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Early Hearing Detection and Intervention Program

Congenital Cytomegalovirus (CMV) Page

  For Parents and Providers

 

 

On January 1, 2016, Public Act Number 15-10 amended existing newborn screening requirements by mandating that infants whom fail a newborn hearing screening also be screened for cytomegalovirus (CMV), as soon after birth as is medically appropriate.  This law also requires each institution caring for newborns (e.g. birthing facilities) to report any cases of CMV to the Department of Public Health.

**Please note: Birthing hospitals will be responsible for arranging CMV testing at a qualified laboratory.  The State Public Health Laboratory will not conduct CMV testing.**  

The following is for informational purposes only and is not intended to take the place of individual medical advice. Please speak with your healthcare provider if you have questions\concerns regarding any of the following information.  

           

Table of Contents

About CMV

FAQ

Prevention

For Healthcare Providers

For Childcare Providers

Resources\Links

  

       

 

CMV infection during pregnancy can seriously harm your baby. 

               

Cytomegalovirus (pronounced: sy-toe-MEG-a-low-vy-rus), or CMV, is a common virus that infects people of all ages. The majority of people who are infected with CMV have no signs or symptoms of the virus, and there are no harmful effects. However, when CMV occurs during a woman’s pregnancy, it is possible for the unborn baby to become infected, which is then called “congenital CMV”. Congenital CMV can potentially damage the brain, eyes, and/or inner ears of the unborn infant. Health problems or disabilities due to congenital CMV infection may appear immediately, or any time after birth, or  they may never appear.

 

Permanent health problems or disabilities due to congenital CMV infection:

  • Hearing Loss
  • Vision Loss
  • Mental Disability
  • Small Head Size ( Microcephaly)
  • Lack of Coordination
  • Seizures
  • Death (In rare cases)
 

 

 

 

 

 

 

How Do I Get CMV?

Cytomegalovirus is generally passed from infected people to others through direct contact with body fluids, such as urine or saliva. CMV can also be found in tears, blood, and semen.

In the United States, about half of all pregnant women have never been infected with CMV. About 1% to 4% of these women have a primary (or first) CMV infection during their pregnancy. Most people have no symptoms when they get infected with CMV, but some may have symptoms similar to mononucleosis (mono).  

Will I know I am infected with CMV?

Most healthy children and adults infected with CMV do not feel ill so they don't know that they have been infected; others may have mild flu-like symptoms such as fever, sore throat, fatigue or swollen glands.  The only way to know for sure that you have CMV is to have your medical provider test you for it.   

Am I at risk for getting CMV?

Pregnant women should avoid getting body fluids in their eyes, nose, or mouth. One of the most common exposures is through contact with saliva or urine of young children who recently had the virus.

Research shows that women who work closely with small children in settings such as child care facilities or have other children in the home while pregnant may be at greater risk.

Women can also be exposed to the CMV virus through body fluids during sexual activity. Those who participate in high-risk behaviors are at greater risk.

The Centers for Disease Control and Prevention states that the risk of getting CMV through casual contact, such as hugging, is very small.       

How can I help prevent CMV?

Please see the below section labeled "Prevention".

Is there a vaccine I can get that will stop me from getting CMV?

Please speak with your healthcare provider and visit the Centers for Disease Control and Prevention (CDC) website here: http://www.cdc.gov/cmv/clinical/diagnosis-treatment.html   

Is there treatment for congenital CMV?

Please speak with your healthcare provider and visit the Centers for Disease Control and Prevention (CDC) website here: http://www.cdc.gov/cmv/clinical/diagnosis-treatment.html  

If I have had CMV in the past, is it still possible to pass it on to the unborn baby?

It is possible if the CMV becomes active again. CMV is a member of the herpes viruses so once you have been infected, it remains in your system, and can re-activate in the future. When someone catches CMV for the first time, it is called a primary infection. When someone who already has had the virus gets infected with another strain, or their current strain becomes active again, this is called a non-primary or secondary infection. Although it is more likely that the fetus will be affected by a primary infection, a secondary infection may still cause harm to the baby.

Also, infants and children who are infected with CMV after birth rarely have symptoms or problems.  

Can my newborn be tested for congenital CMV? 

Yes. Congenital CMV testing for an infant is simple and painless . It is accomplished using either a urine or saliva sample. The inside of your baby's cheek is swabbed when a saliva sample is taken. It is very important that this swabbing be done at least 90 minutes, ideally 120 minutes, after feeding as CMV could be present in breast milk.

This testing is time-sensitive and the urine or saliva sample must be taken before your baby is 21 days old to be accurate for the detection of congenital CMV infection. The sample may be taken at the hospital, your medical providers' office, or directly at a lab. Please contact your baby's doctor as soon as you are told you need this testing to be done.

Many insurance companies, including Medicaid, report that this testing is covered, but check with your insurance provider and healthcare provider to determine if it is covered. The CPT code for qualitative CMV detection by PCR (via urine or saliva) is 87496, which is considered to be the most sensitive for congenital CMV testing. CPT code 87497 represents quantitative CMV detection by PCR (via urine or saliva).       

 

 

If you're pregnant or planning a pregnancy, the best way to protect your baby from CMV is to protect yourself by avoiding exposure to saliva and urine that might contain CMV.

