Skip to main content

Advertisement

SpringerLink
Log in

Congenital Cytomegalovirus and Zika Infections

  • Review Article
  • Published:
The Indian Journal of Pediatrics Aims and scope Submit manuscript

Abstract

Congenital infections affecting newborn infants can have potentially devastating clinical outcomes. They are usually caused by viruses that infect mothers during pregnancy and are transmitted to the fetus or newborn during the prenatal, perinatal or postnatal periods. Congenital cytomegalovirus (cCMV) is the most common congenital infection affecting up to 2.5% of all live births. Even though most infected infants are asymptomatic at birth, cCMV is an important cause of neurodevelopmental impairment and represents the main cause of non-hereditary sensorineural hearing loss. Also, congenital Zika infection has emerged in recent years as a cause of microcephaly and neurodevelopmental delays. Currently, universal screening is not recommended for either infection in pregnant women or newborn infants. Therefore, screening for both conditions is based on multiple factors such as maternal immune status, exposure, and clinical manifestations of the infant. Use of antiviral medications on symptomatic cCMV has shown improvement in outcomes, in contrast with congenital Zika for which there are no therapeutic options available. Even though both viruses can be present in breast milk, there are no recommendations against breastfeeding in full-term infants. Close follow-up for affected infants is necessary to monitor for developmental delays and sensory impairments to implement interventional therapies at the earliest time possible.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Dollard SC, Grosse SD, Ross DS. New estimates of the prevalence of neurological and sensory sequelae and mortality associated with congenital cytomegalovirus infection. Rev Med Virol. 2007;17:355–63.

    Article  Google Scholar 

  2. Palma SRM, Bettini M, Mazzoni S, et al. Hearing loss in children with congenital cytomegalovirus infection: an 11-year retrospective study based on laboratory database of a tertiary paediatric hospital. Acta Otorhinolaryngol Ital. 2019;39:40–5.

    Article  CAS  Google Scholar 

  3. Kenneson A, Cannon MJ. Review and meta-analysis of the epidemiology of congenital cytomegalovirus (CMV) infection. Rev Med Virol. 2007;17:253–76.

    Article  Google Scholar 

  4. Pass RF, Anderson B. Mother-to-child transmission of cytomegalovirus and prevention of congenital infection. J Pediatr Infect Dis Soc. 2014;3:S2–6.

    Article  Google Scholar 

  5. Fowler KB, Stagno S, Pass RF. Maternal immunity and prevention of congenital cytomegalovirus infection. JAMA. 2003;289:1008–11.

    Article  Google Scholar 

  6. Faure-Bardon V, Magny JF, Parodi M, et al. Sequelae of congenital cytomegalovirus (cCMV) following maternal primary infection are limited to those acquired in the first trimester of pregnancy. Clin Infect Dis. 2018;69:1526–32.

    Article  Google Scholar 

  7. Pass RF, Fowler KB, Boppana SB, Britt WJ, Stagno S. Congenital cytomegalovirus infection following first trimester maternal infection: symptoms at birth and outcome. J Clin Virol. 2006;35:216–20.

    Article  Google Scholar 

  8. Fowler KB, Stagno S, Pass RF, Britt WJ, Boll TJ, Alford CA. The outcome of congenital cytomegalovirus infection in relation to maternal antibody status. New Engl J Med. 1992;326:663–7.

    Article  CAS  Google Scholar 

  9. Rawlinson WD, Boppana SB, Fowler KB, et al. Congenital cytomegalovirus infection in pregnancy and the neonate: consensus recommendations for prevention, diagnosis, and therapy. Lancet Infect Dis. 2017;17:e177–88.

    Article  Google Scholar 

  10. Foulon I, Naessens A, Foulon W, Casteels A, Gordts F. A 10-year prospective study of sensorineural hearing loss in children with congenital cytomegalovirus infection. J Pediatr. 2008;153:84–8.

    Article  Google Scholar 

  11. Riga M, Korres G, Chouridis P, Naxakis S, Danielides V. Congenital cytomegalovirus infection inducing non-congenital sensorineural hearing loss during childhood; a systematic review. Int J Pediatr Otorhinolaryngol. 2018;115:156–64.

    Article  Google Scholar 

  12. Rosenthal LS, Fowler KB, Boppana SB, et al. Cytomegalovirus shedding and delayed sensorineural hearing loss: results from longitudinal follow-up of children with congenital infection. Pediatr Infect Dis J. 2009;28:515–20.

