Congenital cytomegalovirus (cCMV)

• Reporting criteria
• The disease and its epidemiology
• Case definitions
• Laboratory testing

• Case investigation
• Disease control measures
• References

What and how to report to the Colorado Department of Public Health and Environment (CDPHE) or local public health agency 

• If the patient is < 1 year, all positive results for CMV must be reported within four (4) calendar days by the lab and provider.
• If the patient is < 1 year, only negative NAAT or culture results on urine must be reported within four (4) calendar days by labs capable of reporting electronically.
• Report to CDPHE or your local public health agency.
  • Phone: 303-692-2700
  • After hours: 303-370-9395
  • Fax: 303-782-0338 

Purpose of surveillance and reporting

• Identify cases for surveillance.
  • Identify cases of confirmed congenital CMV (cCMV) infection.
  • Identify cases of probable or confirmed cCMV disease.
• Use the data collected to understand long-term health outcomes and how cCMV impacts babies across Colorado. 

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Etiologic agent

Human CMV is a member of the herpesvirus family, which includes herpes simplex virus types 1 and 2, varicella-zoster virus, and Epstein-Barr virus. CMV is specifically human herpesvirus-5 (HHV-5). These viruses share a characteristic ability to establish lifelong latency. 

Clinical description

Most infants born with CMV infection never have health problems. About 10% of infants with cCMV infection will have signs at birth, which include:

• Petechiae/purpura (blood spots)
• Jaundice
• Microcephaly (small head)
• Intrauterine growth restriction (low birth weight)
• Hepatosplenomegaly (enlarged liver and spleen)
• Seizures
• Retinitis (damaged eye retina)

About 40-60% of infants born with signs of cCMV at birth will have long-term health problems including:

• Hearing loss
• Developmental and motor delay
• Vision loss
• Microcephaly (small head)
• Lack of coordination or weakness
• Seizures

Reservoirs

There is no known animal reservoir of human CMV.

Modes of transmission

If a person is pregnant and acquires CMV, they can pass the virus to the developing fetus during pregnancy. 

CMV is spread through direct contact with infectious body fluids, including urine, saliva, blood, tears, semen, and breast milk. However, there is no recommendation against breast/chestfeeding by seropositive parents. Additionally, CMV can be transmitted through transplanted organs and blood transfusions and contact with the pregnant patient's genital secretions during delivery.

Although the virus is not highly contagious, it has been shown to spread among household members and young children in daycare centers.

Incubation period

In general, the incubation period for CMV is 3-12 weeks. However, the timeline for transmission to the fetus during pregnancy is not well-established.   

Infectious period 

CMV is characterized by shedding of the virus in bodily fluids, primarily urine and saliva. In young children, shedding of the virus in the saliva and urine can persist or recur for months to years. Adults typically shed the virus for a shorter duration, usually less than six months, but may shed virus intermittently in the saliva and urine for the rest of a person’s life. If a pregnant person experiences a primary infection, reinfection with a different CMV strain, or reactivation of a previous CMV infection during pregnancy, they can transmit the virus to the developing fetus. The virus crosses from the blood of the pregnant patient into the placenta. Risk of transmission to the fetus for primary infection is 30-40% in the first and second trimesters, and 40-70% in the third trimester. The risk of transmission following non-primary infection is much lower (3%). 

Epidemiology

Congenital CMV (cCMV) infection is the most common intrauterine infection in the United States, with approximately one in 200 infants born with cCMV annually. Of those born with cCMV, one in five will demonstrate clinical signs of cCMV in the neonatal period and/or have long-term health conditions. Symptomatic cCMV has a mortality risk of up to 7-12% in the early neonatal period. Approximately 10-15% of those with initially asymptomatic disease may go on to develop long-term morbidities such as neurodevelopmental delays, sensorineural hearing loss, and vision impairment. 

Based on literature, seroprevalence rates are higher in those with lower socioeconomic status and disproportionately impacts Black and multiracial infants. 

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For information on clinical and laboratory criteria for diagnosis and case classification, refer to the Council of State and Territorial Epidemiologists (CSTE) Position Statement 23-ID-02 Standardized Surveillance Case Definition for Congenital Cytomegalovirus (cCMV) Infection and Disease, or see CDC’s National Notifiable Diseases Surveillance System (NNDSS) webpage for the 2024 Case Definition for cCMV Infection and Disease.

