Congenital Cytomegalovirus

CDC's Information on cCMV¹

How common is CMV infection?

Over half of adults by age 40 have been infected with CMV, and the virus remains in the body for life, occasionally reactivating. Most people won't show any symptoms. But those with weakened immune systems and babies infected before birth are at risk of problems. In the U.S., around 1 in 200 babies are born with congenital CMV, and 1 in 5 of them will experience health issues. CMV is a common viral cause of birth defects and a leading non-genetic cause of hearing loss in the U.S.

How is CMV spread?

CMV is passed through body fluids like urine, saliva, blood, tears, semen, and breastmilk. People with CMV can spread the virus in different ways:

• Direct contact with urine or saliva, especially from babies and young children.
• Through sexual contact.
• From breastmilk.
• From organ transplants and blood transfusions.
• From a mother to her child during pregnancy (congenital)

What are cCMV symptoms in infants?

Most babies born with congenital CMV infection don't experience health issues. However, approximately 10% of them may have health problems at birth, which could include:

1. Rash
2. Jaundice (yellowing of the skin or eyes)
3. Microcephaly (small head)
4. Low birth weight
5. Intrauterine growth restriction (low weight)
6. Hepatosplenomegaly (enlarged liver and spleen)
7. Seizures
8. Retinitis (eye retina damage)

Around 40 to 60% of infants showing signs of congenital CMV disease at birth might face long-term health challenges, such as:

1. Hearing loss
2. Vision loss
3. Intellectual disability
4. Microcephaly (small head)
5. Lack of coordination or weakness
6. Seizures

Some babies may experience hearing loss, which may or may not be identified during the newborn hearing test.

How is cCMV diagnosed for infants?

Medical providers diagnose congenital CMV by looking for CMV DNA in the urine or saliva within 3 weeks (21 days) after birth. If the samples are collected more than three weeks after birth, it becomes challenging to determine if the infection is congenital or acquired after birth or delivery. So, it's crucial to perform the test within the first three weeks to get an accurate diagnosis.

How is cCMV treated?

Some babies born with congenital CMV infection might receive antiviral medicines, which could lower the risk of health issues and hearing loss if they show signs of the infection at birth. However, using antivirals for babies with congenital CMV infection who don't show signs at birth is not currently recommended.

Regardless of whether babies show signs at birth or not, those with congenital CMV infection should have regular hearing checks and developmental screenings. These check-ups are essential to monitor their health and development.

¹CDC's Cytomegalovirus (CMV) Overview

5 Tips to Prevent CMV Infection:

If you are pregnant or planning to become pregnant, it's essential to take simple steps to protect yourself and your baby from CMV. This virus can spread through young children's saliva or urine, so it's crucial to be cautious. Here are five practical tips to reduce the risk of contracting CMV:

1. Avoid Sharing Food, Utensils, Drinks, or Straws: Saliva may carry CMV and pass it to you or your unborn baby. Even though it might be tempting to share food with your child or not waste their leftovers, it's best to avoid sharing to stay safe.
2. Don't Put a Pacifier in Your Mouth: Cleaning your child's pacifier with your mouth can transmit CMV to you and your unborn baby. Instead, use your pinky to hold the pacifier if needed.
3. Be Careful with Kissing: Try not to kiss children under six years old on the lips or cheek to avoid saliva contact. Show your love by kissing them on the forehead or the top of their head and giving them a big, warm hug.
4. Keep Your Toothbrush to Yourself :Toddlers love to copy grown-ups, and that includes using your toothbrush. Store it in a place out of their reach to keep it clean and safe.
5. Wash Your Hands Regularly: Wash your hands with soap and water for at least 15-20 seconds, especially after activities like wiping a child's nose or drool, changing diapers, feeding a child, or handling their toys.

By following these simple tips, you can help protect yourself and your baby from CMV infection. Remember, taking small precautions can make a big difference in maintaining a healthy pregnancy.

cCMV Prevention Tip Resources:

CDC's Fact Sheet for Pregnant Women and Parents (English)

CDC's Fact Sheet for Pregnant Women and Parents (Spanish)

National CMV Foundation Prevention Tips

Understanding CMV and Hearing Loss in Young Children

In the United States, around 15-20% of bilateral moderate to profound sensorineural hearing loss (SNHL) cases among young children are caused by congenital cytomegalovirus (CMV) infection. For some babies, hearing loss might be the only sign of cCMV infection at birth.

