Congenital Cytomegalovirus Disease Research Articles

Pharmacokinetic and Pharmacodynamic Assessment of Oral Valganciclovir in the Treatment of Symptomatic Congenital Cytomegalovirus Disease

Intravenous ganciclovir administered for 6 weeks improves hearing outcomes in infants with symptomatic congenital cytomegalovirus (CMV) disease involving the central nervous system. Twenty-four subjects received antiviral therapy for 6 weeks. Serial pharmacokinetic assessments were performed after administration of valganciclovir oral solution and of intravenous ganciclovir. On the basis of a previous pharmacokinetic study of the use of intravenous ganciclovir in this population, a target AUC12 (area under the concentration-time curve over a 12-h period) of 27 mg x h/L was defined. The median dose of oral valganciclovir administered in the present trial was 16 mg/kg, which produced a geometric mean AUC12 of 27.4 mg x h/L. The bioavailability of valganciclovir was 41.1%. Of the 18 subjects who had detectable CMV in whole blood at baseline or during therapy, 11 had <4 log viral DNA copies/mL at baseline, and 7 had > or =4 log viral DNA copies/mL at baseline; subjects who started the study with the higher viral burden experienced greater decreases in viral load but did not clear virus during the 42-day course of therapy. Neutropenia of grade 3 or 4 developed in 38% of subjects. In neonates with symptomatic congenital CMV disease, valganciclovir oral solution provides plasma concentrations of ganciclovir comparable to those achieved with administration of intravenous ganciclovir. The results of the present study cannot be extrapolated to extemporaneously compounded liquid formulations of valganciclovir.

Congenital Hearing Loss and CMV Infection

Congenital cytomegalovirus (CMV) infection is associated with sensorineural hearing loss and is the leading nongenetic cause of hearing impairment in infants, but the majority of newborns infected with CMV do not have any clinical signs of CMV disease. To examine the incidence of CMV infection among infants with hearing loss, researchers reviewed the charts of 79,047 infants who were born at one hospital …

Prospects for Development and Potential Impact of a Vaccine Against Congenital Cytomegalovirus (CMV) Infection

A recent review made note of the 50th anniversary of the identification of human cytomegalovirus (CMV) in cell culture, an important milestone that paved the way to today’s understanding of the molecular biology, immunology, and clinical importance of this ubiquitous viral infection.1 In the past 50 years, much progress has been made in the characterization of disease caused by CMV. Solid organ and hematopoietic stem cell (HSC) transplant patients have significant problems with CMV disease, including pneumonia, retinitis, and graft rejection, and there are extensive efforts to identify immune correlates of protection in these populations.

Primary versus Nonprimary Cytomegalovirus Infection during Pregnancy, Israel

We examined prospectively the outcome of primary and nonprimary maternal cytomegalovirus (CMV) infection during pregnancy among 88 and 120 women, respectively. The risk for vertical transmission was 1.83× higher for primary infection than for nonprimary infection. Nonetheless, congenital CMV disease was diagnosed in both infection groups at similar rates.

Ganciclovir Population Pharmacokinetics in Neonates Following Intravenous Administration of Ganciclovir and Oral Administration of a Liquid Valganciclovir Formulation

Cytomegalovirus (CMV) is the most common viral congenital infection, producing both sensorineural hearing loss and mental retardation. Our objective was to assess the population pharmacokinetics of a research-grade oral valganciclovir solution in neonates with symptomatic congenital CMV disease. Twenty-four neonates received 6 weeks of antiviral therapy. Ganciclovir and valganciclovir were measured by liquid chromatography/tandem mass spectroscopy. NONMEM version VI beta was used for population analyses. All profiles were consistent with a one-compartment model. Postnatal age, body surface area, and gender did not improve the model fit after body weight was taken into account. The typical value of clearance (l/h), distribution volume (l), and bioavailability of ganciclovir were 0.146 x body weight (WT)(1.68), 1.15 x WT, and 53.6%, respectively. Although these results cannot be extrapolated to extemporaneously compounded valganciclovir preparations, they provide the foundation on which a commercial-grade valganciclovir oral solution may be a viable option for administration to neonates.

