CMV In Pregnancy: What Should I Know?

CMV
Cytomegalovirus (CMV) is the most common virus most people have never heard of! It is the most common congenitally acquired virus, and about 1 out of every 100 to 150 newborns is born congenitally infected with CMV. It is common in both children and adults. Between 50 to 80 percent of women of childbearing age have caught CMV and between 1 and 5 percent of pregnant women will catch CMV for the first time during their pregnancy.

Most CMV infections are “silent” and harmless, but in pregnant women, CMV can be transmitted to the fetus, with sometimes devastating effects to the unborn baby and newborn.

Therefore, it is important if you are pregnant, or know someone who is pregnant, to be “CMV Aware” and “CMV Cautious”.

Women who are pregnant should discuss CMV with their obstetrician. Testing for CMV infection is a simple blood test. And, there are interventions available to help.

Unfortunately, studies have shown most women of childbearing age and surprisingly, many obstetricians, are not aware of the most recent advances in management of CMV infection in pregnancy. Because many of the questions I received from my first blog post were about CMV infection during pregnancy, I decided to post some basic information that I hope you find helpful:

What are the signs and symptoms of CMV during pregnancy?

Most CMV infections in pregnant women are “silent” and cause no symptoms.  When symptoms do occur, they most commonly are fever, sore throat, swollen lymph glands and extreme fatigue. Rarely, a rash, cough or diarrhea may occur. These symptoms are not specific for CMV infection and may be cause by other conditions. And, unfortunately, often the first time a pregnant woman is aware of CMV is when she has a baby who is diagnosed with congenital CMV infection. Therefore, blood tests are needed to accurately diagnose a CMV infection during pregnancy.

Is CMV infection common in pregnancy?

Approximately 1-4% of all pregnant women will experience a primary CMV infection during their pregnancy. If you work in a child care setting, the risk increases to approximately 10%. If you have a toddler at home who is actively infected with CMV and shedding CMV in their saliva or urine, the risk is even higher, approaching 50% in some studies.

What is the risk to my baby if I have a CMV infection during pregnancy?

CMV infections in pregnancy may be primary (first infection with CMV) or recurrent (infection with a second strain of CMV or reactivation of your own CMV strain). Approximately 40% of women who experience a primary CMV infection during pregnancy will transmit the CMV infection to their baby, and approximately 60% will not. The reason why some women transmit CMV to their baby and some women do not is not known.

Most babies born congenitally infected with CMV will appear normal at birth. However, approximately 10% of babies born congenitally infected as a result of their mother’s primary CMV infection during pregnancy will have symptoms in the womb or at birth. Newborns with symptomatic congenital CMV disease at birth may have a variety of signs and symptoms in many organ systems, and also may experience disabilities long term in hearing, vision, cognition and motor development. In some babies with severe congenital CMV disease, the congenital CMV infection is fatal. Therefore a maternal primary CMV infection may carry a significant risk to the unborn baby.

Women who experience a recurrent CMV infection also may transmit CMV to their baby, but the occurrence is much, much lower ( 0.1% or less) than after a primary CMV infection (40%), and serious symptoms rarely occur in the fetus or newborn born congenitally infected as a result of a maternal recurrent infection.

How do you test for CMV during pregnancy?

Testing for CMV infection is a simple blood test, called a CMV IgG antibody. It will determine if a pregnant woman has had CMV.  A positive result indicates a current or past CMV infection.

A second blood test, called CMV IgM antibody will help determine if the CMV infection is current or past. If positive, the infection may be current, usually sometime within the last 4 months. CMV IgM antibody in some women may remain positive for over 4 months (sometimes up to a year or more) or may be a false positive result. Therefore, a third CMV antibody test may be performed, called CMV IgG avidity index. A low CMV IgG avidity index indicates the primary CMV infection occurred less than 4 months prior to the blood test, and a high CMV IgG avidity index indicates a CMV infection occurred 4 months ago or longer.  A CMV IgG avidity test is not recommended if the CMV IgM antibody is negative, and the test cannot be performed if the CMV IgG antibody is negative.

What can be done if I catch CMV during my pregnancy?

If you experience a CMV infection during your pregnancy, your obstetrician should follow the growth and development of your fetus carefully with serial fetal ultrasound examinations and other tests. In addition, consultation with a maternal-fetal medicine specialist or a specialist in high risk obstetrics may be indicated, especially if the effects of in utero CMV are seen in the fetus. At Texas Children’s Hospital Pavilion for Women consultations with a maternal fetal medicine specialist may be requested through this website.

Prenatal treatment of the pregnant mother with CMV hyperimmune globulin (CMV enriched antibody) may reduce the transmission of CMV to the fetus and reduce or reverse some of the effects of CMV on the fetus. If you have experienced a primary CMV infection during pregnancy, please consult with your obstetrician or maternal-fetal medicine specialist about whether or not CMV hyperimmune globulin treatment is right for you and your baby, in addition to following the health and well-being of your baby while still in the womb. A national randomized clinical trial is also underway in the United States (and also possibly in other countries in Europe) to more carefully study the potential benefits of this treatment.  More information may be available as well at http://www.clinicaltrials.gov.

