Prevention strategies


Considering the detrimental effects of cCMV on affected children and families, the lack of treatment options, and the related health-care costs, the primary-care provider should focus on preventing primary CMV infection in women who are pregnant or who are planning a pregnancy.

It has been noted that CMV incidence among hospital workers is no higher than CMV incidence in the rest of the population, validating the effectiveness of standard precautions in preventing transmission of CMV infection.5Prevention and risk reduction consist of educating patients regarding simple hygienic measures that help reduce the spread of most infections, including CMV.5

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Online Resources for Parents

National Congenital CMV Disease Registry, Baylor College of Medicine Department of Pediatrics
bcm.edu/departments/pediatrics/cmvregistry/
Stop CMV
stopcmv.org
Brendan B. McGinnis Congenital CMV Foundation
CMVfoundation.org

For several years, guidelines from The American College of Obstetricians and Gynecologists (ACOG) have recommended that pregnant women be counseled regarding methods to prevent acquisition of CMV during pregnancy.13Primary-care providers need to instruct women of childbearing age during preconception and throughout pregnancy to practice good hand hygiene, washing with antimicrobial soap and water for periods of 15 to 20 seconds throughout the day, particularly after changing diapers and coming into contact with any bodily fluid.8Also, pregnant women should develop the habit of kissing children, including their own, on the forehead rather than on or near the mouth, to minimize contact with the child’s saliva.8These women also should avoid sharing their drinks or eating utensils with others. In addition, they should regularly disinfect children’s toys and items that are frequently handled by others.8These simple steps can greatly reduce the risk of CMV transmission to an expectant mother.

Conclusion


Regardless of the scientific advances in the field of CMV and the increasing burden of cCMV infections, lack of awareness and lack of screening continue to be the norm. Despite being the leading cause of disability in children, congenital CMV continues to be underrecognized and underdiagnosed.3Primary-care providers and pediatricians should discuss the importance of prevention strategies with their patients and should themselves be aware of the clinical presentation of CMV in order to identify symptoms that would warrant further evaluation.

Primary-care providers have a critical role in CMV and cCMV prevention, diagnosis, and management, particularly as the lack of awareness about this infection persists.6The involvement of these clinicians is imperative to breaking the silence about congenital CMV. 

Anna Lilia Piña, APRN, MSN, NP-C is a provider at Pr1me Health & Wellness, Tulsa, Okla. 


References 


  1. Griffiths PD. The Stealth Virus . CreateSpace/On-Demand Publishing LLC (Amazon);2012: chap 1, chap 2.
  2. Thackeray R, Wright A, Chipman K. Congenital cytomegalovirus reference material: a content analysis of coverage and accuracy. Matern Child Health J. 2014;18(3):584-591. Available at link.springer.com/article/10.1007%2Fs10995-013-1275-0
  3. Swanson EC, Schleiss MR. Congenital cytomegalovirus infection: new prospects for prevention and therapy. Pediatr Clin North Am. 2013;60(2):335-349. Available at ncbi.nlm.nih.gov/pmc/articles/PMC3807860/
  4. Yinon Y, Farine D, Yudin MH. Screening, diagnosis, and management of cytomegalovirus infection in pregnancy. Obstet Gynecol Surv. 2010;65(11):736-743.
  5. Johnson J, Anderson B, Pass RF. Prevention of maternal and congenital cytomegalovirus infection. Clin Obstet Gynecol. 2012;55(2):521-530. Available at ncbi.nlm.nih.gov/pmc/articles/PMC3347968/
  6. Manicklal S, Emery VC, Lazzarotto T, et al. The “silent” global burden of congenital cytomegalovirus. Clin Microbiol Rev. 2013;26(1):86-102. Available at ncbi.nlm.nih.gov/pmc/articles/PMC3553672/
  7. Centers for Disease Control and Prevention. Cytomegalovirus (CMV) and congenital CMV infection. (Page last reviewed and updated June 5, 2013.) Available at cdc.gov/cmv/trends-stats.html 

  8. Centers for Disease Control and Prevention. Protect your baby. (Page last reviewed and updated June 23, 2014.) Available at cdc.gov/features/cytomegalovirus/ 

  9. Gabbe SG, Niebyl JR, Simpson JL, et al. Maternal and perinatal infection – viral. Obstetrics: Normal and Problem Pregnancies. 6th ed. Philadelphia, Pa.: Elsevier Saunders; 2012: chap 50. Available at www.mdconsult.com/books/page.do?eid=4-u1.0-B978-1-4377-1935-2..00050-8–s0250&isbn=978-1-4377-1935-2&type=bookPage&from=content&uniqId=452463989-2
  10. Maidji E, Nigro G, Tabata T, et al. Antibody treatment promotes 
compensation for human cytomegalovirus-induced pathogenesis 
and a hypoxia-like condition in placentas with congenital infection. Am J Pathol. 2010;177(3):1298-1310. Available at ncbi.nlm.nih.gov/pmc/articles/PMC2928963
  11. Carlson A, Norwitz ER, Stiller RJ. Cytomegalovirus infection 
in pregnancy: should all women be screened? Rev Obstet Gynecol. 2010;3(4):172-179. Available at ncbi.nlm.nih.gov/pmc/articles/
PMC3046747/
  12. Nigro G, Adler SP. Cytomegalovirus infections during pregnancy. Curr Opin Obstet Gynecol. 2011;23(2):123-128.
  13. The American College of Obstetricians and Gynecologists. ACOG practice bulletin. Perinatal viral and parasitic infections. Number 20, September 2000. Int J Gynaecol Obstet. 2002;76(1):95-107.

All electronic documents accessed on November 15, 2014.


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Infectious Disease Obstetrics and Gynecology Pediatrics Polls