Vaccination as an Antiviral Strategy for Control of Cytomegalovirus (CMV) Disease: A Vectored Vaccine Approach Targeting the UL83 (pp65) Homolog Protects Against Congenital CMV Disease in the Guinea Pig Model

Vaccination as an Antiviral Strategy for Control of Cytomegalovirus (CMV) Disease: A Vectored Vaccine Approach Targeting the UL83 (pp65) Homolog Protects Against Congenital CMV Disease in the Guinea Pig Model

Preconceptual Administration of an Alphavirus Replicon UL83 (pp65 Homolog) Vaccine Induces Humoral and Cellular Immunity and Improves Pregnancy Outcome in the Guinea Pig Model of Congenital Cytomegalovirus Infection

Development of a vaccine against congenital cytomegalovirus (CMV) infection is a major public health priority. We report the use of a propagation-defective, single-cycle, RNA replicon vector system, derived from an attenuated strain of the alphavirus Venezuelan equine encephalitis virus, to produce virus-like replicon particles (VRPs) expressing GP83, the guinea pig CMV (GPCMV) homolog of the human CMV pp65 phosphoprotein. Vaccination with VRP-GP83 induced antibodies and CD4(+) and CD8(+) T cell responses in GPCMV-seronegative female guinea pigs. Guinea pigs immunized with VRP-GP83 vaccine or with a VRP vaccine expressing influenza hemagglutinin (VRP-HA) were bred for pregnancy and subsequent GPCMV challenge during the early third trimester. Dams vaccinated with VRP-GP83 had improved pregnancy outcomes, compared with dams vaccinated with the VRP-HA control. For VRP-GP83-vaccinated dams, there were 28 live pups and 4 dead pups (13% mortality) among 10 evaluable litters, compared with 9 live pups and 12 dead pups (57% mortality) among 8 evaluable litters in the VRP-HA-vaccinated group (P<.001, Fisher's exact test). Improved pregnancy outcome was accompanied by reductions in maternal blood viral load, measured by real-time polymerase chain reaction. These results indicate that cell-mediated immune responses directed against a CMV matrix protein can protect against congenital CMV infection and disease.

Passive Immunization During Pregnancy for Congenital Cytomegalovirus Infection

Purpose of the Study. To investigate the effectiveness of cytomegalovirus (CMV)-specific hyperimmune globulin for primary CMV infection during pregnancy as a preventive therapy for fetal CMV infection. Study Population. One hundred fifty-seven pregnant women from 8 Italian cities with a primary CMV infection diagnosed via serologic testing. Methods. Women were placed in 1 of 2 groups. The therapy group comprised women who underwent amniocentesis and whose amniotic fluid contained either CMV detected by culture or CMV DNA detected by polymerase chain reaction. The group was offered intravenous CMV-specific hyperimmune globulin at a dose of 200 U per kg of maternal weight. Additional intravenous, intraumbilical-cord, or intra-amniotic doses were administered if evidence of persistent fetal involvement was present on ultrasound. Women with CMV-positive amniotic fluid who declined to receive hyperimmune-globulin infusions were followed as a comparison group. Those in the prevention group, consisting of women with a recent primary infection before 21 weeks’ gestation or who declined amniocentesis, were offered monthly hyperimmune globulin (100 U/kg intravenously). Pregnant women who declined monthly administration of hyperimmune globulin were followed as a comparison group. Results. In the therapy group, 31 women received hyperimmune globulin, only 1 (3%) of whom gave birth to an infant with symptomatic CMV disease, compared with 7 (50%) of 14 women who did not receive hyperimmune globulin. Thus, hyperimmune-globulin therapy was associated with a significantly lower risk of congenital CMV disease (adjusted odds ratio: 0.02; 95% confidence interval: −∞ to 0.15; P &amp;lt; .001). In the prevention group, 37 women received hyperimmune globulin, 6 (16%) of whom had infants with congenital CMV infection, compared with 19 (40%) of 47 women who did not receive hyperimmune globulin. Thus, hyperimmune-globulin therapy was associated with a significantly lower risk of congenital CMV infection (adjusted odds ratio: 0.32; 95% confidence interval: 0.10 to 0.94; P = .04). No adverse effects resulted from CMV-specific hyperimmune globulin administration. Conclusions. Treatment of pregnant women with CMV-specific hyperimmune globulin is safe, and the findings of this nonrandomized study suggest that it may be effective in the treatment and prevention of congenital CMV infection. A controlled trial of this agent may be appropriate. Reviewer Comments. The risk of congenital CMV infection is high after primary maternal CMV infection. Although the majority of congenitally acquired CMV infections are asymptomatic, symptomatic infections result in significant morbidity and possible mortality. The implementation of CMV-specific hyperimmune globulin may reduce or prevent the devastating effects of symptomatic congenital CMV.

