An overlooked cause of hearing loss among infants and children is Congenital Cytomegalovirus (CMV). CMV is a fairly common virus that a great majority of people will be exposed to in their lifetime. However, most people infected by CMV will show no signs of symptoms. Nonetheless, in the United States 1 in 100 children are born with congenital CMV and 20% will suffer permanent disabilities as a result.
As listed by Centers for Disease Control and Prevention and Stop CMV, children who are born with CMV can display many symptoms:
- Hearing and vision loss
- Mental disability
- Low birth weight
- Rash at birth
- Small head/small brain
- Sleeping, sensory and behavior issues
- Lack of coordination
- An enlarged liver and spleen
Within 2-3 weeks after birth, an infant can be diagnosed with the CMV infection if the virus is discovered in the child’s urine, blood or saliva. Fetal ultrasounds can also diagnose the baby with congenital CMV. However if an infant is diagnosed with congenital CMV, it does not necessarily mean that he or she will develop the symptoms listed above.
For precaution, children and infants who are diagnosed with congenital CMV infection should have their hearing checked regularly. There have been many cases where infants pass their initial hearing tests but lose their hearing months later, because the infection can be progressive. The sooner children can be helped, the better.
The CMV infection can be passed from the mother to the fetus through the placenta and bodily fluids including blood, urine, semen, saliva, vaginal fluids and breast milk.
Steps should be taken to prevent the spread of the virus since CMV is the most common infection in the United States that causes deafness in childhood.
Gail J. Demmler, a professor at Baylor College of Medicine and a doctor at Texas Children’s Hospital, is an advocate of finding methods for the prevention of congenital CMV infection. She also conducts multidisciplinary studies of long-term effects of CMV infection on vision and hearing, growth, development and benefits of fetal antiviral therapy. Dr. Demmler came to The Center for Hearing and Speech on June 3 and informed The Center’s employees about the CMV infection.
“An ounce of CMV awareness and 3 simple hygiene precautions will significantly reduce the risk of catching CMV during pregnancy," said Dr. Demmler.
- Washing your hands regularly using soap and hot water, particularly before preparing food, before eating, after close contact with children and after changing diapers.
- Avoiding kissing a young child on the face.
- Do not share eating utensils (forks and spoons) with young children, or drink from the same glass as them.
Figure 1: A significantly small number of women know about CMV, even though a large number of children are born with or develop long-term medical conditions due to the infection. Even more appalling is that CMV is just as common as other disabilities but not known as well; we must spread the word. (CMV Foundation)
“Only 14% of women have heard of CMV and the virus causes more long-term problems and childhood deaths than Down syndrome, Fetal Alcohol syndrome and HIV. By increasing awareness, I’m confident that this percentage will increase significantly,” said Demler.
While there is no vaccine for CMV, there are a variety of maternal and neonatal treatments for those infected with CMV:
- Ganciclovir 6 mg/kg/dose IV every 12 hours for 6 weeks significantly
- Oral valganciclovir 15 to 18 mg/kg/dose every 12 hours for 6 months
- Accommodations -Speech therapy, hearing aids, cochlear implants
Maternal Treatment to Benefit Fetus:
- Antenatal treatment with CMV hyperimmune immunoglobulin-
- CMV hyperimmune globulin intravenous
- (CMV-IVIG) 15 gm given to mother at 25 3/7 and 28 weeks gestation
States like Utah understand the importance of educating the public of CMV and passed the law, Cytomegalovirus Public Education and Testing, which created a public education program that informed pregnant women and women who may become pregnant how CMV is transmitted, its’ birth defects, and prevention tips. The law also allows doctors to test infants for congenital CMV if their child fails newborn hearing tests. In addition, the doctors go into great detail of the child’s possible birth defection and immediate treatments to be taken. This law is another step in the right direction as the state of Utah is doing her best to inform the public of CMV, help children infected with the virus, and ultimately prevent the spread of the infection.
By spreading the word and raising awareness, hopefully we can exponentially decrease the number of babies who suffer from congenital CMV.