Unborn babies can get CMV during pregnancy

Donya Betancourt, Pediatrician, Sanur, Bali, drdonya@hotmail.com

More and more cases of CMV are being reported each year. CMV is a member of the herpes virus group that includes herpes simplex virus types 1 and 2, varicella-zoster virus, which causes chickenpox and Epstein-Barr virus, which causes infectious mononucleosis.

For most healthy people who acquire CMV after birth, there are few symptoms and no long-term health consequences.

Some people with symptoms experience a mononucleosis-like syndrome with prolonged fever, and a mild hepatitis. Once a person becomes infected, the virus remains alive, but is usually dormant within that person's body for life.

Recurrent disease rarely occurs unless the person's immune system is suppressed due to therapeutic drugs or disease. For the vast majority of people, CMV infection is not a serious problem.

CMV is also the virus most frequently transmitted to a developing child before birth.

CMV infection is most relevant to certain high-risk groups: * The unborn baby during pregnancy * People who work with children * Immunocompromised people, such as organ transplant recipients and people infected with human immunodeficiency virus (HIV).

Transmission of CMV occurs from person to person. Infection requires close, intimate contact with a person excreting the virus in their saliva, urine or other bodily fluids.

CMV can be sexually transmitted and can also be transmitted via breast milk, transplanted organs, and rarely from blood transfusions.

Although the virus is not highly contagious, it has been shown to spread in households and among young children in day care centers. Transmission of the virus is often preventable because it is most often transmitted through infected bodily fluids that come into contact with hands and are then absorbed through the nose or mouth of a susceptible person. Simple hand-washing with soap and water is effective in removing the virus from the hands.

CMV infection without symptoms is common in infants and young children; it is unjustified and unnecessary to exclude them from school.

Most infections with CMV are not diagnosed because the virus usually produces few, if any, symptoms, and tends to reactivate intermittently without symptoms. However, people who have been infected with CMV develop antibodies to the virus, and these antibodies persist in the body for the lifetime of that individual.

A number of laboratory tests that detect these antibodies to CMV have been developed to determine if infection has occurred and are widely available from commercial laboratories. In addition, the virus can be cultured from specimens obtained from urine, throat swabs, and tissue samples to detect active infection.

For best diagnostic results, laboratory tests for CMV antibody should be performed by using paired serum samples. One blood sample should be taken upon suspicion of CMV, and another one taken within two weeks. A virus culture can be performed at any time the patient is symptomatic.

The enzyme-linked immunosorbent assay (or ELISA) is the most commonly available serologic test for measuring antibody to CMV.

Currently, no treatment exists for CMV infection in the healthy individual. Antiviral drug therapy is now being evaluated in infants. Ganciclovir treatment is used for patients with depressed immunity who either have sight-related or life- threatening illnesses. Vaccines are still in the research and development stage.