June is National Congenital Cytomegalovirus Awareness Month

National Congenital Cytomegalovirus Awareness Month is observed annually in June to raise awareness about congenital cytomegalovirus, more commonly known as CMV, the most common infectious cause of birth defects. 

CMV is the most common infectious cause of birth defects in the United States. About 1 out of 5 babies with congenital CMV infection will have birth defects or other long-term health problems, such as hearing loss.  In 2011, Congress passed a resolution naming June “National CMW Awareness Month.” The CDC takes this opportunity to increase awareness of congenital cytomegalovirus (CMV) among healthcare providers, pregnant women, and parents.

What is Cytomegalovirus?

Cytomegalovirus (CMV) is a common virus. Once infected, your body retains the virus for life. Most people don't know they have CMV because it rarely causes problems in healthy people.

If you're pregnant or if your immune system is weakened, CMV is cause for concern. Women who develop an active CMV infection during pregnancy can pass the virus to their babies, who might then experience symptoms. For people who have weakened immune systems, especially people who have had an organ, stem cell, or bone marrow transplant, CMV infection can be fatal.

CMV spreads from person to person through body fluids, such as blood, saliva, urine, semen, and breast milk. There is no cure, but there are medications that can help treat the symptoms.

History of National Congenital Cytomegalovirus Awareness Month

The origins of newborn screening can be traced to the 1950s and 1960s when Robert Guthrie pioneered a blood test (bacterial inhibition assay) to screen for phenylketonuria in newborn babies on the second day of life. In 1962, using funds from the Child Health Bureau, Guthrie began a pilot study in 29 states of the United States, enrolling 400,000 newborns. Because of the success of this study, many states began adopting newborn screening. By 1965, newborn screening for phenylketonuria had become mandatory in 27 states, with others giving public health departments the power to decide. In the 1970s, the testing for congenital hypothyroidism was included in newborn screening.

In the early 1990s, scientists introduced tandem mass spectrometry as more effective equipment for newborn screening. While as affordable as Guthrie’s bacterial inhibition assay, tandem mass spectrometry detected more disorders than previous techniques using a single drop of blood. The introduction of tandem mass spectrometry allowed an expansion in the number of disorders screened in various states. Over time, the technology began replacing Guthrie’s bacterial inhibition assay as the primary technique for newborn screening. However, the filter paper developed by Guthrie is still used today across the globe.

In March 2005, the American College of Medical Genetics released a report recommending that all states screen infants for 29 specific disorders — mainly using tandem mass spectrometry. On April 24, 2008, the administration of President George W. Bush introduced the Newborn Screening Saves Lives Act of 2007. This act aimed to increase the awareness of screening newborns to identify specific disorders. In 2011, Congress passed a resolution, designating June as National Congenital Cytomegalovirus Awareness Month.

What Causes CMV?

CMV is related to the viruses that cause chickenpox, herpes simplex, and mononucleosis. CMV may cycle through periods when it lies dormant and then reactivates. If you're healthy, CMV mainly stays dormant.

When the virus is active in your body, you can pass the virus to other people. The virus is spread through body fluids — including blood, urine, saliva, breast milk, tears, semen, and vaginal fluids. Casual contact doesn't transmit CMV.

Ways the virus can be transmitted include:

• Touching your eyes or the inside of your nose or mouth after coming into contact with the body fluids of an infected person.
• Sexual contact with an infected person.
• The breast milk of an infected mother.
• Organ, bone marrow, stem cell transplantation, or blood transfusions.
• Birth. An infected mother can pass the virus to her baby before or during birth. The risk of transmitting the virus to your baby is higher if you become infected for the first time during pregnancy.

Symptoms of CMV

Most healthy people who are infected with CMV may experience no symptoms. Some experience minor symptoms. People who are more likely to experience signs and symptoms of CMV include:

• Newborns who became infected with CMV before they were born (congenital CMV).
• Infants who become infected during birth or shortly afterward (perinatal CMV). This group includes babies infected through breast milk.
• People who have weakened immune systems, such as those who have had an organ, bone marrow, or stem cell transplant, or those who are infected with HIV.

Babies

Most babies who have congenital CMV appear healthy at birth.

A few babies who have congenital CMV who appear healthy at birth develop signs over time — sometimes not for months or years after birth. The most common of these late-occurring signs are hearing loss and developmental delay. A small number of babies may also develop vision problems.

The following signs and symptoms are more common in babies who have congenital CMV and who are sick at birth:

• Premature birth
• Low birth weight
• Yellow skin and eyes (jaundice)
• Enlarged and poorly functioning liver
• Purple skin splotches or a rash or both
• Abnormally small head (microencephaly)
• Enlarged spleen
• Pneumonia
• Seizures

People with weakened immunity

If your immune system is weakened, you might experience serious problems that affect your eyes, lungs, liver, esophagus, stomach, intestines, or brain.

Healthy adults

Most people who are infected with CMV and who are otherwise healthy experience few if any symptoms. When first infected, some adults may have symptoms similar to infectious mononucleosis, including:

• Fatigue
• Fever
• Sore throat
• Muscle aches

CMV Information for Pregnant Women and Parents

Most people have been infected with cytomegalovirus (CMV), but do not have symptoms. If a pregnant woman is infected with CMV, she can pass it to her developing baby. This is called congenital CMV, and it can cause birth defects and other health problems.

