According to the Center of Disease Control and Prevention (2010), CMV is a common virus that infections individuals of all ages. Approximately 50-80% of adults in the United States are infected with the virus by age 40. CMV is a herpesvirus and is similiar in characteristics to the herpes simplex viruses, varicella-zoster virus, and the Epstein-Barr virus. The virus can be transmitted in many ways.
The CDC (2010) reports that of the approximate 30-50% of women who are not infected, 33% will become infected during pregnancy and pass the infection to their infant. The risk of passing the virus is 1% of those infected with the virus before becoming pregnant. Once contracted the virus stays in the body for life usually in a harmless, dormant state as the body builds immunity. A fever, sore throat, fatigue, and swollen glands may develop after becoming infected but according to the CDC (2010), healthy adults face little risk of getting seriously sick from CMV infection". But what happens to the vulnerable population, such as infants and immunocompromised individuals?
Individuals with weakened immune systems, such as transplant recipients, cancer patients, HIV-infected patients, and patients recieving immunosuppressive drugs, are also vulnerable to infection. The Mayo Clinic (2011) describes symptoms that may include visual impairment, pneumonia, diarrhea, digestive tract ulcers, hepatitis, encephalitis, behavioral changes, seizures, and a coma. The only way to identify if person has CMV is a blood test that will examine for antibodies which have developed after exposure. The virus itself can also be "detected in the blood, saliva, urine, and other body tissues [and] it means that the person has an active infection" (CDC, 2010) Congenital CMV can be diagnosed in an infant 2-3 weeks after birth if the virus is detected in the urine, saliva, or blood (CDC, 2010). Once diagnosed, there are very few treatment options available.
The Mayo Clinic reports that there is no cure for CMV and treatment is based on the experienced symptoms and their serverity. Treatment is often in the form of antiviral drugs which slow down viral reproduction, but are unable to destroy it (2011). So what is the best way to prevent getting the virus in the first place?
The CDC (2010) and Mayo Clinic (2011) both stress the importance of good hand hygiene, especially after contact with young children and their secretions, in the prevention against CMV. The Mayo Clinic also recommends to "avoid contact with tears and saliva when you kiss a child, avoid sharing food or drinking out of the same glass as others, be careful with disposable items, and practice safe sex" (2011). The CDC (2010) reports that vaccinations are still at the research and development stage and per the Mayo Clinic (2011) are being tested on women of childbearing age to prevent CMV infection of mothers and infants.
Nurses play an important role in the prevention and treatment of cytomegalovirus. First, nurses need to continually assess all vulnerable patients for signs and symptoms of an active infection. If infected and treated with antiviral medications, the importance and risks of taking their medication need to be understood. Secondly, parents of infants born with congenital CMV will need support and education on the monitoring and care of their child, especially those born with a permanent disability. Depending on the severity of the disability, the parents may need assistance from many outside sources in the community. Lastly, nurses can be proactive in educating the population on the importance of proper hand hygiene in preventing the spread of CMV.
For more information, please visit Center for Disease Control and Prevention
References
Brenden B. McGinnis congenital cmv foundation. (2013). Retrieved from http://cmv
foundation.org/index.html
Cytomegalovirus (cmv) and congenital cmv infection. (2010, December 06). Retrieved
from http://www.cdc.gov/index.html
Mayo Clinic Staff. (2011, April 30). Cytomegalovirus (cmv) infection. Retrieved from
http://www.mayoclinic.com/health/cmv/DS00938
Hey Ginny,
ReplyDeleteYou did a really great job of fully describing CMV and explaining several different aspects of who it affects, what symptoms are present, and how the disease is spread. I found it very interesting how CMV affects so many people in the United States, and yet I’ve never really heard about it.
I was a little confused about the fourth paragraph where you stated that of the 30-50% of women not infected, 33% will become infected during pregnancy. I don’t understand how a woman becoming pregnant would infect her with CMV, and it’s a bothersome thought that so many women become infected and can pass it on to their fetus. I also found it quite bothersome how there is no cure and very few treatments for CMV, and the advice given is to prevent becoming infected is to avoid other individuals’ saliva, tears, urine, etc. It seems as though the only way to avoid becoming infected is to become germaphobic!
Hey Ginny!
ReplyDeleteGreat post! This was really fascinating to read. Like you said most people are not really aware of CMV, including myself! I had no idea what it was before reading your blog.