Children with cCMV can also develop hearing loss later on, which is why infants who test positive for CMV on a neonatal screen need regular monitoring by audiology to check for any changes in their hearing ability.

It's crucial to follow up with another hearing screening if your baby didn't pass the initial test. This follow-up screening should be done before your baby turns one month old. As of October 10, 2024, all birthing facilities must test all infants for cCMV who fail their final hearing screening. See  cCMV Policy and Procedure Manual  for comprehensive procedures.

Why Test Infants with Failed Hearing Screening or Diagnosed Sensorineural Hearing Loss for cCMV?

Given the time-sensitivity of cCMV testing (prior to 21 days of life), a hearing loss diagnosis may not be confirmed; however, cCMV-associated congenital hearing loss can sometimes get worse over time. So, if a baby has hearing loss related to CMV, it's important to have regular check-ups with a specialized audiologist who knows how to assess and treat hearing problems in infants and children. These check-ups help monitor the hearing loss and keep track of any changes.

The timing and frequency of these visits will be different for each child, as recommended by the audiologist. In general, it's not unusual for audiologic evaluations to happen every 3 months during the first 3 years of life, and then every 6 months until the child turns 6 years old.

Source: CDC 

cCMV and Hearing Loss Resources:

CDC's cCMV and Hearing Loss Fact Sheet (English)

CDC's cCMV and Hearing Loss Fact Sheet (Spanish)

National CMV Foundation

Baby's First Test: cCMV

Pediatricians and other specialists play an important role in making sure that children with congenital CMV infection are assessed and treated as needed.

Recognizing Signs and Symptoms of Congenital CMV Infection¹:

Most babies born with congenital CMV infection don't experience health issues. However, approximately 10% of them may have health problems at birth, which could include:

1. Rash
2. Jaundice (yellowing of the skin or eyes)
3. Microcephaly (small head)
4. Low birth weight
5. Intrauterine growth restriction (low weight)
6. Hepatosplenomegaly (enlarged liver and spleen)
7. Seizures
8. Retinitis (eye retina damage)

Around 40 to 60% of infants showing signs of congenital CMV disease at birth might face long-term health challenges, such as:

1. Hearing loss
2. Vision loss
3. Intellectual disability
4. Microcephaly (small head)
5. Lack of coordination or weakness
6. Seizures

Some babies may experience hearing loss, which may or may not be identified during the newborn hearing test.

Testing for cCMV:

Congenital CMV is diagnosed by detection of CMV DNA in the urine or saliva (preferred methods) or blood within 3 weeks (21 days) of birth. Congenital CMV infection cannot be diagnosed using samples collected more than three weeks after birth because testing after this time cannot distinguish between congenital infection and an infection acquired during or after delivery.

The Department of Public Health adopts amendments to Rule 511-5-5, "  Testing for Inherited Disorders in the Newborn  ," as provided in the Notice of Proposed Rulemaking issued on July 25, 2024. This amendment will go into effect on October 10, 2024 and will require birthing facilities to test all infants for cCMV who fail their final hearing screening. See  cCMV Policy and Procedure Manual  for comprehensive procedures.

¹Cytomegalovirus (CMV) and Congenital CMV Infection

cCMV Resources for Providers:

cCMV Policy and Procedure Manual

Clinical Assessment and Management of cCMV Flow Sheet

Hearing-Targeted cCMV Screening Process Map

cCMV and Hearing Loss Provider Palm Card

CDC's Overview on cCMV Laboratory Testing

CDC's cCMV and Hearing Loss Fact Sheet

National CMV Foundation's Resources for Healthcare Providers

Children 1st Referral Form - This is the referral form to DPH's Child Health programs (e.g. Children 1st, Babies Can't Wait, and Children's Medical Services)

cCMV Organizations and Support Groups:

National CMV Foundation: Parent Stories

Parent-to-Parent Support Network

National CMV Foundation

cCMV Informational Resources for Parents:

CDC's cCMV and Hearing Loss Fact Sheet (English)

CDC's cCMV and Hearing Loss Fact Sheet (Spanish)

CDC's CMV Fact Sheet for Pregnant Women and Parents (English)

CDC's CMV Fact Sheet for Pregnant Women and Parents (Spanish)

National CMV Foundation - cCMV and Hearing Screening

National CMV Foundation - Next Steps After a CMV Diagnosis 

Baby's First Test: cCMV