Human CMV is one of the largest virus infecting human beings, belonging to the family of herpesviruses which are capable of persisting all lifelong in the infected cells alternating latency with reactivations. CMV infects nearly all humans but causes serious diseases almost exclusively in those with an impaired immunity, particularly following immunosuppressive therapies or AIDS. Because the fetus, mostly during the embryonic phase, has a developing then immature immune system, and CMV is neurotropic, congenital CMV infection can cause cerebral and sensorineural abnormalities. In the immunocompetent subjects, antiviral antibodies play a key role in the prevention of CMV dissemination mostly after reactivation from latency or reinfection (infection by a CMV strain different from that already present in the subject).
Maternal CMV infection
After about 70 years from the discovery of congenital CMV, 31 years from starting antiviral therapy, and 24 years from the introduction of the CMV-specific immunotherapy, many mothers and infants have still to suffer, sometimes all life long, because the CMV experts do not find an agreement about the urgent need of:
- Informing CMV-seronegative pregnant women about the hygienic measure to be adopted for avoiding the transmission in pregnancy (which is facilitated by the physiological immune depression occurring in pregnancy to avoid fetal rejection), particularly from their children under 3 years of age
- Rapid diagnosis of primary and, possibly, recurrent (reactivation or reinfection), CMV infection in the first half of pregnancy by screening CMV IgG and IgM at least twice (i.e. 8-10 and 14-16 weeks)
- Informing pregnant women with primary CMV infection in the first 4 months of pregnancy about the possible immunotherapy with at least one infusion of HIG (200 units/kg) to prevent CMV transmission or fetal disease, and suggesting amniocentesis at 20 weeks to exclude fetal infection or fetal MRI at 20-21 weeks to exclude fetal cortical malformations.
Prevention / Treatment of fetal infection