By: Mary T. Caserta, MD, FAAP
Cytomegalovirus (CMV) is a common virus in the same family as the virus that causes chickenpox. When a baby is infected with CMV before birth, it is called congenital cytomegalovirus (cCMV). Congenital CMV is the most common infection acquired before birth in the United States.
Read on to learn how CMV affects children and adults, how congenital CMV is diagnosed and treated, how the virus spreads and what to know if you are pregnant.
How does CMV affect children?
CMV infection is generally mild. In fact, most people who get CMV have no symptoms at all and may never know they were infected.
For babies, the timing of infection matters. Most newborns with
congenital CMV infection have no signs of illness at birth. While many remain healthy, some develop hearing and developmental differences or other health challenges during infancy or childhood.
CMV infection acquired after birth does not usually cause major symptoms or long-term health problems for healthy children. However, it can cause serious illness in people who have conditions that lead to a weakened immune system.
CMV disease: when infection leads to health problems
About 1 in 5 babies with
congenital CMV infection will have congenital disability or other long-term health issues.
Congenital CMV is one of the leading causes of childhood hearing loss. It can also lead to learning disabilities.
Newborns may have low birth weight,
jaundice (yellowing of the skin and eyes), a small head compared to their body, an enlarged liver or a
skin rash.
- Teens who acquire CMV infection may have symptoms similar to infectious
mononucleosis. These may include fever that lasts more than a few days, sore throat, body aches and fatigue.
Children with
immune system compromise may have symptoms that affect their lungs, liver, kidneys, bone marrow or bowels. The infection can also cause problems for children who receive an organ transplant.
Why is CMV infection so common?
More than half of adults acquire CMV infection by age 40. Once a person is infected, the virus stays in their body for the rest of their life—usually in a resting or inactive state. But the virus can become active and be detected in that person's spit, urine or other body fluids. Because of this, people can spread it to others through close contact.
How CMV spreads
CMV infection spreads through contact with body fluids such as spit (saliva), tears, urine and blood.
The virus can spread among infants, children and adults at home, in child care settings and through close personal contact, including:
during diaper changes
while bathing young children
during close contact such as kissing, placing an infant's
pacifier in your mouth or sharing food
CMV can pass during pregnancy to the fetus through the placenta and cause congenital CMV. It can pass to the infant through fluids in the birth canal during childbirth and to babies through breast milk.
Let's Stop Congenital CMV: Pippa's Story
By: Amanda Devereaux, RN, BSN
Although most people expect to have a healthy delivery, about 1 in 33 babies in the U.S. have a health condition at
birth. Our daughter's condition stemmed from an infectious disease called cytomegalovirus, or CMV.
Before my daughter's diagnosis, I knew very little about CMV. It is a common virus, and the infection is not harmful for most people.
But when the virus crosses the placenta during pregnancy, it may have lasting effects on the baby's body and brain. This type of CMV infection before birth is called congenital CMV (cCMV).
I did not know that I was at higher risk of acquiring CMV infection because I had a toddler at home. But after our 20-week ultrasound, we found out that I had a CMV infection early in my second pregnancy. The infection passed to our daughter, Pippa, in the womb. She was severely affected by cCMV.
Because she was diagnosed early, Pippa had access to early intervention, monitoring and antiviral treatment right away. She began walking at age 2 ½ years. Although she is non-speaking, she uses an augmentative and alternative communication (AAC) device to communicate. Pippa loves bowling, going for walks and bike rides and Daniel Tiger. She loves riding the bus to school each morning and is described as a leader in her school classroom.
There is no vaccine to prevent CMV. But there are
steps that pregnant people can take before and during pregnancy to reduce the risk. I wish I had known about these tips while I was pregnant—not because we love Pippa any less, but because her life is more difficult due to cCMV and we deserved to have the knowledge to reduce the risk during pregnancy.
A congenital CMV diagnosis can be a big challenge for families. It took time for us to
adjust. Our dreams for Pippa are different than they once were, and that is OK! We are learning to embrace this.
Pippa is a happy, wonderful child, and she makes us laugh every day. However, we often think about what her life—and ours—might be like if we had known about CMV during pregnancy. We hope that someday all cases of cCMV can be prevented and no more families will be affected by this devastating virus.
Amanda Devereaux RN, BSN, is a program director for the
National CMV Foundation. She has served on the Iowa Congenital and Inherited Disorders
Advisory Committee and was co-president of Iowa Hands & Voices organization to support families of children who are deaf or hard of hearing.
Ways to prevent spreading CMV infection
These steps can help reduce the spread of infection:
- Wash your hands often, especially before and after feeding infants and toddlers, wiping noses or faces, changing diapers or handling pacifiers and other items that have been in contact with saliva.
- Keep children's pacifiers out of other people's mouths, including those of parents, caregivers and other children.
- Avoid sharing cups, utensils and toothbrushes.
How is CMV diagnosed and treated?
To diagnose a CMV infection, a pediatrician or other health care clinician may order
lab tests of urine, saliva, blood or other body fluids.
Fortunately, most children with CMV do not need treatment. Medical treatment is recommended for
newborns with congenital CMV who have
signs of illness. Even with treatment, babies with CMV infection may have or develop hearing changes or other developmental challenges.
Serious CMV infections in children with immune system compromise, such as those with HIV infection or an organ transplant, can be treated with a medicine called ganciclovir or valganciclovir. This medicine is also used to treat newborns with
moderate or severe congenital CMV disease.
Can newborns be tested congenital CMV?
Hearing loss may be the only sign of congenital CMV. If a baby does not pass a newborn hearing test, additional testing may be recommended to look for congenital CMV, especially if testing can be completed within the first few weeks after birth. Early diagnosis helps families and pediatricians plan appropriate monitoring, support services and treatment when necessary.
Key takeaways for parents
Many of us do not know we have a CMV infection. Even without symptoms, we can spread the virus through body fluids like urine and saliva. But there are ways to help reduce the spread of the virus to those who are pregnant and others at risk of serious illness. Learning about CMV during pregnancy and infancy can help you find prevention opportunities and seek care when needed.
More information
About Dr. Caserta
 Mary T. Caserta, MD, FAAP, is a Professor of Pediatrics in Infectious Diseases at the University of Rochester Medical Center (URMC) in New York. Her early research focused on human herpesvirus research. Recently, her research has focused on viral respiratory disease. For over 10 years, she also has conducted clinical trials, including on the treatment of congenital CMV infection. Dr. Caserta is a fellow of the Infectious Disease Society of America and member of the Pediatric ID Society. Dr. Caserta is a member of the American Academy of Pediatrics Committee on Infectious Diseases.
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