By: Mary T. Caserta, MD, FAAP
Cytomegalovirus (CMV) is a common virus that belongs to the herpes family, like the one that causes
chickenpox (varicella zoster virus). CMV is the most common infection acquired before birth—known as a "congenital" CMV infection—in the United States.
Read on to learn about signs of CMV in children and adults, ways to treat congenital CMV and what to know if you are pregnant.
How does CMV affect children?
CMV infection is generally mild. Most newborns with
congenital CMV infection have no signs of illness at birth and remain well. However, it may lead to
hearing and developmental differences in infancy and childhood. CMV infection
acquired after birth can cause serious illness for people who have conditions that affect their immune system.
The virus is common in adults, too. More than half of adults acquire CMV infection by age 40. Most people do not have signs or symptoms, so they do not know that they have been infected.
Once a person is infected, the virus stays in their body for the rest of their life—usually in a resting or inactive state. But the virus can become active and be detected in that person's spit, urine or other body fluids. People can spread it to others through close contact. If the virus becomes active, it can cause illness if the person has a condition or takes medication that affects their immune system.
CMV disease
In some cases, CMV infection can cause serious problems. About 1 in 5 babies with
congenital CMV infection will have congenital disability or other long-term health issues.
Babies born with congenital CMV infection may have hearing changes or a
learning disability.
Newborns may have low birth weight,
jaundice (yellowing of the skin and eyes), swollen lymph nodes, a small head compared to their body, an enlarged liver or a
skin rash. They may have problems throughout life such as deafness and other
health needs.
Infants with congenital CMV infection may not show signs of infection at birth. Still, some may develop changes in hearing or other health needs in childhood. This is not very common.
Teens who acquire CMV infection may have symptoms similar to infectious
mononucleosis. These may include fever that lasts more than a few days, sore throat, body aches and fatigue.
Children with
immune system compromise may have symptoms that affect their lungs, liver, kidneys, bone marrow or bowels. The infection can also cause problems for children who receive an organ transplant.
How CMV spreads
CMV infection spreads through contact with body fluids such as spit (saliva), tears, urine and blood.
It can spread in infants, children and adults at home or
child care, including:
Ways to lower the risk of spreading CMV infection
Handwashing. Clean hands before and after feeding or wiping the noses/faces of infants and toddlers, changing diapers or touching objects such as pacifiers that were in contact with saliva.
Keep a child's pacifier out of a parent, caregiver or other child's mouth.
Avoid sharing cups, utensils and toothbrushes with others.
CMV can pass during
pregnancy to the fetus through the placenta and cause congenital CMV. It can pass to the infant through fluids in the birth canal during childbirth and to babies through breastmilk. Newborns and infants who acquire CMV infection during or after birth usually remain well and without any signs of CMV disease.
(Read "Can cytomegalovirus (CMV) cause hearing loss in infants?")
Let's Stop CMV: Pippa's Story
By: Amanda Devereaux, RN, BSN
Although most people expect to have a healthy delivery, about 1 in 33 babies in the U.S. have a health condition at
birth. Our daughter's condition stemmed from an infectious disease called cytomegalovirus, or CMV.
Before my daughter's diagnosis, I knew very little about CMV. It is a common virus, and the infection is not harmful for most people.
But when the virus crosses the placenta during pregnancy, it may have lasting effects on the baby's body and brain. This type of CMV infection before birth is called congenital CMV (cCMV).
I did not know that I was at higher risk of acquiring CMV infection because I had a toddler at home. But after our 20-week ultrasound, we found out that I had a CMV infection early in my second pregnancy. The infection passed to our daughter, Pippa, in the womb. She was severely affected by cCMV.
Because she was diagnosed early, Pippa had access to early intervention, monitoring and antiviral treatment right away. She began walking at age 2 ½ years. Although she is non-speaking, she uses an augmentative and alternative communication (AAC) device to communicate. Pippa loves bowling, going for walks and bike rides, and Daniel Tiger. She loves riding the bus to school each morning and is described as a leader in her school classroom.
There is no vaccine to prevent CMV. But there are
steps that pregnant people can take before and during pregnancy to reduce the risk. I wish I had known about these tips while I was pregnant—not because we love Pippa any less, but because her life is more difficult due to cCMV and we deserved to have the knowledge to reduce the risk during pregnancy.
A congenital CMV diagnosis can be a big challenge for families. It took time for us to
adjust. Our dreams for Pippa are different than they once were, and that is OK! We are learning to embrace this.
Pippa is a happy, wonderful child, and she makes us laugh every day. However, we often think about what her life—and ours—might be like if we had known about CMV during pregnancy. We hope that someday all cases of cCMV can be prevented and no more families will be affected by this devastating virus.
Amanda Devereaux RN, BSN, has worked in public health for 16 years, most recently focusing on maternal child health. She is a program director for the
National CMV Foundation. Ms. Devereaux has served on the Iowa Congenital and Inherited Disorders
Advisory Committee and was co-president of Iowa Hands & Voices organization to support families of children who are deaf or hard of hearing.
How is CMV diagnosed and treated?
To diagnose a CMV infection, a pediatrician or other health care clinician may order
lab tests of urine, saliva, blood or other body fluids.
Fortunately, most children with CMV do not need treatment. Medical treatment is recommended for
newborns with congenital CMV who have
signs of illness. Even with treatment, babies with CMV infection may have or develop hearing changes or other developmental challenges.
Serious CMV infections in children with immune system compromise, such as those with HIV infection or an organ transplant, can be treated with a medicine called ganciclovir or valganciclovir. This medicine is also used to treat newborns with
moderate or severe congenital CMV disease.
Remember
Many of us do not know we have a CMV infection. Even without symptoms, we can spread the virus through body fluids like urine and saliva. But there are ways to help reduce the spread of the virus to those who are pregnant and others at risk of serious illness.
More information
About Dr. Caserta
 Mary T. Caserta, MD, FAAP, is a Professor of Pediatrics in Infectious Diseases at the University of Rochester Medical Center (URMC) in New York. Her early research focused on human herpesvirus research. Recently, her research has focused on viral respiratory disease. For over 10 years, she also has conducted clinical trials, including on the treatment of congenital CMV infection. Dr. Caserta is a fellow of the Infectious Disease Society of America and member of the Pediatric ID Society. Dr. Caserta is a member of the American Academy of Pediatrics Committee on Infectious Diseases.
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