Recurrent maternal CMV infection associated with symptomatic congenital infection

Results from a questionnaire study in Portugal

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Abstract

Objective Human cytomegalovirus (CMV) is the most widespread agent of congenital infection in humans and is still a challenging issue. Despite lower rates of vertical transmission being associated with recurrent infection when compared with primary infection, the first still represents the majority of congenital infections worldwide. Based on data from active reporting, we explored the influence of maternal primary/non-primary infection both on the presentation and outcome of congenital CMV infection in early childhood. Design Infants with positive viruria during the first 3 weeks of life were reported through the Portuguese Paediatric Surveillance Unit. Patients Infants born between 2006 and 2011 with confirmed congenital CMV infection. Methods Maternal infection was considered primary if CMV IgG seroconversion occurred during pregnancy or low avidity IgG was documented; it was considered non-primary if positive IgG was documented before pregnancy or high avidity CMV IgG was present early in pregnancy. Follow-up questionnaires were sent up to 6 years of age. Results Forty confirmed cases of congenital CMV infection were reported (6.6:10 5 live births, 95% CI 4.81 to 8.92); 22 out of 40 were asymptomatic. The odds for non-primary maternal infection if the offspring was symptomatic at birth were 6.2 (95% CI 1.2 to 32.27). Conclusion The reported number of confirmed cases of congenital CMV infection was much lower than expected. Under-reporting and missed diagnosis were considered possible reasons. Non-primary maternal infections were associated with symptomatic congenital CMV infection in the offspring. Maternal recurrent infections can have a significant impact on the total number of symptomatic infections in Portugal.

Original languageEnglish
Article numbere000455
JournalBMJ Paediatrics Open
Volume3
Issue number1
DOIs
Publication statusPublished - 1 Jun 2019

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Portugal
Cytomegalovirus Infections
Mothers
Infection
Immunoglobulin G
Cytomegalovirus
Pregnancy
Surveys and Questionnaires
Live Birth
Research Design
Parturition
Pediatrics

Keywords

  • infectious diseases
  • neonatology
  • virology

Cite this

@article{df855ba24bdf473b9debd7f1200ddb74,
title = "Recurrent maternal CMV infection associated with symptomatic congenital infection: Results from a questionnaire study in Portugal",
abstract = "Objective Human cytomegalovirus (CMV) is the most widespread agent of congenital infection in humans and is still a challenging issue. Despite lower rates of vertical transmission being associated with recurrent infection when compared with primary infection, the first still represents the majority of congenital infections worldwide. Based on data from active reporting, we explored the influence of maternal primary/non-primary infection both on the presentation and outcome of congenital CMV infection in early childhood. Design Infants with positive viruria during the first 3 weeks of life were reported through the Portuguese Paediatric Surveillance Unit. Patients Infants born between 2006 and 2011 with confirmed congenital CMV infection. Methods Maternal infection was considered primary if CMV IgG seroconversion occurred during pregnancy or low avidity IgG was documented; it was considered non-primary if positive IgG was documented before pregnancy or high avidity CMV IgG was present early in pregnancy. Follow-up questionnaires were sent up to 6 years of age. Results Forty confirmed cases of congenital CMV infection were reported (6.6:10 5 live births, 95{\%} CI 4.81 to 8.92); 22 out of 40 were asymptomatic. The odds for non-primary maternal infection if the offspring was symptomatic at birth were 6.2 (95{\%} CI 1.2 to 32.27). Conclusion The reported number of confirmed cases of congenital CMV infection was much lower than expected. Under-reporting and missed diagnosis were considered possible reasons. Non-primary maternal infections were associated with symptomatic congenital CMV infection in the offspring. Maternal recurrent infections can have a significant impact on the total number of symptomatic infections in Portugal.",
keywords = "infectious diseases, neonatology, virology",
author = "Paulo Paix{\~a}o and Brito, {Maria Jo{\~a}o} and Daniel Virella and Neto, {Maria Teresa}",
year = "2019",
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doi = "10.1136/bmjpo-2019-000455",
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T1 - Recurrent maternal CMV infection associated with symptomatic congenital infection

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AU - Brito, Maria João

AU - Virella, Daniel

AU - Neto, Maria Teresa

PY - 2019/6/1

Y1 - 2019/6/1

N2 - Objective Human cytomegalovirus (CMV) is the most widespread agent of congenital infection in humans and is still a challenging issue. Despite lower rates of vertical transmission being associated with recurrent infection when compared with primary infection, the first still represents the majority of congenital infections worldwide. Based on data from active reporting, we explored the influence of maternal primary/non-primary infection both on the presentation and outcome of congenital CMV infection in early childhood. Design Infants with positive viruria during the first 3 weeks of life were reported through the Portuguese Paediatric Surveillance Unit. Patients Infants born between 2006 and 2011 with confirmed congenital CMV infection. Methods Maternal infection was considered primary if CMV IgG seroconversion occurred during pregnancy or low avidity IgG was documented; it was considered non-primary if positive IgG was documented before pregnancy or high avidity CMV IgG was present early in pregnancy. Follow-up questionnaires were sent up to 6 years of age. Results Forty confirmed cases of congenital CMV infection were reported (6.6:10 5 live births, 95% CI 4.81 to 8.92); 22 out of 40 were asymptomatic. The odds for non-primary maternal infection if the offspring was symptomatic at birth were 6.2 (95% CI 1.2 to 32.27). Conclusion The reported number of confirmed cases of congenital CMV infection was much lower than expected. Under-reporting and missed diagnosis were considered possible reasons. Non-primary maternal infections were associated with symptomatic congenital CMV infection in the offspring. Maternal recurrent infections can have a significant impact on the total number of symptomatic infections in Portugal.

AB - Objective Human cytomegalovirus (CMV) is the most widespread agent of congenital infection in humans and is still a challenging issue. Despite lower rates of vertical transmission being associated with recurrent infection when compared with primary infection, the first still represents the majority of congenital infections worldwide. Based on data from active reporting, we explored the influence of maternal primary/non-primary infection both on the presentation and outcome of congenital CMV infection in early childhood. Design Infants with positive viruria during the first 3 weeks of life were reported through the Portuguese Paediatric Surveillance Unit. Patients Infants born between 2006 and 2011 with confirmed congenital CMV infection. Methods Maternal infection was considered primary if CMV IgG seroconversion occurred during pregnancy or low avidity IgG was documented; it was considered non-primary if positive IgG was documented before pregnancy or high avidity CMV IgG was present early in pregnancy. Follow-up questionnaires were sent up to 6 years of age. Results Forty confirmed cases of congenital CMV infection were reported (6.6:10 5 live births, 95% CI 4.81 to 8.92); 22 out of 40 were asymptomatic. The odds for non-primary maternal infection if the offspring was symptomatic at birth were 6.2 (95% CI 1.2 to 32.27). Conclusion The reported number of confirmed cases of congenital CMV infection was much lower than expected. Under-reporting and missed diagnosis were considered possible reasons. Non-primary maternal infections were associated with symptomatic congenital CMV infection in the offspring. Maternal recurrent infections can have a significant impact on the total number of symptomatic infections in Portugal.

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