About CMV
Cytomegalovirus, or CMV, is a common virus that can infect people of all ages. According to the Centers for Disease Control and Prevention (CDC), over half of adults have been infected with CMV by the age of 40, and at least one-in-three children have already been infected by the age of five. Most of the time, the virus causes only minor symptoms following infection, and often it causes no symptoms at all. However, CMV infection can cause health issues for those with a weakened immune system, including transplant recipients. CMV can also cause infection of an infant before birth. When acquisition of the virus occurs in utero, it leads to congenital CMV infection.
CMV Virus
The CMV virus is a member of the Herpesvirus family of viruses. This family includes some commonly known viral infections of humans, including chickenpox and Epstein-Barr virus (the cause of most cases of infectious mononucleosis). Like all members of the Herpesvirus family, the CMV virus persists for life, once infection occurs. CMV infections are ubiquitous - most infections are asymptomatic, and over 80% of people around the world have been infected with CMV. The CMV virus genome is made up of double-stranded DNA, and the viral DNA and protein is protected by a lipid envelope (see figure), which is embedded with virus-encoded proteins that have emerged as potential targets for experimental CMV vaccines.
Congenital CMV
Congenital CMV is when a baby is born with CMV. If a woman is infected with CMV when she is pregnant and it is the first time she has ever had the virus in her body, there is a small chance she may pass it to the baby. According to the CDC, one out of every 200 babies is born with congenital CMV. However, most babies born with CMV will never show signs or symptoms of the virus. Only one in five babies born with congenital CMV will have long-term health problems. Symptoms of congenital CMV will be different for each child and can range from mild to severe. Infants who have symptomatic disease at birth are more likely to have long-term disabilities, including neurodevelopmental disabilities and hearing loss, than asymptomatic babies.
Signs and Symptoms
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Transmission
- Direct contact with body fluids from an infected person (urine, saliva, blood, etc.)
- From breast milk to nursing infants
- Through transplanted organs and blood transfusions
- From a woman to her unborn child, likely via the blood and through the placenta
Prevention
- Wash hands often, especially after touching a child’s urine, saliva, or body fluids
- Avoid sharing food, cups, eating utensils, or a toothbrush with other people
- Don’t clean a baby’s pacifier with your mouth
- Avoid contact with saliva when kissing a child
Diagnosis
Blood tests can diagnose CMV infection in adults. Saliva and urine are preferred testing methods in children. To diagnose congenital CMV in babies, testing must occur within the first 2-3 weeks of life.
Treatment
Healthy people who are infected with CMV do not require treatment. There is no treatment that results in permanent eradication of the virus. But, in patients with CMV disease, antiviral drugs such as ganciclovir or valganciclovir, can improve disease outcomes and limit the duration of symptoms. Infants with symptomatic congenital CMV have improved hearing and neurological outcomes if they are treated with antiviral therapy. It is unknown if antiviral therapy improves the hearing or neurodevelopmental outcomes of asymptomatic congenital CMV infection.
The National CMV Foundation provides a source for extensive and outstanding background information on congenital CMV infection.
Source: CDC: About Cytomegalovirus
Additional information about the impact of congenital CMV can be found in this manuscript.
Contact Us
Please email any questions or comments to [email protected].
Dr. Mark Schleiss
Mark R. Schleiss, MD is a Professor of Pediatrics at the University of Minnesota Medical School. Dr. Schleiss received his MD degree from the Oregon Health and Sciences University, Portland, Oregon. He completed his residency at Doernbecher Children’s Hospital, Oregon Health and Sciences University, Portland, Oregon and his Pediatric Infectious Diseases fellowship at Children’s Hospital Medical Center, University of Washington, Seattle, Washington. He also completed a fellowship in Molecular Medicine studying cytomegalovirus molecular genetics at the Fred Hutchinson Cancer Research Center, Seattle, Washington.
Dr. Erin Osterholm
Erin A. Osterholm, MD, is an Assistant Professor in the Division of Neonatalogy and is Medical Director of the Newborn Intensive Care Unit at UMMCH. She received her MD degree at the University of Minnesota Medical School, Minneapolis, MN, and also completed pediatric residency (serving for a year as Chief Resident in Pediatrics), and fellowship training in neonatology at the University of Minnesota Medical School, Minneapolis, MN. She is co-Principal Investigator of a grant with Dr. Schleiss, Longitudinal Assessment of Asymptomatic Congenital CMV Infection in Minnesota Infants Identified by Universal Screening: What is Risk of Sequelae?
Craig Bierle, PhD
Craig J. Bierle, Ph.D., is an Associate Professor in the Division of Pediatric Infectious Diseases and Immunology. Dr. Bierle received his doctorate in Molecular and Cellular Biology from the University of Washington and the Fred Hutchinson Cancer Research Center in Seattle. He heads a research laboratory that studies viral infections of pregnancy, and is an active collaborator with Dr. Schleiss on laboratory-based congenital CMV studies.
From Bedside to Bench
Shortly after being born, Solomon Skelton Harris was diagnosed with congenital cytomegalovirus (cCMV) and group B streptococcus. For the first three years of his life, he was a regular patient at the M Health Fairview Masonic Children’s Hospital where he received treatment from Mark Schleiss M.D. and Patricia Ferrieri M.D. Now, Skelton Harris is beginning a promising career in medicine, influenced by his diagnosis eighteen years ago at the University of Minnesota.
