Current status of primary, secondary and tertiary prevention of congenital cytomegalovirus disease: a call to action.

PURPOSE OF REVIEW

Globally, sequelae of congenital CMV (CCMV) impact an estimated 350 000 children born annually. In this review, we consider new evidence across primary, secondary and tertiary prevention approaches, and remaining evidence gaps.

RECENT FINDINGS

Education on hygiene precautions can reduce risk of primary CMV acquisition in pregnancy, and may have a role in some settings in reducing CCMV cases resulting from nonprimary infection, but public and health worker knowledge and awareness remains low. Evidence that valaciclovir treatment can reduce CMV vertical transmission has led to renewed interest in antenatal CMV screening in some high-income countries over recent years, although there is a lack of recommendation in most guidelines and significant evidence gaps remain. Newborn CCMV screening has been adopted in some states/provinces in Canada/USA, with first results recently published. Newborn prognostic scoring systems are evolving, with potential for more effective targeting of newborn treatment and tertiary prevention of CCMV disease.

SUMMARY

We make suggestions for clinical practice and research, particularly to address evidence gaps around: safety and effectiveness of antenatal CMV screening and antiviral prophylaxis; findings relating to detection of nonprimary infection in pregnancy; new prognostic neonatal scoring systems; and learning from follow-up of children born into state-wide universal CMV screening programmes.