    Article  Google Scholar 

  13. Fowler KB, Boppana SB. Congenital cytomegalovirus (CMV) infection and hearing deficit. J Clin Virol. 2006;35:226–31.

    Article  Google Scholar 

  14. Fowler KB, McCollister FP, Sabo DL, et al. A targeted approach for congenital cytomegalovirus screening within newborn hearing screening. Pediatrics. 2017;139: pii: e20162128.

  15. Boppana SB, Ross SA, Novak Z, et al. Dried blood spot real-time polymerase chain reaction assays to screen newborns for congenital cytomegalovirus infection. JAMA. 2010;303:1375–82.

    Article  CAS  Google Scholar 

  16. Kimberlin DW, Lin CY, Sanchez PJ, et al. Effect of ganciclovir therapy on hearing in symptomatic congenital cytomegalovirus disease involving the central nervous system: a randomized, controlled trial. J Pediatr. 2003;143:16–25.

    Article  CAS  Google Scholar 

  17. Kimberlin DW, Jester PM, Sánchez PJ, et al. Valganciclovir for symptomatic congenital cytomegalovirus disease. New Engl J Medicine. 2015;372:933–43.

    Article  CAS  Google Scholar 

  18. Boppana SB, Ross SA, Fowler KB. Congenital cytomegalovirus infection: clinical outcome. Clin Infect Dis. 2013;57:S178–81.

    Article  Google Scholar 

  19. Pass RF, Zhang C, Evans A, et al. Vaccine prevention of maternal cytomegalovirus infection. Obstet Gynecol Survey. 2009;64:502–4.

    Article  Google Scholar 

  20. Hamprecht K, Maschmann J, Vochem M, Dietz K, Speer CP, Jahn G. Epidemiology of transmission of cytomegalovirus from mother to preterm infant by breastfeeding. Lancet. 2001;357:513–8.

    Article  CAS  Google Scholar 

  21. Meier J, Lienicke U, Tschirch E, Kruger DH, Wauer RR, Prosch S. Human cytomegalovirus reactivation during lactation and mother-to-child transmission in preterm infants. J Clin Microbiol. 2005;43:1318–24.

    Article  Google Scholar 

  22. Kurath S, Halwachs-Baumann G, Muller W, Resch B. Transmission of cytomegalovirus via breast milk to the prematurely born infant: a systematic review. Clin Microbiol Infect. 2010;16:1172–8.

    Article  CAS  Google Scholar 

  23. Maschmann J, Muller D, Lazar K, Goelz R, Hamprecht K. New short-term heat inactivation method of cytomegalovirus (CMV) in breast milk: impact on CMV inactivation, CMV antibodies and enzyme activities. Arch Dis Child Fetal Neonat Ed. 2019;104:F604–8.

    Article  Google Scholar 

  24. Josephson CD, Caliendo AM, Easley KA, et al. Blood transfusion and breast milk transmission of cytomegalovirus in very low-birth-weight infants: a prospective cohort study. JAMA Pediatr. 2014;168:1054–62.

    Article  Google Scholar 

  25. Wikan N, Smith DR. First published report of Zika virus infection in people: Simpson, not MacNamara. Lancet Infect Dis. 2017;17:15–7.

    Article  Google Scholar 

  26. Barzon L, Trevisan M, Sinigaglia A, Lavezzo E, Palu G. Zika virus: from pathogenesis to disease control. FEMS Microbiol Lett. 2016;363:pii: fnw202.

  27. Gubler DJ, Vasilakis N, Musso D. History and emergence of Zika virus. J Infect Dis. 2017;216:S860–7.

    Article  Google Scholar 

  28. Lanciotti RS, Lambert AJ, Holodniy M, Saavedra S, Signor LDCC. Phylogeny of Zika virus in western hemisphere, 2015. Emerg Infect Dis. 2016;22:933–5.

    Article  Google Scholar 

  29. Moreira J, Peixoto TM, Siqueira AM, Lamas CC. Sexually acquired Zika virus: a systematic review. Clin Microbiol Infect. 2017;23:296–305.

    Article  CAS  Google Scholar 

  30. World Health Organization. WHO guidelines for the prevention of sexual transmission of Zika virus: executive summary 2019. Available at: https://apps.who.int/iris/bitstream/handle/10665/311026/WHO-RHR-19.4-eng.pdf?ua=1. Accessed 17 May 2019.

  31. Magnus MM, Espósito DLA, Vad C, et al. Risk of Zika virus transmission by blood donations in Brazil. Hematol Transfus Cell Ther. 2018;40:250–4.