Protection against congenital cytomegalovirus (CMV) disease, conferred by a replication-disabled, bacterial artificial chromosome (BAC)-based DNA vaccine

It is unclear if protective immunity can be conferred by a cytomegalovirus (CMV) vaccine encoding a single protein subunit, or if multiple viral genes need to be targeted. Using the guinea pig model of congenital CMV infection, these studies examined the immunogenicity and efficacy of a DNA vaccine based on the guinea pig cytomegalovirus (GPCMV) genome cloned as a non-infectious BAC plasmid, modified by transposon insertion into the homolog of the HCMV tegument protein, UL48. Following vaccination of female Hartley guinea pigs with BAC DNA, adverse GPCMV-related pregnancy outcome were assessed after establishment of pregnancy, followed by GPCMV third-trimester challenge. Animals immunized with recombinant BACmid engendered anti-GPCMV antibodies by ELISA assay. Immunogenicity of BAC plasmid DNA was augmented by inclusion of the lipid adjuvant, DOTMA/DOPE, in the vaccine regimen. Among pups born to 12 control (sham-immunized) dams challenged with GPCMV in the third trimester, mortality was 23/35 (66%). In contrast, among evaluable pregnancy outcomes in pups born to 10 BAC-immunized pregnant dams, preconception immunization resulted in reduced pup mortality, to 10/34 pups (29%; p < 0.005 versus control, Fisher's exact test). In addition, vaccinated dams had reduced viral load, compared to controls, as assessed by quantitative, real-time PCR.

The Epidemiology and Prevention of Congenital Cytomegalovirus Infection and Disease: Activities of the Centers for Disease Control and Prevention Workgroup

Perhaps no single cause of birth defects and developmental disabilities in the United States currently provides greater opportunity for improved outcomes in more children than congenital cytomegalovirus (CMV). --Cannon and Davis. BMC Public Health 2005;5:70 Each year in the United States, thousands of children and their families are affected by congenital cytomegalovirus (CMV) infection. More children may be affected by congenital CMV than by other, better known childhood conditions, such as Down syndrome, fetal alcohol syndrome, and spina bifida. The Centers for Disease Control and Prevention (CDC) has formed a Workgroup on Congenital CMV, led by the National Center on Birth Defects and Developmental Disabilities and the National Center on Infectious Diseases. This report provides background on congenital CMV infection and describes the goals and activities of the workgroup for reducing the burden of sequelae of congenital CMV infection.

Passive Immunization During Pregnancy for Congenital Cytomegalovirus Infection

Approximately 1 % of all newborn infants reportedly have congenital cytomegalovirus (CMV) infection. The disorder is symptomatic in approximately one in 10 infants, and clinically significant neurologic sequelae develop in nearly half of them. Neurologic defects eventually develop in as many as 13% of newborn infants who lack symptoms. This prospective study evaluated hyperimmune globulin for treating or preventing fetal CMV infection. Participants were pregnant women with primary CMV infection. Women with primary infection for longer than 6 weeks were offered amniocentesis and treatment with 200 U/kg of intravenous hyperimmune globulin if CMV DNA was identified in amniotic fluid. If necessary, subsequent doses of 400 U/kg were given intravenously or into the umbilical cord or amniotic fluid. Women who declined amniocentesis were offered preventive treatment (100 U/kg of hyperimmune globulin per month). Untreated women served as control subjects. Of women with documented fetal infection, only one of 31 given hyperimmune globulin delivered an infant with CMV disease compared with 7 of 14 untreated women. On logistic regression analysis, treatment significantly lowered the risk of congenital disease. For prevention of fetal infection, 37 women received monthly infusions of hyperimmune globulin 2 to 11 weeks after presumed maternal seroconversion. Of these, 6 (16%) delivered an infected infant compared with 19 of 47 (40%) of untreated women. Treatment was the only factor that predicted a significant reduction in the risk of congenital infection. Treatment, whether therapeutic or preventive, correlated significantly with increased titers of CMV-specific immunoglobulin G. The percentage of total natural killer cells was significantly less in women receiving hyperimmune globulin. No adverse events were observed. Intravenous treatment with CMV-specific hyperimmune globulin is safe and may be effective both in preventing congenital infection and treating established infection.

