Cytomegalovirus: Epidemiology, Emergence, Transmission, Control, and Critical Assessment of Pathogenesis and Public Health Programs

This presentation provides information on the epidemiology, emergence, transmission, control, and critical assessment of pathogenesis and public health programs related to Cytomegalovirus (CMV). It covers the prevalence of CMV, its effect on socio-economic factors, transmission methods, and control measures. The presentation also includes a critical evaluation of public health programs and initiatives taken by various organizations to prevent the spread of CMV. References are provided for further reading.

Cytomegalovirus
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Epidemiological Data
• Cytomegalovirus or CMV is a very
common disease infecting humans of all
age group.
• One in 5 children in the United States is
affected by CMV.
• CMV can remain asymptomatic for years
in the host.
• It generally affects people with immune-
suppressed conditions.
• It is the causes of the most common
congenital diseases in newborns all over
the world (Cdc.gov 2016).
• 1 out of 3 pregnant women are affected
by CMV.
• 1 in 200 children have congenital CMV.

Emergence
• The prevalence of CMV is
inversely proportional to the
socioeconomic status of the
population.
• Developing countries including
Brazil have over 90%
susceptibility.
• Approximately 2% of congenital
diseases are caused by CMV.
• 90% of congenital cases lead to
death.
• Approximately, 5-15% babies are
asymptomatic with the diseases
resurgence after birth.

Effect of Socio-Economic Factors
• A study showed that CMV was high in
families with rampant poverty by assessing the
data from National Health and Nutrition
Examination Survey (NHANES) from 1999–
2004 (Dowd, Palermo & Aiello, 2012).
• Unhealthy eating habits lead to positive
serological test for CMV in women.
• Bad hygiene also results in the spread to
CMV

Transmission
• Transmission of CMV occurs by
contact with the body fluid of the
affected individual, like breast
milk, semen, excreta and cervical
secretions.
• Pregnant women can pass the
diseases to their children.
• Any form of sexual contact.
• Transplanted organ or blood
transfusion from affected
individual (CMV | Overview |
Cytomegalovirus and Congenital
CMV Infection | CDC, 2016).

Effect of Socio-Economic Factors
• Poor living conditions enhance the diseases
transmission.
• Lack of awareness regarding sexual habits transmits
diseases.
• Immigrants are susceptible to CMV easily.
• Lack of education makes it difficult to control CMV.
• Transmission rate was higher among African
Americans (Lantos, Permar, Hoffman & Swamy,
2015)

Control
• Diagnosis of CMV with respect to
an antibody test can confirm
diseases prevalence.
• Vaccination is a good preventive
measure to control CMV
• Asymptomatic patients do not need
prevention but precautionary
education can be provided to them.
• Universal prophylaxis (Kotton
2013).
• Pre-emptive Therapy (Kotton
2013).

Effect of Socio-Economic Factors
• Poverty makes it difficult to control.
• Most of the affected population are pregnant
women, so it is difficult to educate them.
• Lack of education makes it difficult to make
people understand the consequence .
• Sanitation practices make it difficult to control the
spread of CMV.
• Baby to mother transmission is difficult to
control.

Critical Assessment of CMV pathogenesis
• Approximately 40-100% adults who are
immunosuprpressed have CMV globally.
• The prevalence of seropositive adults ranges from
approximately 60 to 80% in Canada.
• The exposure to the infection occurs in childroom for
most cases, which lead to the latent existence of the
pathogen in the monocytes and macrophages.
• The reactivation causes disruption of the immune
system in times of critical illness.
• 71% of critically ill people have CMV.

Critical Evaluation of Public Health
Programs
• Public health campaigns to educate pregnant women (govt of Iowa).
• 91% of pregnant women do not know about the consequences of CMV.
• Public health initiative was taken up by the government of Utah to prevent
congenital CMV, which includes diagnostic facilities, early detection methods
practice and awareness campaigns.
• Cleanliness campaigns also help prevention of CMV to some extent and lower
their spread according to the guidelines of CDC.
• National Institute of Health (NIH) is trying to formulate vaccines with better
potential to stop the pathogenesis of the CMV and helping millions fight this
problem.
• The joint effort of the important health organisation like NIH, CDC and World
Health Organization need to focus their target and address the threat of CMV
and provide more research regarding this area to completely prevent the
pathogenesis of the CMV.

References
• Cdc.gov. (2016). CMV | Overview | Cytomegalovirus and Congenital CMV Infection | CDC. [online] Available at:
https://www.cdc.gov/cmv/overview.html [Accessed 31 Mar. 2018].
• Dowd, J.B., Palermo, T.M. and Aiello, A.E., 2012. Family poverty is associated with cytomegalovirus antibody titers in US
Children. Health Psychology, 31(1), p.5.
• Hanley, P.J. and Bollard, C.M., 2014. Controlling cytomegalovirus: helping the immune system take the lead. Viruses, 6(6),
pp.2242-2258.
• Kotton, C.N., 2013. CMV: prevention, diagnosis and therapy. American Journal of Transplantation, 13(s3), pp.24-40.
• Lachance, P., Chen, J., Featherstone, R. and Sligl, W. (2016). Impact of cytomegalovirus reactivation on clinical outcomes in
immunocompetent critically ill patients: protocol for a systematic review and meta-analysis. Systematic Reviews, 5(1).
• Lantos, P.M., Permar, S.R., Hoffman, K. and Swamy, G.K., 2015, December. The excess burden of cytomegalovirus in African
American communities: a geospatial analysis. In Open forum infectious diseases (Vol. 2, No. 4). Oxford University Press.
• Marin, L.J., de Carvalho Cardoso, E.S., Sousa, S.M.B., de Carvalho, L.D., Marques Filho, M.F., Raiol, M.R. and Gadelha, S.R.,
2016. Prevalence and clinical aspects of CMV congenital Infection in a low-income population. Virology journal, 13(1), p.148.
• Phpa.health.maryland.gov. (2010). Cytomegalovirus. [online] Available at:
https://phpa.health.maryland.gov/pages/Cytomegalovirus.aspx [Accessed 31 Mar. 2018].
• Thackeray, R. and Magnusson, B.M., 2016. Women's attitudes toward practicing cytomegalovirus prevention
behaviors. Preventive medicine reports, 4, pp.517-524.
• Wizman, S., Lamarre, V., Coic, L., Kakkar, F., Le Meur, J.B., Rousseau, C., Boucher, M. and Tapiero, B., 2016. Awareness of
cytomegalovirus and risk factors for susceptibility among pregnant women, in Montreal, Canada. BMC pregnancy and
childbirth, 16(1), p.54.