoms may develop between 3 weeks and 6 months of age.They may include:

• Abnormal blood test results. For example, the results may show low platelet levels, low white blood cell counts, or abnormal liver function.
• Enlarged liver and spleen
• Swelling (inflammation) of the lungs (pneumonitis)

The symptoms of CMV may look like other health conditions. Make sure your child sees his or her healthcare provider for a diagnosis.

How is CMV in newborns diagnosed?

Most CMV infections in the mother are not diagnosed because the virus causes few symptoms.Tests for diagnosis include:

• In the fetus, amniotic fluid or fetal blood may be checked for CMV.
• In the newborn within 3 weeks from birth, urine and saliva cultures may find CMV.

Other tests may include:

• Blood tests, including complete blood count (CBC) and liver function tests
• CT scan of the brain
• Hearing exams
• Eye exams

Treatments

Treatment will depend on your child’s symptoms, age, and general health.It will also depend on how severe the condition is.

Health care providers usually recommend against treating newborns without symptoms. They do not agree on the treatment for many newborns with symptoms.

Treatment with medicine that works against the virus (ganciclovir) is recommended for some babies with CMV. Babies with the following may get this treatment:

• Swelling of the lungs
• Very low platelet counts
• Eye problems that may lead to vision loss

Babies with hearing loss or small head size may take ganciclovir long-term.

What are the complications of CMV in newborns?

Possible complications of CMV may include:

• Nervous system problems, like seizures
• Problems with growth and development
• Feeding problems

Can CMV in newborns be prevented?

Because it is so common, it is difficult to prevent a CMV infection. The following measures may help to prevent CMV infection, especially in pregnant women:

• Wash hands with soap and water, especially after changing diapers, feeding children, wiping a child’s nose or mouth, or touching toys.
• Avoid kissing young children on the mouth.
• Do not share forks, spoons, cups, or food with young children.

Key points about CMV in newborns

• CMV can be passed to a fetus during pregnancy and to a newborn during delivery or in breastmilk.
• Most babies with congenital CMV do not have symptoms.
• CMV can cause serious problems in the fetus and newborn.
• Some newborns with CMV may be treated with antiviral medicine.
• Washing hands with soap and water works well to remove the virus from the hands to prevent spreading CMV.

Next steps

Tips to help you get the most from a visit to your child’s healthcare provider:

• Know the reason for the visit and what you want to happen.
• Before your visit, write down questions you want answered.
• At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests.Also write down any new instructions your provider gives you for your child.
• Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are.
• Ask if your child’s condition can be treated in other ways.
• Know why a test or procedure is recommended and what the results could mean.
• Know what to expect if your child does not take the medicine or have the test or procedure.
• If your child has a follow-up appointment, write down the date, time, and purpose for that visit.
• Know how you can contact your child’s provider after office hours. This is important if your child becomes ill and you have questions or need advice.

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Cytomegalovirus (CMV) (for Parents) — All Children’s Hospital (XML)

How Long Does CMV Infection Last?

CMV does not always cause symptoms. If it does, how long they last can vary. This depends on how the infection happens and the age and general health of the person who has it.

For example, a serious CMV infection before birth may cause lifelong developmental problems.But CMV infection in teens may last only 2 to 3 weeks and cause no lasting problems.

Once a person has the infection, the virus stays in the body, lying dormant (not active). It can become «reactivated» (come back) weeks or years later. In people with very weakened immune systems (such as those with AIDS, or people getting chemotherapy), the reactivated virus may cause serious illness.Most people, though, will not get symptoms of CMV again.

Is CMV Contagious?

Yes. CMV can spread in a number of different ways. Anyone who has had a CMV infection, even without any symptoms, can spread the virus to others. But this mostly happens through close contact because the virus spreads through saliva (spit), breast milk, vaginal fluids, semen, urine (pee), and stool (poop).

In the United States, about 1% of infants are infected with CMV before birth. This happens because the mother had a first-time CMV infection or a reactivated infection during her pregnancy. An infected mother can pass the virus to her child before, during, or after birth.

The CMV virus also can spread in childcare centers or preschool settings, passing among kids on contaminated toys or by direct contact.

CMV also can be found in blood products and donated organs, causing infection after a blood transfusion or organ transplant. But preventive therapies are done for organ-transplant patients, and blood banks have procedures to help to prevent CMV from passing in blood products.

How Is CMV Diagnosed?

Doctors diagnose a CMV infection by testing fluid or a tissue sample from a person’s throat, pee, blood, or other body tissues or fluid.Blood tests also can look for antibodies that are part of the immune system’s response to a CMV infection. Sometimes other tests are used.

How Is CMV Treated?

There’s no specific treatment recommended for otherwise healthy kids with CMV infection.

But CMV infection can be serious and even life-threatening for:

• newborns infected before birth
• organ-transplant patients
• those being treated for cancer
• kids with severe immune disorders such as AIDS

These people may be treated with intravenous (IV) antiviral medicine, usually in a hospital.Oral antiviral medicine also might be used at home after the infection is under control and no longer poses a serious risk. These antiviral medicines can have serious side effects, so doctors use them with caution, especially in children.

In bone marrow transplant patients, the antiviral drug ganciclovir given in an IV can be helpful in fighting CMV infections. In rare cases, CMV-immune globulin might be given before someone receives an organ transplant.

Can CMV Infection Be Prevented?

Currently, there’s no vaccine to prevent CMV infection. Washing hands well and often can help reduce the risk of infection. This is especially important for:

• pregnant women
• women who might become pregnant
• childcare workers
• anyone who has close contact with children

It’s also a good idea to not share eating utensils with young kids and to avoid close contact with anyone who has the infection.