Cytomegalovirus gB Genotype and Clinical Features in Chinese Infants with Congenital Infections

Objective: To investigate cytomegalovirus (CMV) glycoprotein B (gB) genotypes and clinical features in Chinese infants with congenital infections. Methods: Urine samples were obtained from 79 infants with human CMV infection confirmed by quantitative fluorescence polymerase chain reaction (PCR). A fragment of the gB gene was amplified by nested PCR. CMV gB genotyping was carried out by restriction fragment length polymorphism, and 24 samples of the amplified DNA fragments were verified by DNA sequencing. Results: The levels of CMV DNA in symptomatic and asymptomatic infants were 2.95 × 10⁵ and 4.5 × 10³ copies/ml, respectively, with a significant difference (p < 0.001). In all these cases, the most prevalent genotype was gB1 (50.63%), followed by gB3 (21.52%), gB2 (17.72%), and coinfection (10.13%); gB4 was not found. Moreover, gB1 was more prevalent in infants with liver damage (22/32) than in other symptomatic infants without liver damage (8/22, p = 0.019) or asymptomatic infants (10/25, p = 0.030). The homology of CMV gB in the 24 strains amplified as compared with the sequences of prototype strains in GenBank ranged from 97.06 to 99.64%. Conclusions: The restriction fragment length polymorphism analysis of CMV gB genotypes was definite and reliable. The gB1 genotype is the most prevalent in Chinese infants with congenital CMV disease, especially in those with liver damage, followed by genotypes gB3, gB2, and gB4.

Pneumocystis carinii pneumonia in Hong Kong: a 10 year retrospective study

A retrospective review was performed of patients diagnosed with Pneumocystis carinii pneumonia (PCP) from 1994 to 2003 at the Prince of Wales Hospital in Hong Kong. Eighteen patients were identified. Six (33.3%) were co-infected with human immunodeficiency virus (HIV). The remaining 12 non-HIV-infected patients had underlying diseases: three post-renal transplant recipients, three with haematological malignancies, two with auto-immune diseases, two with renal diseases, one with hepatocellular carcinoma and one with congenital cytomegalovirus disease. Cytomegalovirus co-infection was observed in four patients. All patients received cotrimoxazole therapy, with intolerance observed in four of them, including one with glucose-6-phosphate dehydrogenase deficiency, two with repeated vomiting and one with renal impairment. Overall crude mortality was 33.3%. The results suggested that, apart from being a common infection for patients with HIV infection, PCP can occur during the course of many immunosuppressive diseases and therapies. The mortality of PCP was high despite appropriate treatment. Chemoprophylaxis should be considered in populations at risk.

Nonprimate Models of Congenital Cytomegalovirus (CMV) Infection: Gaining Insight into Pathogenesis and Prevention of Disease in Newborns

Congenital and perinatal infections with cytomegalovirus (CMV) are responsible for considerable short- and long- term morbidity in infants. CMV is the most common congenital viral infection in the developed world, and is a common cause of neurodevelopmental injury, including mental retardation and sensorineural hearing loss (SNHL). Antiviral therapy has been shown to be valuable in ameliorating the severity of SNHL, but CMV disease control in newborns ultimately depends on successful development of a vaccine. Because CMVs are extremely species specific, preclinical evaluation of vaccines must be performed in animal models using the appropriate CMV of the animal being studied. Several small animal models available for CMV vaccine and pathogenesis research are described. The discussion focuses on the guinea pig model because guinea pig cytomegalovirus (GPCMV), which crosses the placenta and causes infection in utero, is uniquely useful. Examination of vaccines in the GPCMV and other nonprimate models should provide insights into the determinants of the host response that protect the fetus, and may help to prioritize potential vaccine strategies for use in human clinical trials related to this important public health problem.