    Article  Google Scholar 

  32. Nogueira ML, Estofolete CF, Terzian AC, et al. Zika virus infection and solid organ transplantation: a new challenge. Am J Transpl. 2017;17:791–5.

    Article  CAS  Google Scholar 

  33. Lazear HM, Govero J, Smith AM, et al. A mouse model of Zika virus pathogenesis. Cell Host Microbe. 2016;19:720–30.

    Article  CAS  Google Scholar 

  34. Hamel R, Dejarnac O, Wichit S, et al. Biology of Zika virus infection in human skin cells. J Virol. 2015;89:8880–96.

    Article  CAS  Google Scholar 

  35. Centers for Disease Control and Prevention. Estimated incubation period for Zika virus disease 2017. Available at: https://wwwnc.cdc.gov/eid/article/23/5/16-1715_article. Accessed 17 May 2019.

  36. Centers for Disease Control and Prevention. A literature review of Zika virus 2016. Available at: https://wwwnc.cdc.gov/eid/article/22/7/15-1990_article#r40. Accessed 17 May 2019.

  37. de Araujo TVB, Ximenes RAA, Miranda-Filho DB, et al. Association between microcephaly, Zika virus infection, and other risk factors in Brazil: final report of a case-control study. Lancet Infect Dis. 2018;18:328–36.

    Article  Google Scholar 

  38. Centers for Disease Control and Prevention. Exposure, testing & risks 2019. Available at: https://www.cdc.gov/pregnancy/zika/testing-follow-up/exposure-testing-risks.html. Accessed 17 May 2019.

  39. Besnard M, Lastere S, Teissier A, Cao-Lormeau V, Musso D. Evidence of perinatal transmission of Zika virus, French Polynesia, December 2013 and February 2014. Euro Surveill. 2014;19:pii: 20751.

  40. Centers for Disease Control and Prevention. Zika in infants & children 2018. Available at: https://www.cdc.gov/pregnancy/zika/testing-follow-up/zika-in-infants-children.html. Accessed 17 May 2019.

  41. Centers for Disease Control and Prevention. Congenital Zika syndrome & other birth defects 2019. Available at: https://www.cdc.gov/pregnancy/zika/testing-follow-up/zika-syndrome-birth-defects.html. Accessed 17 May 2019.

  42. Moore CA, Staples JE, Dobyns WB, et al. Characterizing the pattern of anomalies in congenital Zika syndrome for pediatric clinicians. JAMA Pediatr. 2017;171:288–95.

    Article  Google Scholar 

  43. Centers for Disease Control and Prevention. Update: interim guidance for health care providers caring for pregnant women with possible Zika virus exposure 2017. Available at: https://www.cdc.gov/mmwr/volumes/66/wr/mm6629e1.htm. Accessed 17 May 2019.

  44. Centers for Disease Control and Prevention. Update: interim guidance for the diagnosis, evaluation, and management of infants with possible congenital Zika virus infection 2017. Available at: https://www.cdc.gov/mmwr/volumes/66/wr/mm6641a1.htm. Accessed 17 May 2019.

  45. Centers for Disease Control and Prevention. Update: interim guidance for preconception counseling and prevention of sexual transmission of Zika virus for men with posssible Zika virus exposure 2018. Available at: https://www.cdc.gov/mmwr/volumes/67/wr/mm6731e2.htm?s_cid=mm6731e2_w. Accessed 17 May 2019.

Download references

Author information

Authors and Affiliations

  1. Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Columbia University Medical Center, New York City, NY, USA

    Chantal Angueyra

  2. Emergency Services Institute of the Cleveland Clinic, Cleveland, OH, USA

    Hani Abou Hatab

  3. Division of Neonatology, Department of Pediatrics, Harlem Hospital Center, New York City, NY, USA

    Anil Pathak

Authors
  1. Chantal Angueyra
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hani Abou Hatab
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Anil Pathak
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

CA: Wrote the CMV part of the review and the abstract. HAH: Wrote the Zika part of the review, the conclusion and made the two graphs. AP: Reviewed the content for accuracy and completeness. AP is the guarantor for this paper.

Corresponding author

Correspondence to Chantal Angueyra.

Ethics declarations

Conflict of Interest

None.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Angueyra, C., Abou Hatab, H. & Pathak, A. Congenital Cytomegalovirus and Zika Infections. Indian J Pediatr 87, 840–845 (2020). https://doi.org/10.1007/s12098-020-03260-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12098-020-03260-9

Keywords

Search

Navigation