Cytomegalovirus (CMV) Public Health Initiative

Cytomegalovirus is generally passed from infected people to others through direct contact with body fluids, such as urine or saliva. CMV can also be found in tears, blood, and semen.

Most healthy children and adults infected with CMV don't feel ill so they don't know that they have been infected; others may have mild flu-like symptoms such as fever, sore throat, fatigue or swollen glands. The only way to know for sure that you have CMV is to have your medical provider test you for it.

CMV is a member of the herpes viruses so once you have been infected, it remains in your system, and can re-activate in the future. When someone catches CMV for the first time, it is called a primary infection. When someone who already has had the virus gets infected with another strain, or their current strain becomes active again, this is called a nonprimary or secondary infection.

• 30-40% of pregnant people who experience a primary infection during pregnancy will have an infant affected by congenital CMV
• 1-2% of pregnant people who experience a secondary infection during pregnancy will have an infant affected by congenital CMV

Although it is more likely that the fetus will be affected by a primary infection, a secondary infection may still cause harm to the baby.
CMV transmits easier to the fetus later in the pregnancy but can cause more damage to the fetus if infected early in pregnancy. It is very important to practice behavioral prevention strategies even before getting pregnant.

There is currently no vaccine available to prevent CMV. Research is on-going for the development of a vaccine.

If you're pregnant or planning a pregnancy, the best way to protect your baby from CMV is to protect yourself.

1. When you kiss a young child, try to avoid contact with saliva. For example, you might kiss on the forehead rather than the lips.
2. Try not to put things in your mouth that have just been in a child’s mouth. For example:
   • Cups
   • Forks or Spoons
   • Pacifiers
3. Try not to share food, drinks, or a toothbrush with a child.
4. Wash your hands after touching a child’s saliva or urine, especially after:
   • Wiping a child’s nose, mouth, or tears
   • Changing diapers
5. Use soap and water or a disinfectant to clean toys, countertops, and other surfaces that may have a child's saliva or urine on them.
6. Act as if everyone around you has a cold or a stomach bug and practice the same prevention strategies!

Pregnant people should avoid getting body fluids in their eyes, nose or mouth. One of the most common exposures is through contact with saliva or urine of young children who recently had the virus.

Research shows that pregnant people who work closely with small children in settings such as child care facilities or have other young children in the home while pregnant may be at greater risk. The Centers for Disease Control and Prevention (CDC) estimates that ⅓ of American children have been infected with the virus by 5 years of age.

Pregnant people can also be exposed to the CMV virus through body fluids during sexual activity. Those who participate in high-risk behaviors are at greater risk.
The CDC states that the risk of getting CMV through casual contact, such as hugging, is very small.

If you're pregnant or planning a pregnancy, the best way to protect your baby from CMV is to protect yourself.

• Don't share food, drinks, or eating utensils with a child.
• Do not put a child's pacifier in your mouth.
• Do not share a toothbrush with a young child.
• Use soap and water or a disinfectant to clean toys, countertops, and other surfaces that may have a child's saliva or urine on them.
• Avoid contact with a child's saliva when kissing or snuggling.
• Wash your hands often with soap and water for 15-20 seconds, especially after:
  • changing diapers
  • feeding a young child
  • wiping a young child’s nose or drool
  • handling children’s toys
• CMV can be transmitted during sexual activity

When infected with CMV, most people have no symptoms, but some may have symptoms resembling mononucleosis or influenza. People who develop a mononucleosis or flu-like illness during pregnancy should be tested for CMV. Testing should also be considered for people who have close contact with children or adults with known CMV infection. CMV can cause fetal abnormalities that are visualized by ultrasound. If abnormalities are detected during routine fetal ultrasonography, CMV testing may be important and should be discussed with a high-risk obstetrician (Maternal-Fetal Medicine physician).

For more information on a suspected maternal CMV infection and how to test for it see CMV for Obstetrical Health Care Providers opens in a new tab.

In order to identify infants at risk for congenital CMV-associated progressive hearing loss, infants who fail the second hearing screening, unilaterally or bilaterally, should be tested for CMV no later than 3 weeks of age. This can be performed with a PCR assay for CMV on urine or saliva. After 3 weeks of age, these tests cannot differentiate between congenital CMV and CMV acquired postnatally. It is very important that saliva swabbing be done at least 120 minutes after feeding as CMV could be present in breastmilk. If a saliva test comes back positive, a repeat test on urine should be conducted as soon as possible.

To facilitate timely, accurate testing, the Department of Health and Human Services has a state order for both diagnostic audiologic (Auditory Brainstem Response/ABR) and CMV testing.

These infants should undergo a complete diagnostic audiologic evaluation as soon as possible. Frequent audiologic re-assessment is also needed to promptly identify and treat late-onset or progressive hearing loss, both hallmarks of cCMV-induced hearing loss. A general recommendation for all babies with congenital CMV (regardless of their newborn hearing screening results) is to have a hearing assessed every 3 months in the first three years of life, and then every six months through age six years, annually thereafter - as always, sooner if concerns or changes are noted.

A referral to the Baby Watch Early Intervention Program should also be made. A CMV positive diagnosis is an automatic qualifier for Early Intervention services.

As CMV can have serious consequences in those with compromised immune systems, family counseling should be conducted as congenitally-infected infants can shed the virus in their body fluids for years.

There is limited data on the use of antiviral medications in infants with symptomatic congenital CMV infection. Studies are ongoing to determine what types of therapy are of greatest benefit to CMV-infected infants. Infants with suspected congenital CMV infections should be evaluated by physicians who specialize in these infections.

Because cCMV related symptoms, like hearing loss, may have delayed onset and/or be progressive, it is important infected infants receive timely follow-up. When a child has been diagnosed, the following steps are recommended to help improve the health outcomes of the child:

• Diagnostic audiological evaluation ASAP with frequent monitoring of hearing as recommended above;
• Referral to an Infectious Disease physician;
• Referral to an ENT if the baby has diagnosed hearing loss;
• Referral to a pediatric Ophthalmologist to rule out CMV induced visual concerns;
• Referral to Early Intervention.

To help with this follow-up process, one very helpful resource is the multi-disciplinary cCMV Clinic at Primary Children’s Hospital, facilitated by Albert Park, MD. This clinic includes an expert team of specialists that provide consultation, evaluation, treatment as needed, follow-up and support to cCMV babies, families, and their providers. The cCMV Clinic phone number is 801-662-1705. Note: It is important that babies that have tested positive for cCMV receive continual follow-up, as symptoms may develop over time.