What if I am pregnant and CMV antibody negative?

If you are CMV IgG and CMV IgM antibody negative and pregnant, then you have never had a CMV infection, and are therefore vulnerable to catching CMV for the first time during your pregnancy. By knowing you are CMV negative, and by knowing about the CMV precautions recommended in my first blog post, you may take steps to reduce your CMV risk during pregnancy.

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About Dr. Gail Demmler-Harrison, Infectious Diseases

I am a pediatrician at Texas Children's Hospital who specializes in infectious diseases in children.

I'm an expert in congenital cytomegalovirus (CMV) infection, with over 25 years of experience diagnosing and treating babies born with congenital CMV. I also do research on the long term effects of CMV on children as they grow. I'm an advocate for CMV Awareness in the community.

Posted in Motherhood, Obstetrics and Gynecology, Pavilion for Women, Pregnancy

214 Responses to CMV In Pregnancy: What Should I Know?

  1. Jenny Meeden Bailey says:

    Excellent article, and make sure to read the first blog, too! About 800 babies are permanently disabled every year in Texas alone from congenital CMV. This can change by spreading the knowledge of prevention, treatment in utero and newborn screening of all babies so that those who do have congenital CMV can promptly be treated with antiviral medication. I didn’t know about CMV prevention methods when I was pregnant a quarter century ago, but in utero treatment and ganciclovir at birth saved my daughter’s life and saved her from suffering multiple disabilities. Thank you TCH and Dr. Gail Demmler-Harrison!

    • Dr. Gail Demmler-Harrison, Infectious Diseases Dr. Gail Demmler-Harrison, Infectious Diseases says:

      Dear Jenny,
      Thank you for your kind comments and for posting on my TCH CMV BLOG!
      I am so glad your daughter is doing so remarkably well now as a young adult after having successful CMV treatments as an infant a quarter of a century ago.
      I hope by posting the information on my TCH CMV BLOG and sharing it with others we can continue to raise CMV awareness.
      After so many decades, it is indeed time for us to do more to treat and prevent congenital CMV.
      Dr Gail Demmler Harrison
      CMVDOC

      • Anya says:

        hello Dr

        I am currently 30 weeks pregnant and just found out that I tested positive for cmv still awaiting for our second results so devastated don’t know what to do the baby looks good no signs of any problems so far other then one of the ventricles are a tiny bit larger then the other I do have 3 children and what devastates me more is I never knew abt cmv and how it can effect a baby the reason y I got tested was bec I researched online about what might cause ventricle to be inlarged and the two test came up were cmv and taxo which I tested negative for but have no idea on how to go abt my pregnancy so worried I hope the baby is going to be born healthy I wanted to know if I can get ur contact info where I can reach u since I have so many questions please if u can help me in any way to guide me on treatments available or anything I can do to prevent from baby attracting cmv please in desperate help in need of information so lost so upset and worried as hell thank you

        • Dr. Gail Demmler-Harrison, Infectious Diseases Dr. Gail Demmler-Harrison, Infectious Diseases says:

          I am not able to provide much help since I am not sure what “tested positive for CMV” means in your post.
          Did you test CMV IgG antibody positive?
          CMV IgM antibody positive?
          What was yoru CMV IgG avidity test?
          Did you have an amniocentesis that tested CMV DNA PCR or CMV culture positive and therefore your baby has CMV in utero?
          Is your fetal US testing normal or abnormal?

          There are many things to consider and I am not able to help you with a post reply at this time, based on the information provided.

          There are CMV treatments that can be given to the pregnant to woman who has had a recent CMV infeciton, to reduce the transmission of CMV to the fetus. If the fetus already has in utero CMV and has disease from in utero CMV , then there are also treatments with CMV hyperimmune globulin that may be helpful as well. Careful monitoring by your obstetricians and a high risk maternal fetal medicine specialist would be also recommended. You or your doctors may wish such a consultation.

          You are welcome to contact our Fetal Center and Maternal Fetal Medicine Center at The Pavilion for Women at Texas Children’s Hospital if you wish a formal professional consultation. They may be directly contacted thorugh this link: http://women.texaschildrens.org/MFM/

          • Lisette says:

            I wish I would had known about this article back in December 2014. That’s when I was 5 months pregnant withy son. He was born on April 24 2015. He was born with cmv. I had never heard of the virus in my entire life. I am completely broken. He is profound deaf and has multiple calcifications throughout his brain. Something needs to be done about this terrible virus. My little angel is so beautiful. It’s broken my heart what it’s done to my son. A child who had all his organs working properly. A child who had working ears, who was perfect in everyway now has a disability. This is terrible there isn’t enough education when it comes to this. I’m saddened by this.

          • Lisette says:

            Dr. If I was to consider concieving another child in the future. Now being that I have cmv in my body. Would I be safe to consider having another baby in the future? Or is the chance of the virus reactivity during pregnancy high?

            Also is there a chance that I had been affected with this cmv virus years ago and it reacticated during my pregnancy?

