Children With Special Health Care NeedsPhone:(801)584-8284 TollFree:(800)829-8200


Cytomegalovirus (CMV) Public Health Initiative

photo of girl with hearding aidsH.B. 81 (2013 General Session) UCA 26-10-10, whose Chief Sponsor was Representative Ronda Rudd Menlove, went into effect on July 1, 2013. This law (Cytomegalovirus Public Education and Testing) directs the Utah Department of Health to create a public education program to inform pregnant women, and women who may become pregnant, about the occurrence of CMV, the transmission of CMV, the birth defects that CMV can cause, methods of diagnosis, and available preventative measures.

This law also directs medical practitioners to test infants who fail newborn hearing screening for congenital CMV and inform the parents about the possible birth defects that CMV can cause.

About CMV

Help Stop CMV LogoCMV infection during pregnancy can harm your baby.

Cytomegalovirus (sy toe MEG a low vy rus), or CMV, is a common virus that infects people of all ages. Most CMV infections are "silent", meaning the majority of people who are infected with CMV have no signs or symptoms, and there are no harmful effects. However, when CMV occurs during a woman’s pregnancy, the baby can become infected before birth.  CMV infection before birth is known as “congenital CMV”. When this happens, the virus gets transmitted to the unborn infant and can potentially damage the brain, eyes, and/or inner ears.

Every year, more than 40,000 women in the U.S. experience CMV infection during pregnancy.

  • 1 in 150 babies is born with congenital CMV in America
  • 1 in every 5 children born with CMV will suffer lifelong disabilities

Permanent health problems or disabilities due to congenital CMV include:

  • Hearing Loss
  • Vision Loss
  • Developmental Disability
  • Brain Damage
  • Cognitive Impairment
  • Small head size
  • Lack of coordination
  • Cerebral Palsy
  • Seizures

Frequently Asked Questions (FAQs)

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.

Will I know I have CMV?

Most healthy children and adults infected with CMV don't 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.

If I have already had CMV, do I need to worry about getting it 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 nonprimary or secondary infection.

  • 1-4 out of 100 women will experience a primary infection during pregnancy
  • 1 in 1000 women will experience a secondary infection during pregnancy

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.

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

There is currently no vaccine available to prevent CMV. Research is on-going for the development of a vaccine.

How can I help prevent CMV?

photo of woman kissing babyIf you're pregnant or planning a pregnancy, the best way to protect your baby from CMV is to protect yourself.

  1. When you kiss a young child, try to avoid contact with saliva. For example, you might kiss on the forehead rather than the lips.
  2. Try not to put things in your mouth that have just been in a child’s mouth. For example:
    • Cups
    • Forks or Spoons
    • Pacifiers
  3. Try not to share food, drinks, or a toothbrush with a child.
  4. Wash your hands after touching a child’s saliva or urine, especially after:
    • Wiping a child’s nose, mouth, or tears
    • Changing diapers
  5. Use soap and water or a disinfectant to clean toys, countertops, and other surfaces that may have a child's saliva or urine on them.
  6. Act as if everyone around you has a cold or a stomach bug and practice the same prevention strategies!

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.

Testing

Testing for the presence of congenital CMV infection (acquired in utero) in an infant is different than testing for CMV in an adult.

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 breastmilk.

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 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.

How can I order CMV testing?
If the clinic or hospital is a client of ARUP, they can order the OraCollect OC-100 swabs from ARUP client supplies (item #49295). If they are not ARUP clients, they should contact their reference lab for kit 2 supplies or contact the kit vendor directly (DNA Genotek). If kits for PCR testing on saliva are not available, a PCR for CMV can be sent on a urine sample.

Will insurance cover the cost of the CMV PCR assay testing?
Many insurance companies, including Medicaid, report that this testing 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) and may be used by Viracor-IBT Laboratories.  

Resources:

Providers

About 1 in 150 children is born with congenital CMV infection. In Utah, this equates to approximately one child per day.  CMV is the most common cause of congenital infection/malformation in developed countries. Congenital CMV infection is a known cause of pregnancy loss, still birth, or prematurity.

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.

What should I tell my patients about CMV?

If you're pregnant or planning a pregnancy, the best way to protect your baby from CMV is to protect yourself.

  • Don't share food, drinks, or eating utensils with a child.
  • Do not put a child's pacifier in your mouth.
  • Do not share a toothbrush with a young child.
  • Use soap and water or a disinfectant to clean toys, countertops, and other surfaces that may have a child's saliva or urine on them.
  • Avoid contact with a child's saliva when kissing or snuggling.
  • 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

When should I screen my patients for CMV infection?

When infected with CMV, most women have no symptoms, but some may have symptoms resembling mononucleosis or influenza. Women who develop a mononucleosis or flu-like illness during pregnancy should be tested for CMV. Testing should also be considered for women who have close contact with children or adults with known CMV infection. CMV can cause fetal abnormalities that are visualized by ultrasound. If abnormalities are detected during routine fetal ultrasonography, CMV testing may be important and should be discussed with a high-risk obstetrician (Maternal-Fetal Medicine physician).

For more information on a suspected maternal CMV infection and how to test for it see CMV for Obstetrical Health Care Providers.

When and how should infants who have failed the second hearing screen be tested for CMV?

In order to identify infants at risk for congenital CMV-associated progressive hearing loss, infants who fail the second hearing screening, unilaterally or bilaterally, should be tested for CMV no later than 3 weeks of age. This can be performed with a PCR assay for CMV on urine or saliva. After 3 weeks of age, these tests cannot differentiate between congenital CMV and CMV acquired postnatally.

What action should be taken if an infant who has failed the second hearing screening has a positive CMV test?

These 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.

To date, there is no FDA approved drug to treat congenital CMV infection. There is limited data on the use of antiviral medications in infants with symptomatic congenital CMV infection. Studies are ongoing to determine what types of therapy are of greatest benefit to CMV-infected infants. Infants with suspected congenital CMV infections should be evaluated by physicians who specialize in these infections.

NBHS PCP Flow Chart


Care Documents for Health Care Providers:

Reference Materials for Health Care and Newborn Hearing Screening Providers: Forms for Health Care and Newborn Hearing Screening Providers:

Page last updated