Passive Immunization during Pregnancy for Congenital Cytomegalovirus Infection

Currently, there is no effective intervention for a primary cytomegalovirus (CMV) infection during pregnancy. We studied pregnant women with a primary CMV infection. The therapy group comprised women whose amniotic fluid contained either CMV or CMV DNA and who were offered intravenous CMV hyperimmune globulin at a dose of 200 U per kilogram of maternal weight. A prevention group, consisting of women with a recent primary infection before 21 weeks' gestation or who declined amniocentesis, was offered monthly hyperimmune globulin (100 U per kilogram intravenously). In the therapy group, 31 women received hyperimmune globulin, only 1 (3 percent) of whom gave birth to an infant with CMV disease (symptomatic at birth and handicapped at two or more years of age), as compared with 7 of 14 women who did not receive hyperimmune globulin (50 percent). Thus, hyperimmune globulin therapy was associated with a significantly lower risk of congenital CMV disease (adjusted odds ratio, 0.02; 95 percent confidence interval, -infinity to 0.15; P<0.001). In the prevention group, 37 women received hyperimmune globulin, 6 (16 percent) of whom had infants with congenital CMV infection, as compared with 19 of 47 women (40 percent) who did not receive hyperimmune globulin. Thus, hyperimmune globulin therapy was associated with a significantly lower risk of congenital CMV infection (adjusted odds ratio, 0.32; 95 percent confidence interval, 0.10 to 0.94; P=0.04). Hyperimmune globulin therapy significantly (P<0.001) increased CMV-specific IgG concentrations and avidity and decreased natural killer cells and HLA-DR+ cells and had no adverse effects. Treatment of pregnant women with CMV-specific hyperimmune globulin is safe, and the findings of this nonrandomized study suggest that it may be effective in the treatment and prevention of congenital CMV infection. A controlled trial of this agent may now be appropriate.

Cytomegalovirus Seroprevalence among Women of Childbearing Age during a 10-Year Period

The incidence of congenital cytomegalovirus (CMV) disease is dependent on the rate of virus acquisition by susceptible women in temporal proximity to pregnancy. Information about serostatus may help to identify high-risk groups and target interventions. Each year from 1991 to 2000, cord blood specimens (surrogates for maternal serum) from 100 consecutive deliveries were obtained at three hospitals. The presence of CMV immunoglobulin G antibody was correlated with demographic data. Overall, 58% of 2992 women were seropositive. After stratification by socioeconomic status (SES), nonwhite race was strongly associated with seropositivity (odds ratio, 3.0; 95% confidence interval [CI], 2.5 to 3.8), and after stratification by race, lower SES also was associated (odds ratio, 2.0; 95% CI, 1.7 to 2.3). There were no trends in seroprevalence over time in any demographic group. However, among white women 21 to 29 years of age, a significant association was found with later birth cohort. Seropositivity ranged from 40% among older, white primigravidas of upper SES to 89% among older, nonwhite, multigravid women of lower SES. These data suggest high rates of CMV transmission among nonwhite women of lower SES. Because these women tended to deliver infants at younger ages, delaying pregnancy even a few years might reduce the incidence of congenital disease. In contrast, most white, upper SES women remain susceptible to primary infection during their childbearing years. Such women born after 1975 may be more likely to reach the childbearing years with CMV immunity as compared with women born before then.

Nonimmune Hydrops Fetalis and Fulminant Fatal Disease Due to Congenital Cytomegalovirus Infection in a Premature Infant

We report a case of fatal congenital cytomegalovirus (CMV) disease in a 695 gm, 29 weeks estimated gestational age premature infant. The newborn presented with hydrops fetalis, an unusual presentation of congenital CMV infection. In spite of ganciclovir therapy, the infant succumbed to his illness. Autopsy findings revealed the presence of widespread CMV disease, including pneumonitis, enteritis, and myocarditis. Congenital CMV infection should be considered in the differential diagnosis of hydrops fetalis.

Symptomatic infant characteristics of congenital cytomegalovirus disease in Australia

Human cytomegalovirus (CMV) is the most common cause of viral intrauterine infection. In utero transmission can occur during primary maternal infection, reactivation or reinfection of seropositive mothers. To describe the aetiology and clinical features of infants diagnosed with congenital CMV and to document maternal factors that were presented. Active national surveillance was initiated in 1999 in collaboration with the Australian Paediatric Surveillance Unit. Monthly notifications resulted in 70 cases of congenital CMV being identified between 1999 and 2003. Nearly all of the cases were symptomatic with the most common clinical sequelae reported in infected infants being jaundice, thrombocytopaenia, hepatomegaly, petechiae, purpura and splenomegaly. Almost half (43.5%) of the infants had central nervous system (CNS) complications, such as microcephaly, chorioretinitis, sensorineural hearing loss, intracranial calcifications, developmental delay or seizures, with over half presenting two or more CNS abnormalities. Maternal febrile illness was noted in 54.8% of the cases. The majority of mothers were primiparous (46.4%) or secundiparous (39.3%), indicating two different population groups at risk of primary CMV infection. This study documents symptomatic congenital CMV cases in Australia.

