Primary, Secondary, and Tertiary Prevention of Congenital Cytomegalovirus Infection

Abstract

Cytomegalovirus infection is the most common congenital infection, affecting about 1% of births worldwide. Several primary, secondary, and tertiary prevention strategies are already available during the prenatal period to help mitigate the immediate and long-term consequences of this infection. In this review, we aim to present and assess the efficacy of these strategies, including educating pregnant women and women of childbearing age on their knowledge of hygiene measures, development of vaccines, screening for cytomegalovirus infection during pregnancy (systematic versus targeted), prenatal diagnosis and prognostic assessments, and preventive and curative treatments in utero.

Keywords: congenital infection; cytomegalovirus; prenatal diagnosis; prevention.

Figure 1

Evolution of CMV IgM, IgG, and IgG avidity levels over time following primary cytomegalovirus infection (Prince et al. 2014) [125]. Reprinted with permission from Prince et al. (2014). Copyright 2014, American Society for Microbiology. Note. CMV IgM, IgG, and IgG avidity levels show relative changes over time following primary CMV infection. IgM pattern A represents the typical IgM response pattern, whereas IgM pattern B represents long-term IgM persistence. In a CMV IgG-positive individual, an IgM-positive result of 20 indicates an infection around 3 months ago if the individual exhibits IgM pattern A, but it indicates around 6 months ago if the individual exhibits IgM pattern B. By employing CMV IgG avidity testing, the correct time since infection can be determined: a low-avidity result (expected to be about 30 based on this figure) indicates a primary infection about 3 months ago, whereas a high-avidity result (expected to be about 70) indicates a primary infection more than 6 months ago.