June is Cytomegalovirus (CMV) Awareness Month,1 a crucial period for infection preventionists (IPs) to enhance their knowledge and strategies regarding this pervasive viral infection, one of the most common congenital infections worldwide. Yet, it often flies under the radar, even within the health care community. In the United States, nearly 1 in 3 children is already infected with CMV by age 5, and over half of adults have been infected with CMV by age 40.1 This gap in awareness can result in missed opportunities for early diagnosis and intervention, particularly among high-risk groups such as pregnant women, newborns, and immunocompromised individuals.
During CMV Awareness Month, IPs are called to focus on the transmission pathways, clinical manifestations, and effective prevention measures for CMV. By increasing understanding and vigilance, IPs can play a pivotal role in reducing the spread of CMV, implementing robust infection control practices, and ultimately improving health outcomes for those impacted by this significant pathogen.
In healthy individuals, CMV infection can sometimes manifest as mild illnesses characterized by fever, sore throat, fatigue, and swollen glands. In some instances, CMV can cause more significant conditions like mononucleosis or hepatitis, which involves liver inflammation.1,2
Cytomegalovirus Infection in Saudi Arabia
In Saudi Arabia, cytomegalovirus (CMV) infection management and prevention are taken seriously due to their potential health risks, particularly to immunocompromised individuals, pregnant women, and newborns.
The Ministry of Health has implemented several strategies to combat the spread and impact of CMV. These strategies include routine screening for pregnant women to identify and manage CMV infections early, as well as public health campaigns to raise awareness about the virus. Healthcare providers are trained to recognize and treat CMV-related complications, and antiviral medications are available to manage infections.
Additionally, the Saudi health system emphasizes the importance of hygiene practices, such as regular handwashing and avoiding close contact with infected individuals, to reduce transmission. Research and surveillance programs are also in place to monitor CMV prevalence and develop more effective prevention and treatment protocols. Through these comprehensive efforts, Saudi Arabia aims to mitigate the impact of CMV and protect vulnerable populations.
The specific guidelines for managing CMV in Saudi Arabia are outlined in the "Saudi National Guidelines for the Management of Cytomegalovirus (CMV) Infection in Immunocompromised Patients" issued by the Ministry of Health. These guidelines provide a detailed framework for health care providers to diagnose, treat, and prevent CMV infections, especially among high-risk groups such as pregnant women and immunocompromised individuals.
- Guideline Name: Saudi National Guidelines for the Management of Cytomegalovirus (CMV) Infection in Immunocompromised Patients
Heba AL Zamel, MSN, CIC, CPHQ
Infection control preventionist
Health care policy consultant
Infection Control Today Editorial Advisory Board member
“Human cytomegalovirus infections commonly are associated with the salivary glands. CMV infection may be asymptomatic in healthy people, but it can be life-threatening in an immunocompromised patient. Congenital cytomegalovirus infection can cause morbidity and even death. After infection, CMV often remains latent, but it can reactivate at any time. Eventually, it causes mucoepidermoid carcinoma, and it may be responsible for prostate cancer,” wrote Mohit Gupta Cleveland Clinic Foundation; Mahmoud Shorman in their book Cytomegalovirus.2
In immunocompromised patients, CMV infection can affect various organs, including the eyes, lungs, liver, esophagus, stomach, and intestines, resulting in severe symptoms.
Babies born with CMV can experience a range of health issues affecting the brain, liver, spleen, lungs, and growth. The most prevalent long-term health complication for infants with CMV infection is hearing loss, which can be identified shortly after birth or develop later in childhood.1
Despite the possibility of lifelong challenges from the disease, “Congenital cytomegalovirus (cCMV) is the most common intrauterine infection, leading to neurodevelopmental disabilities. Universal newborn infant screening of cCMV has been increasingly advocated. In the absence of a high-throughput screening test which can identify all infected newborn infants, the development of an accurate and efficient testing strategy has remained an ongoing challenge, “according to the CDC.1
While a vaccine3 is being developed, much more, such as better tests, must be done to protect people of all ages against CMV. “CMV testing is very significant for healthcare personnel due to its communicability. CMV testing can help determine whether a patient should be placed in a monitoring situation. Additionally, it is crucial for making preoperative or postoperative diagnoses. It is particularly important for environmental services (EVS) personnel in the cleaning and decontamination process, as they must ensure the use of a virucidal agent to eliminate the respective pathogens in the environment as they encounter bodily fluids during daily cleanings of occupied and unoccupied patient rooms,” said Tommy Davis, PhD, ACHE, CEPHP, BLS, CSSWB, the CEO, president, and principal officer at High Distinction Consulting, LLC. He is also an Infection Control Today® (ICT®)2023 Editorial Advisory Board member.
ICT spoke with Dana Wolf, MD, the Ted and Frances Chanock Chair in Virology and the Head of the Clinical Virology Unit Department of Clinical Microbiology & Infectious Diseases at Hadassah University Hospital in Jerusalem, Israel, to learn more about CMV and the tests currently available.
ICT: Why is there so little awareness of CMV, especially when people know about rare viruses like Zika?
Dana Wolf, MD: I believe it is mostly because CMV infection is often invisible, unlike some other viral infections presenting with acute symptoms (such as polio or measles) and is not routinely screened; it is often asymptomatic and goes unnoticed in pregnant women (if they are not routinely screened by antibody tests) and in congenitally infected children (if they are not routinely universally screened).
As we stressed in our attached paper,4 the majority (~90%) of neonates born with congenital CMV infection are initially asymptomatic at birth. The second potential reason why public awareness is so low is because congenital CMV is not a "terrifying" emerging pandemic like Zika or COVID-19. But it is still a silent, ongoing worldwide epidemic.
ICT: Why are most people not harmed by it, while some—like newborns and the immunocompromised—are?
DW: Most of the human population lives with CMV. After the primary (first) infection, the virus remains in our body for the rest of our lives in a state of latency, or dormancy, with occasional reactivations and reinfections, which are primarily asymptomatic and well-controlled by the immune system in healthy individuals. There is an ongoing balance maintained between the virus and our immune system.
