Surveillance of congenital cytomegalovirus in the UK and Ireland
- 1MRC Centre of Epidemiology for Child Health, UCL Institute of Child Health, University College London, London, UK
- Correspondence to Dr Claire L Townsend, MRC Centre of Epidemiology for Child Health, UCL Institute of Child Health, University College London, 30 Guilford Street, London WC1N 1EH, UK;
Contributors CT carried out the statistical analyses and drafted the paper. All authors contributed to the interpretation of the study, commented on all drafts of the paper and approved the final version.
- Accepted 16 December 2010
- Published Online First 2 February 2011
Objective To explore the presentation and management of congenital cytomegalovirus (CMV) identified through routine clinical investigations, and ascertain outcome in early childhood.
Design Active population-based surveillance.
Setting UK and Ireland.
Methods Infants born in 2001–2002 with confirmed or suspected congenital CMV infection were reported through the British Paediatric Surveillance Unit, and clinicians completed questionnaires on presentation, diagnosis, management and subsequent outcome.
Results 86 confirmed and 70 possible cases of congenital CMV infection were reported. Over a third (27/72) of singleton infants with confirmed and 44% (27/61) with possible congenital infection were preterm (<37 weeks gestation). Among confirmed cases, 75% (64/85) presented with neonatal manifestations compatible with congenital CMV, over half (34/64) of whom had neurological signs; 17 infants were treated with gancyclovir. Among confirmed cases with information on outcome, 31% (24/78) were developing normally, 18% (14/78) had mild, 24% (19/78) moderate and 14% (11/78) severe sequelae, and 13% (10/78) had died. Median age at follow-up among survivors was 18 months (IQR 15–22 months). Children with neonatal CMV manifestations were significantly more likely than those without to have moderate or severe outcomes (including death) (60%, 36/60, vs 22%, 4/18, p=0.001). 27% of survivors (17/63) had bilateral hearing loss.
Conclusions The number of confirmed cases of diagnosed congenital CMV reported in this study was lower than expected, highlighting the need for early and appropriate investigations when congenital infection is suspected. Due to the unexpectedly high proportion of preterm infants, resulting from differential case ascertainment, it was difficult to distinguish prematurity and CMV-related symptoms.
Funding This work was undertaken at the Centre for Paediatric Epidemiology and Biostatistics, which benefits from funding support from the UK Medical Research Council (MRC) in its capacity as the MRC Centre of Epidemiology for Child Health. The UCL Institute of Child Health, University College London, receives a proportion of funding from the Department of Health's National Institute for Health Research Biomedical Research Centres funding scheme.
Competing interests None.
Ethics approval Ethics approval for this study was granted by the Great Ormond Street Hospital for Children NHS Trust/Institute of Child Health Ethics Committee.
Provenance and peer review Not commissioned; externally peer reviewed.