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Original research
Recurrent maternal CMV infection associated with symptomatic congenital infection: results from a questionnaire study in Portugal
  1. Paulo Paixão1,
  2. Maria João Brito2,
  3. Daniel Virella3,4,
  4. Maria Teresa Neto1,3
  1. 1 Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisboa, Portugal
  2. 2 Infectious Diseases Unit, Hospital Dona Estefânia, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
  3. 3 Neonatal Intensive Care Unit, Hospital Dona Estefânia, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
  4. 4 Portuguese Paediatric Surveillance Unit, Sociedade Portuguesa de Pediatria, Lisbon, Portugal
  1. Correspondence to Dr Paulo Paixão; paulo.paixao{at}


Objective Human cytomegalovirus (CMV) is the most widespread agent of congenital infection in humans and is still a challenging issue. Despite lower rates of vertical transmission being associated with recurrent infection when compared with primary infection, the first still represents the majority of congenital infections worldwide. Based on data from active reporting, we explored the influence of maternal primary/non-primary infection both on the presentation and outcome of congenital CMV infection in early childhood.

Design Infants with positive viruria during the first 3 weeks of life were reported through the Portuguese Paediatric Surveillance Unit.

Patients Infants born between 2006 and 2011 with confirmed congenital CMV infection.

Methods Maternal infection was considered primary if CMV IgG seroconversion occurred during pregnancy or low avidity IgG was documented; it was considered non-primary if positive IgG was documented before pregnancy or high avidity CMV IgG was present early in pregnancy. Follow-up questionnaires were sent up to 6 years of age.

Results Forty confirmed cases of congenital CMV infection were reported (6.6:105 live births, 95% CI 4.81 to 8.92); 22 out of 40 were asymptomatic. The odds for non-primary maternal infection if the offspring was symptomatic at birth were 6.2 (95% CI 1.2 to 32.27).

Conclusion The reported number of confirmed cases of congenital CMV infection was much lower than expected. Under-reporting and missed diagnosis were considered possible reasons. Non-primary maternal infections were associated with symptomatic congenital CMV infection in the offspring. Maternal recurrent infections can have a significant impact on the total number of symptomatic infections in Portugal.

  • infectious diseases
  • virology
  • neonatology

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  • Collaborators The clinical data from this study were sent by the following paediatricians/neonatologists: Elisabete Coelho (Hospital Póvoa de Varzim), José Gonçalo Marques (Hospital de Santa Maria), Ana Nunes (Hospital S Francisco Xavier), Luís Pinto (Maternidade Bissaya Barreto), José Luís Fonseca (Hospital Guimarães), Eduardo Gonçalves and Licínia Lima (Centro Hospitalar Alto Minho), DV (Hospital Dona Estefânia), MTN (Hospital Dona Estefânia), Cristina Godinho (Maternidade Júlio Dinis), Teresa Martins (Hospital Pedro Hispano), Isabel Malta (Maternidade Alfredo da Costa) and MJB (Hospital Fernando Fonseca).

  • Contributors PP designed the study, compiled the data and analysed them, drafted the manuscript and prepared the final version. MJB designed the study, contributed to data interpretation and reviewed the manuscript. DV contributed to data interpretation and reviewed the manuscript. MTN designed the study, contributed to data interpretation, reviewed the manuscript and prepared the final version.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.

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