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Cytomegalovirus in pregnancy: to screen or not to screen

BACKGROUND: Cytomegalovirus (CMV) infection is now the commonest congenital form of infective neurological handicap, recognized by the Institute of Medicine as the leading priority for the developed world in congenital infection. In the absence of an effective vaccine, universal screening for CMV in...

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Autores principales: Walker, Susan P, Palma-Dias, Ricardo, Wood, Erica M, Shekleton, Paul, Giles, Michelle L
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2013
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3661373/
https://www.ncbi.nlm.nih.gov/pubmed/23594714
http://dx.doi.org/10.1186/1471-2393-13-96
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author Walker, Susan P
Palma-Dias, Ricardo
Wood, Erica M
Shekleton, Paul
Giles, Michelle L
author_facet Walker, Susan P
Palma-Dias, Ricardo
Wood, Erica M
Shekleton, Paul
Giles, Michelle L
author_sort Walker, Susan P
collection PubMed
description BACKGROUND: Cytomegalovirus (CMV) infection is now the commonest congenital form of infective neurological handicap, recognized by the Institute of Medicine as the leading priority for the developed world in congenital infection. In the absence of an effective vaccine, universal screening for CMV in pregnancy has been proposed, in order that primary infection could be diagnosed and- potentially- the burden of disability due to congenital CMV prevented. DISCUSSION: Universal screening for CMV to identify seronegative women at the beginning of pregnancy could potentially reduce the burden of congenital CMV in one of three ways. The risk of acquiring the infection during pregnancy has been shown to be reduced by institution of simple hygiene measures (primary prevention). Among women who seroconvert during pregnancy, CMV hyperimmune globulin (CMV HIG) shows promise in reducing the risk of perinatal transmission (secondary prevention), and CMV HIG and/ or antivirals may be effective in reducing the risk of clinical sequelae among those known to be infected (tertiary prevention). The reports from these studies have re-ignited interest in universal screening for CMV, but against the potential benefit of these exciting therapies needs to be weighed the challenges associated with the implementation of any universal screening in pregnancy. These include; the optimal test, and timing of screening, to maximize detection; an approach to the management of equivocal results, and the cost effectiveness of the proposed screening program. In this article, we provide an overview of current knowledge and ongoing trials in the prevention, diagnosis and management of congenital CMV. Recognising that CMV screening is already being offered to many patients on an ad hoc basis, we also provide a management algorithm to guide clinicians and assist in counseling patients. SUMMARY: We suggest that- on the basis of current data- the criteria necessary to recommend universal screening for CMV are not yet met, but this position is likely to change if trials currently underway confirm that CMV HIG and/ or antivirals are effective in reducing the burden of congenital CMV disease.
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spelling pubmed-36613732013-05-23 Cytomegalovirus in pregnancy: to screen or not to screen Walker, Susan P Palma-Dias, Ricardo Wood, Erica M Shekleton, Paul Giles, Michelle L BMC Pregnancy Childbirth Debate BACKGROUND: Cytomegalovirus (CMV) infection is now the commonest congenital form of infective neurological handicap, recognized by the Institute of Medicine as the leading priority for the developed world in congenital infection. In the absence of an effective vaccine, universal screening for CMV in pregnancy has been proposed, in order that primary infection could be diagnosed and- potentially- the burden of disability due to congenital CMV prevented. DISCUSSION: Universal screening for CMV to identify seronegative women at the beginning of pregnancy could potentially reduce the burden of congenital CMV in one of three ways. The risk of acquiring the infection during pregnancy has been shown to be reduced by institution of simple hygiene measures (primary prevention). Among women who seroconvert during pregnancy, CMV hyperimmune globulin (CMV HIG) shows promise in reducing the risk of perinatal transmission (secondary prevention), and CMV HIG and/ or antivirals may be effective in reducing the risk of clinical sequelae among those known to be infected (tertiary prevention). The reports from these studies have re-ignited interest in universal screening for CMV, but against the potential benefit of these exciting therapies needs to be weighed the challenges associated with the implementation of any universal screening in pregnancy. These include; the optimal test, and timing of screening, to maximize detection; an approach to the management of equivocal results, and the cost effectiveness of the proposed screening program. In this article, we provide an overview of current knowledge and ongoing trials in the prevention, diagnosis and management of congenital CMV. Recognising that CMV screening is already being offered to many patients on an ad hoc basis, we also provide a management algorithm to guide clinicians and assist in counseling patients. SUMMARY: We suggest that- on the basis of current data- the criteria necessary to recommend universal screening for CMV are not yet met, but this position is likely to change if trials currently underway confirm that CMV HIG and/ or antivirals are effective in reducing the burden of congenital CMV disease. BioMed Central 2013-04-18 /pmc/articles/PMC3661373/ /pubmed/23594714 http://dx.doi.org/10.1186/1471-2393-13-96 Text en Copyright © 2013 Walker et al.; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Debate
Walker, Susan P
Palma-Dias, Ricardo
Wood, Erica M
Shekleton, Paul
Giles, Michelle L
Cytomegalovirus in pregnancy: to screen or not to screen
title Cytomegalovirus in pregnancy: to screen or not to screen
title_full Cytomegalovirus in pregnancy: to screen or not to screen
title_fullStr Cytomegalovirus in pregnancy: to screen or not to screen
title_full_unstemmed Cytomegalovirus in pregnancy: to screen or not to screen
title_short Cytomegalovirus in pregnancy: to screen or not to screen
title_sort cytomegalovirus in pregnancy: to screen or not to screen
topic Debate
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3661373/
https://www.ncbi.nlm.nih.gov/pubmed/23594714
http://dx.doi.org/10.1186/1471-2393-13-96
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