As a result of these frequent visits to the Masonic Children’s Hospital, Skelton Harris says that he and his family received more than just medical treatment. Ferrieri and Schleiss bonded with the Skelton Harris family, going above and beyond the standard of care. They took the time to get to know the family, forming a long-lasting relationship that continues to this day. The Skelton Harris’ still send both physicians holiday cards and updates on how Solomon is doing.
Skelton Harris’ positive experience with his physicians ultimately led to a personal interest in medicine, prompting him to reach out to Schleiss and Ferrieri about research opportunities before his senior year of high school. As a student-researcher in Schleiss’ lab, Skelton Harris researched the very same virus he was born with: congenital CMV.
Skelton Harris’ typical day in the lab involved looking at tissue samples and trying to determine the possibility of retrospectively diagnosing congenital CMV for children who initially went undiagnosed at birth. Having been born with congenital CMV himself, Skelton Harris had a unique perspective while working in the lab.
“When I was in the lab, I was dealing with patient samples and it really struck me how I was one of those patients and I’m now dealing with their samples in the lab,” Skelton Harris says. “It was really an eye-opening experience in which I was able to truly understand the impact that people in labs have on individual patients and how much work they put in.” It is this perspective that allowed him to truly appreciate the work he was doing.
During his time as a student-researcher, Skelton Harris was able to gain invaluable hands-on experience in the lab that culminated in an opportunity to share his findings at the University of Minnesota’s Pediatric Research, Education & Scholarship Symposium (PRESS). As a high school student, Skelton Harris was the youngest presenter in attendance at the event, yet he received exemplary feedback from judges and his fellow attendees alike. Skelton Harris’ command of the material was evident to Schleiss, who praised the young researcher for displaying a deep understanding of the science behind his project.
After working for Schleiss in his lab, Skelton Harris became determined to continue his medical studies, and set a personal goal to attend medical school someday. Skelton Harris is currently studying biology and pre-medicine at Brandeis University outside of Boston, where he is a first-year student. Skelton Harris plans to use the many connections and opportunities offered by both Brandeis University and in the Boston area to continue fostering his passion for medicine.
While Skelton Harris is not certain what path he will follow in the medical field, he loves the idea of working in pediatrics or research to help patients and families who find themselves in similar situations to the one that he and his family were once in. Skelton Harris says that he hopes to be an advocate for families and share their stories, a great attribute in any future physician. Skelton Harris understands the value of humanizing the struggles of a diagnosis thanks to his own experience with CMV. He shared, “You can always talk about the virus, but I think the biggest thing is showing the people it impacts. So putting a face to the virus, a story to the virus.”
Skelton Harris’ story is a great example of how small, positive interactions while receiving medical care can make a huge difference to families and create a ripple effect of positivity. The compassion shown by Schleiss and Ferrieri influenced Skelton Harris’ passion for helping others, leading to an interest in medicine and doing research with his former physician. While these connections may seem small, the impact on Skelton Harris’ life has been extraordinary, much like many aspects of patient care. Their relationship continues to this day, as Schleiss hopes to see Skelton Harris return to the U of M, this time to attend medical school.
UMMC Masonic Children's Hospital, Pediatric Grand Rounds, April 21, 2021
Dr. Erin Osterholm was the speaker at the UMMC Masonic Children's Hospital Department of Pediatrics "Grand Rounds" on April 21, 2021! Her talk, Advances in Cytomegalovirus Infection in the Newborn; Screening, Infection in At-risk Populations, and Long-term Outcomes, was extremely well-received! In her lecture she updated the status and clinical outcomes of infants with congenital CMV identified in our Minnesota Universal Screening Study (doi: 10.1001/jamapediatrics.2020.5441). Great job, Dr. Osterholm!
CMV "SPRINGing into Action" Event, March 20, 2021
The Biodiscovery District (BDD) was the site for a CMV "SPRINGing into action" event on Saturday, March 20 - the first day of spring! The event was to have a spring "planting" of pinwheels in the BDD in support of SF1698, the "Vivian Act". This bill would enhance efforts in Minnesota toward increasing knowledge and awareness of congenital CMV, the most common infectious disease in the United States that causes disabilities in newborns. The details of the bill can be viewed on the TrackBill website. Thank you to CMV parent advocates Leah Henrikson, Steph Steidl, Abby Stahowiak and Jora Bart for their tireless efforts in organizing this event and to Senator Karin Housley for Minnesota Senate sponsorship of the legislation and to Representative Dan Wolgamott for his sponsorship in the House of Representatives and for his stirring speech at the event!
Media coverage of the event can be viewed via this TVEyes media report.
Thank you to all in the Minnesota Pediatric, Otolaryngology and Ophthalmology communities who have supported this legislation!
Congratulations to Rebecca Kruc for Platform Presentation at St. Jude's/Pediatric Infectious Diseases Symposium, March 4, 2021
Rebecca Kruc, UMN Medical Student, presented her work on viral load analyses in Minnesota newborns screened for congenital CMV infection during a competitive platform poster oral session at the St. Judes/Pediatric Infectious Diseases symposium on March 4. The title of Rebecca's talk was "Does Cytomegalovirus Viral Load Correlate with Disease Severity in the Setting of Congenital CMV Infection? Results from a Universal cCMV Screening Study". Rebecca previously received a competitive educational grant from the Pediatric Infectious Diseases Society for the 2020 PIDS Symposium.