1214. Salivary shedding of cytomegalovirus in children with congenital infection
Session: Poster Abstract Session: Pediatric CMV and Other Herpes Infections
Saturday, October 22, 2011
Room: Poster Hall B1
Background: Congenital cytomegalovirus (CMV) infection is the most common intrauterine infection affecting 0.5-1% of all neonates.  Congenitally infected children excrete virus for prolonged periods and persistent viral shedding might be associated with an increased risk of late sequelae.  Most previous studies have examined urinary viral excretion.  The objective of this study is to examine the duration of salivary shedding of CMV over the first two years of age in a longitudinal cohort of children with congenital CMV infection.

Methods: Infants born at seven medical centers in the U.S. between March 2007 and December 2008 were screened for congenital CMV infection as part of the NIDCD CHIMES study.  Available saliva specimens collected at newborn screening, at enrollment (median 37days), and at 7, 12, 18 and 24 months of age were tested for CMV using rapid culture and real-time PCR.

Results: Ninety infants were found to be CMV positive at birth (and confirmed at enrollment) and had at least one follow-up visit.  All 90 had positive saliva specimens by rapid culture at screening and the rate declined to 26% (16/61) by 24 months of age.  Saliva was positive by PCR in 100% of infants at screening and declined to 41% (25/61) positive by 24 months of age.  Mean duration of shedding was 9.1 ± 6.6 months by rapid culture compared with 14.6±6.6 months by PCR (p<0.001).  There was no difference in the duration of shedding, assessed by PCR, between 81 infants with asymptomatic infection (14.3±6.6 mo) and 9 infants with symptomatic infection (17.0±6.0 mo).  Although saliva viral load was higher in screening samples from infants with symptomatic infection (Median 3.6 x 107 ge/mL) compared to those with asymptomatic infection at birth (Median 5.0 x 106 ge/mL, p=0.047), this difference did not persist at 24 months of age.

Conclusion: A substantial number of infants with congenital CMV infection shed virus in saliva during the first two years of age, and the duration of shedding does not differ between infants with symptomatic and asymptomatic infection.  Real-time PCR appears to be more sensitive than rapid viral culture at detecting CMV over time in the saliva.


Subject Category: P. Pediatric and perinatal infections

Shannon Ross, MD1, Nitin Arora2, Zdenek Novak, MD1, Pablo J. Sanchez, MD3, Robert W. Tolan Jr., MD4, David Bernstein, MD5, Amina Ahmed, MD6, April Palmer, MD7, Marian Michaels, MD8, Masako Shimamura, MD9, Karen Fowler, DrPH1 and Suresh Boppana, MD1, (1)Pediatrics, University of Alabama at Birmingham, Birmingham, AL, (2)The University of Alabama at Birmingham, Birmingham, AL, (3)UT Southwestern, Dallas, TX, (4)Pediatrics, The Children's Hospital at Saint Peter's University Hospital, New Brunswick, NJ, (5)Cincinnati Children's Hospital Medical Center, Cincinnati, OH, (6)Carolinas Medical Center, Charlotte, NC, (7)University of Mississippi Medical Center, Jackson, MS, (8)Children's Hospital of Pittsburgh, Pittsburgh, PA, (9)Pediatrics, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL

Disclosures:

S. Ross, None

N. Arora, None

Z. Novak, None

P. J. Sanchez, None

R. W. Tolan Jr., Novartis: Speaker's Bureau, Speaker honorarium

D. Bernstein, None

A. Ahmed, None

A. Palmer, None

M. Michaels, None

M. Shimamura, None

K. Fowler, None

S. Boppana, None

Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.