Pregnant women may want to take the following steps to reduce their risk of exposure to CMV and so reduce the risk of CMV infection of their fetus: 


  • Wash your hands often with soap and water for 15-20 seconds, especially after:
    • Changing diapers
    • Feeding a young child
    • Wiping a young child’s nose or drool
    • Handling children’s toys 
  • Do not share food, drinks, or eating utensils used by young children.
  • Do not put a child’s pacifier in your mouth.
  • Do not share a toothbrush with a young child.
  • Avoid contact with saliva when kissing a child.
  • Clean toys, countertops, and other surfaces that come into contact with children’s urine or saliva.  


For more information on prevention or transmission:

Visit Transmission (http://www.cdc.gov/cmv/transmission.html) , to learn about the possible spread of CMV infection during pregnancy, at the Centers for Disease Control and Prevention’s website.

Visit Prevention (http://www.cdc.gov/cmv/prevention.html) at the Centers for Disease Control and Prevention’s website.         

 

 

About 1 of every 5 children born with congenital CMV infection (1 in every 750 children born in the United States) will develop permanent problems (such as hearing loss or developmental disabilities) due to the infection.  Congenital CMV infections can only be prevented by preventing CMV infection in pregnant women. There is no available vaccine for preventing CMV. However, pregnant women can take steps that may reduce their exposure to CMV. Congenital CMV infection is a known cause of pregnancy loss, still birth, and prematurity.

Flowcharts 

Please click the following link to view the updated Hospital Service Delivery Flow Chart that now reflects the additional CMV steps: EHDI/NBHS - Hospital Service Delivery Flow Chart      

CMV Refusal Form Template for Birthing Facilities  

Please feel free to copy, modify, and distribute the below refusal template as needed. Use and submission of this form is NOT REQUIRED . Please DO NOT submit it to DPH. It is for your records only. It is merely a template for your use at your discretion: CMV Refusal Template.
Resources for Providers
       
     
CDC Recommendations for People Who Care for Infants and Children
  • Persons who work with children should follow standard hand washing procedures after contact with body fluids, such as urine and saliva, which could contain CMV.
  • Over half of adults have already been infected with CMV by the age of 40 years. Adults who have not had CMV and who work with young children, especially children 1 to 2 ½ years of age, may be exposed to CMV and can become infected.
  • Healthy adults face little risk of getting seriously sick from CMV infection. However, if a woman who has never had CMV infection becomes infected with CMV while pregnant; there is a risk that her fetus will also become infected. Infants born with CMV infection are at risk for CMV-related complications.
  • Persons who work closely with children in settings, such as child care facilities, may be at greater risk of CMV infection than persons who do not work in such settings. There are certain steps everyone can take to reduce their risk of exposure to CMV and other infection. See Prevention(http://www.cdc.gov/cmv/prevention.html) .
  • Women who are pregnant or plan to become pregnant and who have close contact with young children should discuss their risk for CMV infection with their medical provider. Also see Pregnant Women(http://www.cdc.gov/cmv/risk/preg-women.html) .
  • Although CMV is spread through contact with infected body fluids, including urine and saliva, the risk of CMV infection among healthcare workers appears to be no greater than that among the general public. This may be due in part to adherence to standard precautions by healthcare providers when handling body fluids and the lower amount of personal contact in the healthcare setting.

To learn more about how CMV is spread, see Transmission(http://www.cdc.gov/cmv/transmission.html) .

To view a “CMV 101” webinar from NCHAM, please see http://www.infanthearing.org/flashplayer/hd_videos.htm?file=http://www.infanthearing.org/flashvideos/webinars/CMV-Webinar-AlysonWard.mp4.


 infants should undergo a complete diagnostic audiologic evaluation as soon as possible. Frequent audiologic re-assessment is also needed to promptly identify and treat progressive hearing loss. The frequency of this testing should be determined by the child’s audiologist.  A general recommendation for all babies with congenital CMV (regardless of their newborn hearing screening results) is to have a hearing re-assessment every 3 months in the first three years of life, and then every six months through age six years.   

 
Brochures
  • NEW "Your Baby Needs Another Hearing Test\Cytomegalovirus Virus." This brochure replaces "A Parent's Guide to Diagnostic Hearing Testing of Infants". In addition to hearing screening information, this brochure also covers CMV testing. It is still intended to be disseminated to the parents of children who did not pass their newborn hearing screening tests, as well as to also explain CMV testing.  Please note that in order to combine two different topics - Hearing screening and CMV - into one brochure, we opted to print the hearing screening section and CMV section in opposing formats to allow the reader to differentiate between the two topics. This Brochure was designed for double-sided commercial printing on 8.5x14 paper, but can be printed on standard 8.5x11 paper. To print either size, you MUST choose ALL the following settings  ("Fit", "Print Both Sides", and "Flip on Short Edge") as shown in the below screen shot of the Adobe Print Window. Also, upon printing, please fold in half (fold A to A) and then in half again (B to B). There are instructions in the brochure.  If you are unable to print copies of this brochure, please Contact EHDI, and we will mail them to your facility. The Spanish version is here.



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Content Last Modified on 4/26/2017 11:44:40 AM