Congenital Cytomegalovirus and Zika Infections
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REVIEW ARTICLE
Congenital Cytomegalovirus and Zika Infections Chantal Angueyra 1 & Hani Abou Hatab 2 & Anil Pathak 3 Received: 19 September 2019 / Accepted: 25 February 2020 # Dr. K C Chaudhuri Foundation 2020
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. Keywords Congenital infections . Congenital cytomegalovirus . Congenital CMV . Congenital Zika . Microcephaly . Sensorineural hearing loss . Developmental delay . Zika virus exposure . Zika virus screening . CMV screening . Breastfeeding mothers with CMV . Breastfeeding mothers with Zika virus . Diagnosis of congenital Zika . Diagnosis of congenital CMV . CMV transmission . Zika virus transmission
Congenital Cytomegalovirus Infection Background Congenital cytomegalovirus (cCMV) is the most common congenital viral infection worldwide. In high-income countries, the estimated overall prevalence at birth is 0.65%, ranging from 0.2 to 2.5%. High rates of cCMV infection have been consistently demonstrated in populations with high maternal seroprevalence. Approximately 85–90% of infants with
* Chantal Angueyra [email protected] 1
Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Columbia University Medical Center, New York City, NY, USA
2
Emergency Services Institute of the Cleveland Clinic, Cleveland, OH, USA
3
Division of Neonatology, Department of Pediatrics, Harlem Hospital Center, New York City, NY, USA
cCMV are asymptomatic at birth and most cases are not recognized. However, 10–15% of these children may develop hearing, visual or neurodevelopmental impairment later in life. In contrast, 40–60% of infants with symptomatic cCMV that survive past the neo
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