A mother who has a CMV infection should not stop breastfeeding her baby. The benefits of breastfeeding are believed to outweigh the risks of passing CMV to the baby, who is unlikely to develop any symptoms if infected.

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Cytomegalovirus (CMV) and pregnancy fact sheet

What is CMV?

Cytomegalovirus (CMV) is a common virus in the herpes virus family. Fifty per cent people have been infected by young adulthood and up to 85 per cent by 40 years of age.

Peaks of infection occur in children less than 2 years age, and during adolescence. Once a person becomes infected, the virus remains alive but usually inactive (dormant) within that person’s body for life.

It is rare for a person to get symptoms after the initial infection unless their immune system is weakened by severe illness and treatments (e.g. for cancer).

Reactivation can occur during pregnancy in women who have had infection previously, with a very small risk of transmission of CMV to the unborn baby.

What are the symptoms?

Children and adults with healthy immune systems do not usually develop symptoms when infected, but may develop an illness similar to glandular fever with tiredness, sore throat, swollen glands and fever.People with a weakened immune system are more likely to develop symptoms.

How is CMV spread?

Humans are the only source of CMV. The virus is found in urine, saliva, nasal mucous, breast milk, vaginal secretions and semen of infected people.

The risk of transmission from children born with disability due to CMV infection is no greater than that from children who have CMV infection without symptoms.

CMV is spread through:

• close contact with a person excreting the virus in their saliva, nasal mucous, urine or other body fluid
• handling children’s toys that have saliva or mucous on them, or handling contaminated items like dirty tissues or soiled nappies then touching the eyes, nose or mouth without first washing hands
• from mother to her unborn child as a result of maternal infection during pregnancy
• from mother to her unborn child as a result of virus reactivation during pregnancy
• breast milk of an infected woman who is breast feeding
• sexual contact.

Who is at risk?

If a woman is newly infected with CMV while pregnant, there is a risk that her unborn baby will also become infected (congenital CMV). Infected babies may, but not always, be born with a disability.

The highest risk to the unborn baby occurs when a woman who has never had CMV before is infected with the virus for the first time during pregnancy (primary CMV infection) and when infection occurs during the first half of the pregnancy.Infection during one pregnancy does not increase the risk for subsequent pregnancies. However, if primary infection occurs, consideration should be given to waiting for at least 12 months before becoming pregnant again.

Studies in Australia have shown that out of 1,000 live births, about 6 infants will have congenital CMV infection and 1-2 of those 6 infants (about 1 in 1000 infants overall) will have permanent disabilities of varying degree. These can include hearing loss, vision loss, small head size, cerebral palsy, developmental delay or intellectual disability, and in rare cases, death.

Sometimes, the virus may reactivate while a woman is pregnant but reactivation does not usually cause problems to the woman or her unborn baby.

Can congenital CMV be prevented?

There is no licensed vaccine against CMV currently available.

Pregnant women are recommended to take steps to reduce their risk of exposure to CMV and so reduce the risk of their developing baby becoming infected. Preventive steps include:

• wash hands often with soap and running water for at least 15 seconds and dry them thoroughly.This should be done especially after close contact with young children, changing nappies, blowing noses, feeding a young child, and handling children’s toys, dummies / soothers.
• do not share food, drinks, eating utensils or toothbrushes with young children.
• avoid contact with saliva when kissing a child.
• use simple detergent and water to clean toys, countertops and other surfaces that come into contact with children’s urine, mucous or saliva.

Child care workers who are pregnant or considering pregnancy should pay particular attention to good hand hygiene, especially after changing nappies or assisting with blowing noses or toileting.

How is congenital CMV diagnosed?

A person who has been infected with CMV will develop antibodies in their blood that indicate infection has occurred, either recently, or in the past. These antibodies stay in the body for the rest of that person’s life. Other tests, that detect the virus, are used to determine if a person has an active CMV infection.

Testing for CMV is not routinely recommended for all women during pregnancy or for newborn babies. Testing for CMV should only be offered to pregnant women if they come into frequent contact with large numbers of very young children (eg child care workers).

Infants born to mothers diagnosed with a primary CMV infection during pregnancy should be tested for congenital CMV infection. Babies who do not have a normal hearing screening test at birth (SWISH) can also be tested for congenital CMV, as hearing loss is the most common sign of congenital CMV.However, some infants with congenital CMV infection who appear healthy at birth develop hearing or vision loss over time. For this reason babies known to be infected should have their hearing and vision assessed regularly.

Can congenital CMV be treated?

Pregnant women diagnosed with primary (first) CMV infection should be referred for specialist follow up and counselling in order to receive up to date information about the risks and benefits of the available treatments, which are currently experimental.

Infants born with neurological disabilities due to CMV may benefit from early antiviral treatment; this should be discussed with a specialist paediatrician.

Most babies born with CMV infection grow up with normal health. Concerns about CMV infection can be discussed with a general practitioner or MotherSafe- a free telephone service that provides a comprehensive counselling service for women and their healthcare providers concerned about exposures during pregnancy and breastfeeding.

What is the public health response?

CMV infection is not a notifiable disease in New South Wales. Infection with CMV or congenital CMV does not affect access to school, work or childcare, including infants who have disabilities due to congenital CMV.

Further information

Transcript: Congenital CMV — Common and Commonly Missed

For further information please call your local Public Health Unit on 1300 066 055 .

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