For pregnant women

• You can pass CMV to your baby. If you are pregnant and have CMV, the virus in your blood can cross through your placenta and infect your developing baby. This is more likely to happen if you have a first-time CMV infection while pregnant but can also happen if you have a subsequent infection during pregnancy.

• You are not likely to be tested for CMV. It is not recommended that doctors routinely test pregnant women for CMV infection. This is because laboratory tests cannot predict which developing babies will become infected with CMV or have long-term health problems.

• You may be able to reduce your risk. You may be able to lessen your risk of getting CMV by reducing contact with saliva and urine from babies and young children. The saliva and urine of children with CMV have high amounts of the virus. You can avoid getting a child’s saliva in your mouth by, for example, not sharing food, utensils, or cups with a child. Also, you should wash your hands after changing diapers. These cannot eliminate your risk of getting CMV, but may lessen the chances of getting it.

For parents

About 1 out of every 200 babies is born with congenital CMV. About 1 out of 5 of these babies will have birth defects or other long-term health problems

• Babies with congenital CMV may show signs at birth. Some signs that a baby might have congenital CMV infection when they are born are: small head size, seizures, rash, liver, spleen, and lung problems. Tests on a baby’s saliva, urine, or blood done within two to three weeks after birth can confirm if the baby has congenital CMV.

• Early treatment may help. Babies who show signs of congenital CMV at birth may be treated with medicines called antivirals. Antivirals may decrease the severity of health problems and hearing loss but should be used with caution due to side effects.

• Long-term health problems may occur. Babies with signs of congenital CMV at birth are more likely to have long-term health problems, such as: hearing loss, intellectual disability, vision loss, seizures, and lack of coordination, or weakness. Some babies with congenital CMV but without signs of disease at birth may still have or develop hearing loss. Hearing loss may be present at birth or may develop later in babies who passed their newborn hearing test. Sometimes, hearing loss worsens with age.

• Hearing checks and therapies are recommended. Children with congenital CMV should have regular hearing checks. Children with hearing loss should receive services such as speech or occupational therapy. These services help ensure they develop language, social, and communication skills. The earlier your child can get hearing checks and therapies, the more he or she can benefit from them.

Prevention

Careful hygiene is the best prevention against CMV. You can take these precautions:

• Wash your hands often. Use soap and water for 15 to 20 seconds, especially if you have contact with young children or their diapers, saliva, or other oral secretions. This is especially important if the children attend child care.
• Avoid contact with tears and saliva when you kiss a child. Instead of kissing a child on the lips, for instance, kiss on the forehead. This is especially important if you're pregnant.
• Avoid sharing food or drinking out of the same glass as others. Sharing glasses and kitchen utensils can spread CMV.
• Be careful with disposable items. When disposing of diapers, tissues, and other items that have been contaminated with bodily fluids, wash your hands thoroughly before touching your face.
• Clean toys and countertops. Clean any surfaces that come in contact with children's urine or saliva.
• Practice safe sex. Wear a condom during sexual contact to prevent spreading CMV through semen and vaginal fluids.

If you have weakened immunity, you may benefit from taking antiviral medication to prevent CMV disease.

Experimental vaccines are being tested for women of childbearing age. These vaccines may be useful in preventing CMV infection in mothers and infants, and reducing the chance that babies born to women who are infected while pregnant will develop disabilities.

When To See A Doctor

See a doctor if you have a weakened immune system and you're experiencing symptoms of CMV infection. For people who have weakened immune systems, CMV infection can be serious or even fatal. People who have undergone stem cell or organ transplants seem to be at the greatest risk. See your doctor as well if you develop a mononucleosis-like illness while you're pregnant.

If you have CMV but are otherwise healthy, and you're experiencing any mild, generalized illness, you could be in a reactivation period. Self-care, such as getting plenty of rest, should be enough for your body to control the infection.

If you know you were infected with CMV during your pregnancy, tell your baby’s doctor. They will likely assess your baby for hearing or vision problems.

Observing National Congenital Cytomegalovirus Awareness Month

Share information about congenital cytomegalovirus

Sharing information is one of the easiest ways to make the most impact during National Congenital Cytomegalovirus Awareness Month. You can share anything from details about the virus and facts to signs, symptoms, and how to prevent transmitting it to unborn infants and children. Share the information on your social media pages, with colleagues at your workplace, or over coffee with friends and acquaintances.

Donate to charity

Another way to make the most impact is to donate to foundations and not-for-profit organizations focusing on congenital cytomegalovirus. By doing so, you can contribute to vaccine development, increase awareness and reduce the effects of the virus. One of such organizations you can donate to is the National CMV Foundation.

Organize an awareness program

If you are already a member of a C.M.V. organization or a health practitioner, you can organize activities or events during National Congenital Cytomegalovirus Awareness Month to increase your impact. These could be public health forums, educational programs, or community outreach.

Sources:

https://www.cdc.gov/cmv/resources/index.html

https://www.cdc.gov/cmv/fact-sheets/parents-pregnant-women.html

https://www.mayoclinic.org/diseases-conditions/cmv/symptoms-causes/syc-20355358