Paul Malgorzata, Szczapa Jerzy, Wojsyk-Banaszak Irena, Jaworska Anna, Stefaniak Jerzy
Department and Clinic of Tropical and Parasitic Diseases, University of Medical Sciences, Poznan, Poland.
Clinic of Neonatal Infectious Diseases, Department of Neonatology, University of Medical Sciences, Poznan, Poland.
EJIFCC. 2007 Oct 4;18(3):68-90. eCollection 2007 Oct.
Congenital infection with cytomegalovirus (CMV) is the main cause of sensorineural hearing loss and psychomotor impairment which can develop at birth or later in infant's life. Because of a lack of nation-wide serological screening for pregnant women and accepted antiviral therapy during pregnancy in a high seroprevalence rate population of Poland, we introduced the regional screening programme for CMV infection in neonates from the Poznan Province to diminish a risk of the symptomatic disease. The aims of the study were: (i) to determine the prevalence of specific anti-CMV antibodies in populations of pregnant women and newborns from the Poznan area, (ii) to increase the early postnatal detection of congenital CMV infections, and (iii) to evaluate a risk of perinatal or early postnatal infections with CMV in newborns or infants born to seropositive mothers. Serological testing was performed in 4.192 live born neonates, using dried blood filter-paper specimens. The seropositivity rate in the studied population of neonates and pregnant women was 78.6%. The incidence of perinatal and early postnatal CMV infections was evaluated to be 3.1% or 1 per 25 neonates born to seropositive mothers. Congenital CMV infections confirmed by a presence of specific IgM antibodies were diagnosed in 5 newborns, which represent 1 case per 838 successive deliveries. In a clinical pattern of cytomegalovirus disease respiratory disorders and low birth weight were most frequently observed, and neurological signs, hepatitis, haemorrhagies or jaundice were sporadically diagnosed. Implementation of mass immunodiagnostic screening for congenital CMV infection, combined with other obligatory neonatal tests for metabolic errors, congenital malformations and endocrine disorders seems to be a valuable third line prophylactic strategy to prevent a late development of clinically overt cytomegalovirus disease.
先天性巨细胞病毒（CMV）感染是导致感音神经性听力损失和精神运动障碍的主要原因，这些问题可能在出生时或婴儿期后期出现。由于波兰血清阳性率较高的人群中缺乏针对孕妇的全国性血清学筛查以及孕期可接受的抗病毒治疗，我们在波兹南省引入了针对新生儿CMV感染的区域筛查计划，以降低出现症状性疾病的风险。本研究的目的是：（i）确定波兹南地区孕妇和新生儿群体中特异性抗CMV抗体的流行率；（ii）提高先天性CMV感染的产后早期检测率；（iii）评估血清阳性母亲所生新生儿或婴儿围产期或产后早期感染CMV的风险。使用干血滤纸标本对4192例活产新生儿进行了血清学检测。所研究的新生儿和孕妇群体中的血清阳性率为78.6%。围产期和产后早期CMV感染的发生率估计为3.1%，即每25例血清阳性母亲所生新生儿中有1例感染。通过特异性IgM抗体的存在确诊的先天性CMV感染在5例新生儿中被诊断出来，相当于每838次连续分娩中有1例。在巨细胞病毒疾病的临床症状中，呼吸道疾病和低出生体重最为常见，神经系统体征、肝炎、出血或黄疸则偶尔被诊断出来。实施针对先天性CMV感染的大规模免疫诊断筛查，并结合其他针对代谢错误、先天性畸形和内分泌紊乱的强制性新生儿检测，似乎是预防临床显性巨细胞病毒疾病后期发展的一项有价值的三线预防策略。