I thought it was interesting to see how healthy adults face little risk since the virus can remain inactive; however it is a serious concern for infants and immunocompromised, especially pregnant people as mentioned. I thought that it was also very intriguing that many pregnant people have delayed signs of this disease, which could be a major health concern. I have to agree with Courtney though, I was a little confused with the statistics as well that you had mentioned.
I think you were also accurate in your ideas and thoughts on nurses being a critical part in the prevention of this disease. It is scary, like you and Courtney mentioned, there is no cure. Education to the public is certainly the key since many people (or at least in our case) have no idea what CMV really is or how you can get it! If this is such a hard core virus the public needs to be made aware! It is this sort of thing that makes me and I'm sure others upset. Patient education is one of the most useful and important job patients rely on. Teaching the importance of safe sex is a great place to start. By mentioning it when we also talk to teens about safe sex or even adults and couples trying to conceive, the risk of STI’s in oneself or ones partner is something everyone should be aware of.
Courtney and Jillian,
ReplyDeleteIn response to both of your questions regarding the pregnancy statistic, I can see reading it again how it might be confusing. I went back to the CDC website and after digging a bit more on the cite, I found a few additional facts that seems to make the numbers make more sense.
According to the CDC (2010), "Between 30% and 50% of women of childbearing age in the United States have never been infected with CMV. In the United States, about 1%-4% of (1-4 of every 100) uninfected women have a primary (or first) CMV infection during a pregnancy. About 33% of (33 of every 100) women who become infected with CMV for the first time during pregnancy pass the virus to their fetuses".
So the risk is much smaller than my initial post with only 33% of that 1-4%. After studying our immunology notes for the exam this week, understanding why this happens makes the numbers make sense.
The child in utero contracts the CMV infection when the virus enters the bloodstream of the mother. Because the mother has no prior immunities to fight off the infection, the bloodstream carries the infection to the baby who still has a vulnerable immune system and is unable to protect itself. Once in the system, the virus is able to influence the developing fetus.
This link provided by the CDC (2010), gives a nice visual demonstration of the number of babies affected by CMV in a population of 1000 pregnancies.
http://www.cdc.gov/cmv/images/how-many-babies-lg.jpg
Does this help clarify it a little more?
Ginny
Cytomegalovirus (cmv) and congenital cmv infection. (2010, December 06). Retrieved from http://www.cdc.gov/index.html
Ginny, you did an excellent job of breaking down this unfamiliar disease. Wow, I am just blown away. First of all I will admit, I've never even heard of this disease. Second of all, I am extremely surprised at the statistic saying that 50-80% of adults will be infected by the age 40! I agree with you, with such high numbers of infection, education about this virus is critical. Especially since it is not a casual contact virus, this means the community needs to understand how body fluids can transmit this virus. Ultimately, I think that education could raise awareness and lower infection rates.
ReplyDeleteThe way that I would explain this virus to someone who has never heard about it before is that it is sort of like the chicken pox. It is in a sense that you “outbreak” for a while and continue to have the virus for life, except it isn’t continuously affecting you. Honestly, as a healthy adult I think it would be very easy to overlook this disease. Especially with symptoms that are similar to that of a cold or short-term infection, many people probably have the dormant bodies in them without even knowing. This is why prevention is going to be the number one line of defense in ensuring the virus isn't contracted.
With such devastating symptoms in the immunosuppressed individuals, it is disappointing to learn that there is little that can be done. Especially with deadly symptoms, just think if these individuals knew about how this virus was transmitted. If they had known, would they have done anything differently? I think that excepting mothers, new parents, and individuals dealing with children need to be educated to ensure that chances of contracting the virus is slim to none. Also, hospitals could implement some sort of pregnancy classes that talk about high infection risk timing, who is at the most risk, and when/what should be done to prevent (i.e. pertussis vaccine in a newborn of 2 months). Finally, we as nurses need to be able to take the complex information of this disease and translate it into everyday language so that our patients can fully understand the extent and importance of treatment and prevention.
