Cytomegalovirus (CMV)
What is Cytomegalovirus?
Cytomegalovirus (CMV) is a common viral infection. One in three children acquire the infection before the age of 5 and 50-70% of adults have been infected by the age of 40.
Signs and symptoms
- Most CMV infections cause no symptoms.
- Some people, especially adolescents and adults who are infected for the first time, will have a mononucleosis-like illness with fever, sore throat, and swollen lymph nodes.
- A rash can occur in about one third of people with mono-like illness. Infected people who receive ampicillin, augmentin, or related antibiotics are more likely to get a rash. (Antibiotics do not treat CMV.)
- The disease can be serious in people with impaired immune systems, such as those with HIV or a bone marrow or organ transplant. These people can have serious complications affecting many different body symptoms, including the gut, brain, lungs, eyes, or heart.
Congenital CMV Infection
If a person develops an active CMV infection during pregnancy, the fetus can be infected before birth, resulting in congenital CMV infection (cCMV). While most infants with cCMV have no or minimal symptoms, cCMV can cause severe life-long problems, including hearing loss, vision loss, cerebral palsy, seizures, balance problems, and developmental delays. Children with cCMV may have symptoms present at birth or develop symptoms over the first few years of life.
Incubation period
The incubation period of CMV can vary from several weeks to months.
Contagious period and spread
CMV is spread by contact with body secretions of people who are infected, including urine, saliva, blood, tears, semen, and human milk. Once a person is infected, the virus is shed intermittently for the rest of the person’s life. Toddlers will excrete live virus in their urine and saliva for long periods (from months to years). At any given time, 30-40% of children aged 1 to 3 years in group care settings are excreting CMV in their saliva and urine.
Public health reporting requirements
- Individual cases of CMV are not reportable in Colorado. The school nurse or child care health consultant should be consulted for specific concerns. Consultation with the state or local public health agency is available.
- Referral to a health care provider is usually not necessary unless symptoms are severe.
Control of spread
- Those who are pregnant or may become pregnant should avoid contact with the saliva and urine of young children, both at work and at home. They should discuss other ways to reduce CMV exposure with their health care provider.
- Pay close attention to proper handwashing and hygiene techniques, especially after changing diapers.
- Do not put anything in your mouth that has been in contact with a child’s saliva, such as a spoon, pacifier, drink straw, or toothbrush.
- Wash hands immediately after wiping a child’s nose or mouth.
- Do not kiss a child on the lips; instead, kiss a child on top of the head.
Testing
Testing for CMV is generally not required for healthy children and adults, even if they develop symptoms. Routine screening is not recommended for those who are pregnant. In March of 2024, the Colorado Board of Health approved targeted screening for congenital cytomegalovirus infection for newborns who do not pass the newborn hearing screen, newborns who do not have a newborn hearing screen completed by Day 10 of life, and newborns whose birth weight is in the bottom 10% of the population.
Treatment
No treatment for CMV infection in healthy children and adults. Infants with cCMV and people with certain forms of immunocompromise may benefit from antiviral medications to prevent or treat serious complications.
Exclusion
No exclusion is necessary unless the child is too sick to participate or other exclusion criteria apply.