Program Schedule

Saliva vs. Urine PCR: The Ideal Sample for congenital CMV Screening and Diagnosis

Session: Poster Abstract Session: Pediatric - Viral Studies
Friday, October 10, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC
  • Saliva vs. Urine PCR - The Ideal Sample for congenital CMV Screening and Diagnosis.pdf (87.8 kB)
  • Background: Congenital CMV infection (cCMV) is a common congenital infection and a significant contributor to non-genetic sensorineural hearing loss (SNHL). Real-time PCR of newborn saliva specimens has been shown to be highly sensitive and specific compared to culture based methods for CMV screening. Although both saliva and urine samples are known to be acceptable for identifying infants with cCMV, it is thought that urine samples may contain more virus and thus, are optimal for cCMV screening. The objective is to compare viral load (VL) levels between saliva and urine samples from a large cohort of infants with cCMV infection identified through a newborn screening program. 

    Methods: As part of the NIDCD CHIMES study, newborns at 7 U.S. medical centers were screened for CMV by saliva and dried blood spot PCR. Infants who screened positive were enrolled in a follow-up study to confirm congenital infection by testing saliva and urine samples using a previously described real-time PCR assay. CMV viral load in saliva samples obtained at screening and enrollment was compared to urine collected at enrollment in follow-up.   

    Results: Of the 100,332 newborns screened for CMV from 2007 to 2011, viral load levels in both saliva and urine samples were available in 73% (336/462) of infants with confirmed cCMV. Of these, 36% (121/336) were enrolled within the first 3 weeks of life. The median viral load level in saliva at screening and enrollment (2.x106 IU/ml and 1.1x107 IU/ml, respectively) was significantly higher than in urine (8.3x105 IU/ml; p < 0.0001). There was no significant difference between VL in saliva and urine in infants with and without symptomatic disease and with and without congenital SNHL. In the smaller cohort of infants enrolled within 3 weeks of birth, median saliva VL at screening and enrollment (1.1x106 IU/ml vs. 9.3x106 IU/ml, respectively) was higher than urine VL (7.9x105IU/ml; p < 0.0001) .  

    Conclusion: Infants with congenital CMV infection shed large amounts of virus in both saliva and urine. However, saliva samples contained higher viral load than urine, are easier to collect and do not require DNA extraction. Therefore, we propose that saliva should be considered the ideal specimen and real-time PCR of saliva is appropriate for both newborn screening and diagnosis of cCMV.

    Swetha G. Pinninti, MD1, Shannon Ross, MD1, Zdenek Novak, MD1, April Palmer, MD2, Amina Ahmed, MD3, Pablo J. Sanchez, MD, FIDSA4, Marian Michaels, MD5, David Bernstein, MD6, Kristina N. Feja, MD, MPH7, Audra Stewart, D.O., MPH8, Karen Fowler, DrPH1, Suresh Boppana, MD, FIDSA1 and CMV and Hearing Multicenter Screening (CHIMES) study, (1)Pediatrics, University of Alabama at Birmingham, Birmingham, AL, (2)Pediatrics, University of Mississippi Medical Center, Jackson, MS, (3)Carolinas Medical Center, Charlotte, NC, (4)Pediatrics, Nationwide Children's Hospital - The Ohio State University, Columbus, OH, (5)Children's Hospital of Pittsburgh, Pittsburgh, PA, (6)Cincinnati Children's Hospital Medical Center, Cincinnati, OH, (7)Pediatrics, The Children's Hospital at Saint Peter's University Hospital, New Brunswick, NJ, (8)Pediatrics, University of Texas Southwestern Medical School, Dallas, TX, United States, Dallas, TX


    S. G. Pinninti, None

    S. Ross, None

    Z. Novak, None

    A. Palmer, None

    A. Ahmed, None

    P. J. Sanchez, None

    M. Michaels, None

    D. Bernstein, Genocea: Research Contractor, Research support

    K. N. Feja, None

    A. Stewart, None

    K. Fowler, None

    S. Boppana, None

    Findings in the abstracts are embargoed until 12:01 a.m. EDT, Oct. 8th with the exception of research findings presented at the IDWeek press conferences.

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