55 - Prevalence and Clinical Characteristics of Congenital CMV (cCMV) Infection in a Population-Based Universal Newborn Screening Study in Minnesota

Poster Board #: 55
Publication #: 1905-HP-QA.55

Background: With an estimated prevalence of 4.5 per 1,000 live births, cCMV is the most common congenital infection in the United States, but optimal screening strategies and clinical outcomes remain incompletely characterized.


Objective: To estimate prevalence and describe the demographic and clinical characteristics of infants with cCMV identified in a universal screening study in an unselected cohort of Minnesota newborns.


Design/Methods: Dried blood spots (DBS) and saliva collected 1-2 days after birth were compared in a cCMV screening study. The sensitivity and specificity of CMV PCR were 92.9 and 99.9% for saliva, and 85.7 and 100% for DBS, respectively. In screen-positive infants, urine CMV PCR confirmation was obtained by 3 weeks of age and diagnostic evaluation undertaken. Infections were categorized as: 1) moderately to severely symptomatic; 2) mildly symptomatic; 3) asymptomatic with isolated sensorineural hearing loss (SNHL); and 4) asymptomatic.


Results: Among 15,619 (97.1%) screened infants in the well-baby nursery and 473 (2.9%) in the neonatal intensive care unit, 68 and 4 had cCMV, corresponding to prevalence of 4.4 per 1,000 and 8.5 per 1,000, respectively (Table 1). Among 72 infants with cCMV, 59 (82%; 4.9 per 1,000) were born to non-Hispanic White women and 8 (11%; 4.8 per 1,000) to non-Hispanic Black women; median maternal age was 32.0 years (interquartile range: 28.8-34.0). Twenty-seven (37.5%) cCMV cases were in first-born infants and 45 (62.5%) were in infants born to multiparous mothers. Prevalence was higher among second-born than first-born infants (prevalence ratio: 1.8; 95% CI: 1.1-2.9; p=0.02). Among 72 infants with cCMV, 5 (7%) had moderate-to-severe symptoms and 7 (10%) were mildly symptomatic. Four asymptomatic infants had isolated SNHL (delayed in onset in one infant), and 56 were asymptomatic with normal hearing (Table 2). In total, 6 (8.3%) infants had SNHL. Mean saliva viral load in infants with confirmed cCMV and any symptomatic disease was 3.2×10³ IU/ml, versus 7×10⁶ IU/ml in asymptomatic infants (p<0.05, Mann-Whitney; Figure 1). Antiviral therapy was prescribed to 14/72 (19.4%) infants.

Conclusion(s): The overall prevalence of cCMV was similar to that reported in previous studies, but a higher prevalence in infants of non-Hispanic White women (4.8 v. 2.7 per 1,000) was observed. A significantly higher prevalence was noted among second-born compared to first-born infants. Salivary viral load at birth did not correlate with clinical outcomes.


Table 1. Prevalence of cCMV infection by selected maternal demographics and infant characteristics, MN universal screening study.


Table 2. Clinical classification of infants with cCMV infection identified through newborn CMV screening, MN [based on DOI: 10.1016/S1473-3099(17)30143-3].


Figure 1. Viral load comparisons at time of newborn saliva screening in infants with any cCMV-associated symptoms (left panel, shaded circles) and asymptomatic infants (right panel, shaded boxes; four infants in this group were asymptomatic, but had isolated SNHL and are indicated in open boxes). There was no correlation between the viral load in saliva and the likelihood of cCMV-associated symptoms; infants in the asymptomatic category had a higher mean salivary viral load than symptomatic infants (see text for details).

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Authors/Institutions: Mark R. Schleiss, University of Minnesota, Department of Pediatrics, Minneapolis, Minnesota, United States; Erin A. Osterholm, Department of Pediatrics, Minneapolis, Minnesota, United States; Nelmary Hernandez-Alvarado, University of Minnesota, Department of Pediatrics, Minneapolis, Minnesota, United States; Ryan Shanley, University of Minnesota, Minneapolis, Minnesota, United States; Kristin E. Gravel, Lions Children's Hearing and ENT Clinic, Minneapolis, Minnesota, United States; Rebecca Kruc, University of Minnesota Medical School, Minneapolis, Minnesota, United States; Sondra Rosendahl, Minnesota Department of Health, St. Paul, Minnesota, United States; Mark McCann, Minnesota Department of Health, St. Paul, Minnesota, United States; Abbey Sidebottom, Allina Health, Minneapolis, Minnesota, United States; Minal M. Amin, Centers for Disease Control and Prevention, Atlanta, Georgia, United States; Sheila Dollard, Centers for Disease Control and Prevention, Atlanta, Georgia, United States; Tatiana M. Lanzieri, Centers for Disease Control and Prevention, Atlanta, Georgia, United States