Pre- and Periconceptional Primary Cytomegalovirus Infection: Risk of Vertical Transmission and Congenital Disease

In both the United States and West Europe, cytomegalovirus (CMV) infection is the most common viral form of congenital infection. Intrauterine transmission of CMV takes place in approximately 40% of infections, and approximately 10% of live-born infants have symptomatic disease at the time of birth and later. Late sequelae such as sensorineural hearing loss and neurodevelopmental disorders occur in 10% to 15% of infants lacking symptoms at birth. Recurrent maternal infection contributes substantially to the rate of congenital infection. This cohort study, covering the years 1990–2003, estimated the risk of congenital CMV infection and disease after primary maternal infection at approximately the time of conception and also in later stages of pregnancy. The study population included 166 pregnant women with serologically confirmed primary CMV infection. The timing of primary infection was studied by measuring CMV-specific immunoglobulin (Ig)M and IgG antibodies, the IgG avidity index, and titers of neutralizing antibodies. Prenatal diagnosis of CMV infection was attempted in 79 of the 166 pregnancies by analyzing amniotic fluid samples for viral DNA by the polymerase chain reaction technique and also for infectious virus. Women with symptomatic primary CMV infection and those with subclinical infection had similar transmission rates (41% and 37%, respectively). Fetal transmission of infection occurred in 45% of pregnancies with periconceptional infection, in 3 of 10 pregnancies before gestational week 6, and in none of 3 pregnancies with preconceptional infection. Eighty-nine women had primary CMV infection at gestational weeks 6–20 and 31 at weeks 20–38. The transmission rate was lowest (30%) when primary infection occurred in weeks 6–20. Rates were 39% for infection gestational at weeks 18–22 and 58% during weeks 20–38. Seven fetuses or newborn infants had congenital disease (defined as ultrasound abnormalities in cases of therapeutic abortion or the presence in newborn infants of neurologic or systemic manifestations of congenital CMV disease), all of them before gestational week 22. None of 18 infected live-born infants infected after 20 weeks gestation had congenital disease. Congenital disease was found in 4 of 25 pregnancies with vertical transmission after maternal infection in gestational weeks 6–20. Four pregnancies were ended at weeks 7–11 when primary infection was diagnosed, and there was 1 missed abortion. Only 1 of 5 live-born infants had mild symptoms at birth. Two of 3 subclinically infected newborn infants were healthy when followed up for 8 months or longer; 1 had late-onset hearing loss. The authors believe that women with periconceptional CMV infection should be managed like those having primary infection in the first 20 weeks of pregnancy. Prenatal diagnosis done at gestational weeks 21–23 can exclude fetal infection with a high degree of accuracy. Congenital infection should be sought in newborn infants of mothers having primary infection late in pregnancy or at approximately the time of conception.

Washing our hands of the congenital cytomegalovirus disease epidemic

BackgroundEach year in the United States, an estimated 40,000 children are born with congenital cytomegalovirus (CMV) infection, causing an estimated 400 deaths and leaving approximately 8000 children with permanent disabilities such as hearing or vision loss, or mental retardation. More children are affected by serious CMV-related disabilities than by several better-known childhood maladies, including Down syndrome, fetal alcohol syndrome, and spina bifida.DiscussionCongenital CMV is a prime target for prevention not only because of its substantial disease burden but also because the biology and epidemiology of CMV suggest that there are ways to reduce viral transmission. Because exposure to the saliva or urine of young children is a major cause of CMV infection among pregnant women, it is likely that good personal hygiene, especially hand-washing, can reduce the risk of CMV acquisition. Experts agree that such measures are likely to be efficacious (i.e., they will work if consistently followed) and the American College of Obstetricians and Gynecologists recommends that physicians counsel pregnant women about preventing CMV acquisition through careful attention to hygiene. However, because of concerns about effectiveness (i.e., Will women consistently follow hygienic practices as the result of interventions?), the medical and public health communities appear reluctant to embrace primary CMV prevention via improved hygienic practices, and educational interventions are rare. Current data on the effectiveness of such measures in preventing CMV infection are promising, but limited. There is strong evidence, however, that educational interventions can prevent other infectious diseases with similar transmission modes, suggesting that effective interventions can also be found for CMV. Until a CMV vaccine becomes available, effective educational interventions are needed to inform women about congenital CMV prevention.SummaryPerhaps no single cause of birth defects and developmental disabilities in the United States currently provides greater opportunity for improved outcomes in more children than congenital CMV. Given the present state of knowledge, women deserve to be informed about how they can reduce their risk of CMV infection during pregnancy, and trials are needed to identify effective educational interventions.