Ontario Program Screens Newborns for Congenital CMV

TOPLINE:

A population-based congenital cytomegalovirus screening program in Ontario successfully screened 551,034 (97.4%) newborns, with 689 (0.13%) testing positive. Of those completing assessment, 96 (16.0%) were symptomatic, with 63 receiving valganciclovir treatment.

METHODOLOGY:

• A diagnostic study of a population-based screening program in Ontario, Canada, evaluated 551,034 newborns from July 29, 2019, to July 31, 2023, using polymerase chain reaction analysis of dried blood spots (DBS) for cCMV as a risk factor for hearing loss.
• Researchers confirmed positive DBS results through urine polymerase chain reaction testing, followed by complete medical and audiologic assessments for sequelae of cCMV infection.
• Infants with possible or confirmed symptomatic cCMV were referred to pediatric infectious disease specialists for evaluation of potential valganciclovir treatment.

TAKEAWAY:

• Of 565,987 infants born during the screening period, 551,034 (97.4%) received cCMV screening, with 689 (0.13%) screening positive and 601 (87.2%) completing comprehensive assessment.
• Among the 96 infants deemed symptomatic, 63 (65.6%) initiated valganciclovir treatment, with sensorineural hearing loss confirmed in 34 (35.4%) of symptomatic cases.
• The program demonstrated lower than expected prevalence of cCMV-positive screens but successfully identified many children who would otherwise not have been diagnosed.
• Implementation of the population-based screening program using routinely collected dried blood spot samples proved acceptable and feasible.

IN PRACTICE:

“This program found acceptable and feasible implementation of a population-based screening program using routinely collected DBS samples, suggesting that it may serve as a template for jurisdictions considering universal cCMV screening. The program had a much lower than expected prevalence of cCMV-positive screens but still identified many children who would otherwise not have been diagnosed and who would benefit from ongoing audiologic surveillance,” wrote the authors of the study. In a related editorial, the commentator wrote, “At this stage, we may be missing cases of cCMV by DBS screening, but we should not let the perfect be the enemy of the good. As Dunn et al report, universal cCMV has been a game changer for many infants in Ontario. The identification of almost 100 symptomatic and more than 500 asymptomatic infants with cCMV for whom anticipatory hearing, speech and language, and neurodevelopmental surveillance can be conducted will improve outcomes for these children.”

SOURCE:

The study, published online on January 21 in JAMA Pediatrics, was led by Jessica K. E. Dunn, MD, MPH, Alberta Children’s Hospital in Calgary, Canada. The related editorial by Mark R. Schleiss, MD, University of Minnesota Medical School, Minneapolis was also published online on January 21 in JAMA Pediatrics.

LIMITATIONS:

According to the authors, the program showed a relatively high rate of negative confirmatory urine testing in those with positive dried blood spot results (9.2%), contrasting with the high specificity noted in research settings. The researchers also noted challenges in clinical management regarding numerous children with head ultrasonographic findings of variable severity potentially attributable to cCMV, particularly in determining the role of magnetic resonance imaging and prescribing valganciclovir treatment.

DISCLOSURES:

Dunn disclosed receiving grants from the Canadian Institute for Health Research and being a coinvestigator on the KidCOVE pediatric study of the mRNA-1273 COVID-19 vaccine (Moderna). Schleiss reported grant support but no personal honoraria from Moderna Vaccines. Additional disclosures are noted in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.