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Tests for cCMV in newborns

Polymerase chain reaction (PCR) on urine is the most reliable laboratory test for diagnosing cCMV infection. Saliva testing is often used as a screening test due to ease of collection. Saliva testing has more false-positive results than urine PCR testing due to seropositive parental shedding of CMV into breastmilk. Additionally, the Colorado Department of Public Health and Environment (CDPHE) Newborn Screening Program will begin targeted screening of cCMV in 2025 on the newborn dried blood spot (DBS) for newborns that meet the following criteria:

• Failed the newborn hearing screening
• Birthweight at or below 10th percentile for gestational age
• No hearing result within 10 days of birth

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All cases with probable or confirmatory lab evidence of cCMV receive a medical record review to determine case classification. Cases are not interviewed. 

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Treatment

Antivirals such as Ganciclovir or Valganciclovir may be used, after discussion of risks and benefits with the treating medical provider. For healthy babies born without symptoms of CMV, it’s unlikely treatment will be needed. Treatment or therapy for complications of cCMV such as hearing aids for hearing loss may also be appropriate. 

Prophylaxis

• There is currently no role for post-exposure prophylaxis with antivirals or immune globulin.
• There is no effective vaccine against CMV at this time, but CMV vaccine development is underway.

Education

Congenital CMV (cCMV) prevention focuses on preventing CMV infection in pregnant people, which solely entails limiting exposure. Pregnant individuals should be educated on the following measures to limit exposure to saliva and urine from infants and young children:  

• Wash hands with soap and water for 20 seconds, especially after changing diapers, feeding a young child, wiping a young child’s nose or saliva, handling children’s toys, etc.
• Do not share food, drinks, or eating utensils used by young children.
• Do not put a child’s pacifier in your mouth.
• Do not share a toothbrush with a young child.
• Avoid contact with saliva when kissing a child.
• Clean toys, countertops, and other surfaces that come into contact with children’s urine or saliva.

Managing special situations

Child care/preschool

Exclusion is not necessary for individuals with CMV. For pregnant workers in child care/preschools, see the education section above for measures to decrease risk. 

School

Exclusion is not necessary for CMV cases.

Environmental measures

To prevent or reduce child care workers' cytomegalovirus (CMV) infection risk, employers should develop an infection control plan that addresses sources of CMV exposure and infection prevention measures. Provide disposable gloves and encourage employees to use them for any activities that involve contact with body fluids. Latex-free gloves, such as nitrile and vinyl, are preferred to prevent allergic reactions. Require workers to discard gloves immediately after use, and to wash their hands, preferably with soap and water, rather than use an alcohol-based hand sanitizer. 

Workplace surfaces that may be contaminated with body fluids should be cleaned regularly with disinfectant. Common problem areas include countertops, tables, cabinets, chairs, door knobs, telephones, faucet handles, and equipment. In addition to the previous items, child care workers should consider disinfecting any toys or small objects that may have been exposed to a child’s saliva or other body fluids. To minimize infection risk, child care workers should treat all body fluids as if they are infectious, and avoid sharing food, drinks, or utensils with young children.

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Akpan, U; Pillarisetty, L. (2023). Congenital Cytomegalovirus Infection. National Library of Medicine.

American Academy of Pediatrics. Cytomegalovirus Infection. Red Book 2024-2027: Report of the Committee on Infectious Diseases, 33rd Edition. 2024.  

About Cytomegalovirus. (2025). CDC: Cytomegalovirus (CMV) and Congenital CMV Infection. 

Clinical Overview of CMV and Congenital CMV (2024). CDC: Cytomegalovirus (CMV) and Congenital CMV Infection.

Congenital Cytomegalovirus (cCMV) Infection and Disease 2024 Case Definition. CDC National Notifiable Diseases Surveillance System (NNDSS).

Council of State and Territorial Epidemiologists (CSTE). Standardized Surveillance Case Definitions for Congenital Cytomegalovirus (cCMV) Infection and Disease. 

Cytomegalovirus. (2024). CDC: Infection Control.

Infectious Diseases in Child Care and School Settings, Cytomegalovirus (CMV). (2025).

Johnson, J; Anderson, B; Pass, R. (2012). Prevention of Maternal and Congenital Cytomegalovirus Infection. PMC PubMed Central. 

Pediatric Patient Education, American Academy of Pediatrics. (2020). Cytomegalovirus (CMV) Infection - Child Care and Schools. PediaTrust.

Perinatal Viral Infections. WHEC Practice Bulletin and Clinical Management Guidelines for healthcare providers. Women’s Health and Education Center (WHEC).

Schleiss, Mark R. (2024). Newborn Screening for Congenital Cytomegalovirus (cCMV) Infection: Universal, Targeted, Expanded-Targeted, or None-of-the-Above? Neonatol Today. 2024 August; 19(8): 3-12.

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