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Open AccessReview

Impact of Maternal Immunity on Congenital Cytomegalovirus Birth Prevalence and Infant Outcomes: A Systematic Review

1
Department of Pediatrics, Duke University Hospital, Durham, NC, 27701, USA
2
Duke HumanVaccine Institute, Durham, NC, 27701, USA
3
Medical Center Library & Archives, Duke University, Durham, NC, 27701, USA
*
Author to whom correspondence should be addressed.
Vaccines 2019, 7(4), 129; https://doi.org/10.3390/vaccines7040129
Received: 20 May 2019 / Revised: 17 September 2019 / Accepted: 22 September 2019 / Published: 26 September 2019
(This article belongs to the Special Issue Cytomegalovirus Infection and Vaccine Development)
Congenital cytomegalovirus (cCMV) is the leading non-genetic cause of sensorineural hearing loss (SNHL), and efforts are geared towards prevention through vaccine development. Transmission rates following primary maternal infection occur at rates of 30–40%, however reported placental rates upon non-primary maternal infection is reported to be less than <4%. There is significant debate about whether this reduction in transmission rate is due to pre-existing maternal immunity, which could identify possible immunologic targets for vaccines. To address this question, we performed a systemic review of the literature using Preferred Reporting Items for Systematic Review and Analysis (PRISMA) guidelines. We identified cohort studies in high CMV seroprevalent (>80%) areas or in developing regions that examined a cohort of at least 50 infants for congenital CMV acquisition. We identified 19 articles that met criteria and were further categorized based on pre-conception serology, maternal seroprevalence, or previously known seroprevalence. Birth prevalence rates ranged from 0.4% to 6% (median 1.1%), with the studies reporting on clinical outcome (16/19 studies) noting the majority of infected infants as asymptomatic. We also utilized a recent study that differentiated primary maternal infections from chronic infections in a highly seropositive population to calculate a placental transmission rate in women with pre-existing immunity compared to that of no pre-existing immunity. This work confirms a low cCMV birth prevalence in highly seropositive populations, indicates via a calculated placental transmission rate that the CMV placental transmission rate is lower in non-primary infection than that of primary infection, and reveals gaps in data for further research aiming to identify targets for vaccine development. View Full-Text
Keywords: vertical transmission; hearing loss; reactivation; primary infection; congenital cytomegalovirus; maternal immunity vertical transmission; hearing loss; reactivation; primary infection; congenital cytomegalovirus; maternal immunity
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Coppola, T.; Mangold, J.F.; Cantrell, S.; Permar, S.R. Impact of Maternal Immunity on Congenital Cytomegalovirus Birth Prevalence and Infant Outcomes: A Systematic Review. Vaccines 2019, 7, 129.

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