I had not had a previous understanding of what cytomegalovirus was and found this blog to be quite interesting. I was shocked by the incidences of the disease among the population. I always find myself skeptical of the accuracies in such statistics because the disease seems to have so few symptoms that I can’t understand how it’s possible for 50%-80% of the population to be positive for this unseen enemy. I read through the facts and statistics posted on the blog and found myself wanting to look for myself what more the CDC had to say about the virus. According to the CDC (2010) CMV testing is done on women who show symptoms similar to mononucleosis and on infants whose mother’s tested positive for CMV. It sounds to me that although education about the disease and how to prevent it is essential, that more people should be regularly screened for CMV to be aware themselves if they are carriers. In a way I believe this would an upstream way of thinking because if the people who are infected aren’t aware they have the disease, they do not understand the particular caution they need to take with the public and may unknowingly be spreading the virus. I once expressed symptoms similar mononucleosis and tested negative for it, never was it mentioned or in any way indicated that my symptoms could have been those of CMV. If the test is simple enough, I would be interested to know the outcomes that awareness might bring to those who test positive. The CDC also reported that infants who appeared healthy are not routinely tested in the United States, something I would also consider making routine.
ReplyDeleteCenters for Disease Control and Prevention. (2012). Pertussis.
Retrieved from http://www.cdc.gov/pertussis/
Ginny, I thought you did a great job on presenting this information. It was easy to follow and understand, especially after the clarification you made in your later comment. I, like most of the others, had never heard of this disease before reading your post. If we, as nursing students, are unaware of this infectious disease than it scares me to know how little the general public know about it. How is it that 50-80% of the population are infected by age 40, yet we knew nothing of this virus? I think that steps need to be taken to education and inform the public about this virus and its harmful effects. Also, It is another important reminder to practice hand hygiene and other safety measures in order to keep ourselves and others from contracting contagious viruses.
ReplyDeleteThe information that interested me the most about this disease was that infected mother's pass the virus along to the fetus during pregnancy. If 1 out of every 5 babies infected with this virus are born with disabilities that is a very high percentage. Also you stated it was the "second leading cause of intellectual disabilities, second only to Down syndrome". In that case it seems that these disabilities are very prevalent and I am continually shocked that we are not more aware of this virus and its effects. I wonder should woman of child bearing age have blood tests to determine if they carry CMV before getting pregnant? Do doctors suggest that woman with the virus abstain from having children? Also are pregnant woman being educated about CMV and how to avoid contracting it?
I was also curious to know what type of developmental disabilities a baby born with CMV would have, so I did a little research. According to the Centers for Disease Control and Prevention (CDC) signs of CMV at birth are premature birth, small body size, seizures and liver, lung and spleen problems (2010). After birth symptoms include hearing and vision loss, seizures, mental disabilities and lack of coordination. If a parent is aware that their child was born with a CMV infection it is important to keep an eye out for symptoms and early detection, though the CDC states "about 80% of babies born with congenital CMV infection grow up healthy" (2010).
Overall very interesting topic which I am curious to learn more about in the future.
References
Cytomegalovirus (cmv) and congenital cmv infection. (2010, December 06). Retrieved
from http://www.cdc.gov/cmv/congenital-infection.html
I found this post absolutely fascinating and the statistics alarming. “50-80% of adults contract this disease by age 40” and what is more shocking than that is that the majority of the population doesn’t even know what the cytomegalovirus is, myself previously included. For this reason I really appreciate you sharing this information with us in such detail. Thankfully the symptoms for adults are not severe and those with a health immune system are able to suppress the virus. However, I too am concerned with what effects this has on the immunosuppressed, transplant patients, and children in our society. This virus contributes to a large amount of cases of permanent disabilities in children and as nurses we have to be concerned with what kind of lifelong effects this can have on patients, their families, and the expense it creates for our society to treat such infections. I think it is important for us to be cognizant of the ways of preventing the disease which at the time seem to be the standard infection control practices at this time.
ReplyDeleteI found quite a few promising articles related to the search for a treatment, vaccination, and prophylaxis of the disease. One study was particularly interesting, it pertained to the use of an antiviral medication called Valganciclovir post kidney transplant to prevent the contraction of the cytomegalovirus. The study states, “In summary, 6-mo prophylaxis with Valganciclovir combined with a one-time determination of Viremia is cost effective in reducing CMV infection and disease in seronegative recipients of seropositive kidney and/or pancreas transplants” (Luan, Stuckey, Park, et al, 2009). Prophylaxis is not a cure but it is a good start, I hope research will keep advancing so we can effectively slow the spread of this highly contagious virus.
Reference
Luan, F.L., Stuckey, L.J., Park, J.M., Kaul, D., Cibrk, D., Ojo. A. (2009). Six-month prophylaxis is cost effective in transplant patients at high risk for cytomegalovirus infection. Journal of the american society of nephrology, 12(1). DOI 10.1681/ASN.2008111166
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