          • Dr. Gail Demmler-Harrison, Infectious Diseases Dr. Gail Demmler-Harrison, Infectious Diseases says:

            Spreading CMV awareness must continue. We have so much work to be done. CMV remains the most common virus most people have never heard of. Because of the importance of congenital CMV as a public health problem, some states (Utah, Hawaii, Texas, Connecticut, Illinois) have laws enacted for CMV awareness and education and/or CMV testing for newborns. The state of Tennessee also has considered a CMV law as well. You may wish to look into this type of CMV awareness effort in your own home state.

            Once an individual is infected with CMV it stays with them for their lifetime. However, most of tee time CMV will remain latent, dormant or “asleep” and not cause problems after the primary or first CMV infection is over.

            The risk of having another child with symptomatic congenital CMV disease involving the nervous system is quite rare to nil risk.
            CMV recurrent infections rarely cause severe CMV disease and neurologic impairment in the newborn.

            Most CMV experts would recommend to have CMV IgG and CMV IgM antibody tested. If the CMV IgM antibody is negative then the active CMV infection is resolved, it is likely safe to try again for another child, from the CMV perspective. Also, waiting at least one year is another good guideline, to allow the primary CMV infection to resolve. CMV reactivation or reinfection (that is, a form of recurrent CMV infection) may result in congenital CMV in < 1% of the time, so it is much less a risk of transmission than a first or primary CMV infection during pregnancy. In addition, most babies are born without symptoms if they have congenital CMV infection as a result of a maternal CMV infection.

            Consult your OB and also involve a high-risk maternal fetal medicine specialist or perinatologist so your next pregnancy can be watched carefully.

            I hope this information is helpful to you.

            Dr Gail Demmler Harrison
            CMVDOC

    • kalyani says:

      Hello Dr. Gail !
      Thank You for writing this wonderful article on CMV.

  2. Sandra S. says:

    Thank you for this article. CMV is so common yet very few people know about it (50-80% of adults have had CMV at some point!) ! I didn’t know about it until my family was devastated to learn that our daughter was born with multiple disabilities due to the virus! We can’t thank Dr. Gail Demmler-Harrison enough for all she has done for our family, but we wish it hadn’t happened to us! Please be educated and share with your friends.

    • Dr. Gail Demmler-Harrison, Infectious Diseases Dr. Gail Demmler-Harrison, Infectious Diseases says:

      Dear Sandra,
      Thank you for your kind comments and for posting on my TCH CMV BLOG and for encouraging other to share this information with others.
      I hope your daughter continues to do better each day, as she grows and learns!
      I hope by posting the information on my TCH CMV BLOG we can raise CMV awareness and save a baby today or tomorrow or some day soon !
      Dr Gail Demmler Harrison
      CMVDOC

  3. Sally Rana says:

    Thank you so much for your efforts to spread awareness about CMV to ordinary people as well as doctors and hospitals,
    I have a great grandson who is seriously disabled due to a primary CMV infection. Of course our family had never heard of CMV. When the baby was born he had 4 of the signs of cCMV and yet the OB and hospital did not diagnose the infection. It wasn’t until four months later that the baby received the diagnose. Severe brain damage has left him with CP, Cortical Vision Impairment, loss of hearing, and a host of other problems. He is g tube dependent.

    What baffles our family is that the extended family and close friends are not concerned enough to share articles about CMV. They shared once. It is too late for our little boy, but hopefully not for other babies yet to be born.

    • Dr. Gail Demmler-Harrison, Infectious Diseases Dr. Gail Demmler-Harrison, Infectious Diseases says:

      Dear Sally,
      Thank you for your post. I am sorry to hear your great grandson was seriously disabled from congenital CMV but I hope his doctors and family and friends are providing support so he can maximize his potential. My next TCH CMV BLOG post will be in 2015 and will focus on the effects of congenital CMV on the newborn, so people can understand how devastating CMV infection can be for some children.
      Spreading CMV awareness to all pregnant women and mothers is important. The efforts of even one person or a few individuals can make a big difference and may one day save a baby!
      Best wishes and I hope you will spread CMV Awareness.
      Dr Gail Demmler Harrison
      CMVDOC

  4. Nelly G says:

    Thank you for the informative blogs and responses to comments. We’re planning IUI with donor sperm. I have just tested cmv neg; however the donor has history of (antibodies) but not active cmv. I have read many different opinions but would be interested in your opinion of how risky this would be. How likely is donor sperm in IUI prep to transmit cmv infection to me?

    • Dr. Gail Demmler-Harrison, Infectious Diseases Dr. Gail Demmler-Harrison, Infectious Diseases says:

      Thank you for your post on my TCH CMV BLOG.
      CMV may be present in semen. It is difficult to predict the presence of CMV in semen from the CMV serology results. However, men who have experienced a recent CMV infection (CMV seroconversion from CMV IgG negative in serum to CMV IgG positive or presence of both CMV IgG and CMV IgM positive antibodies within 6 months of semen donation) are more likely to be actively shedding CMV in their semen than men with a past CMV infection (CMV IgG positive but CMV IgM negative antibody in blood), and therefore porbably mor elikely to transmit CMV to the woman who receives the donation. The precise CMV transmission risk is difficult to predict.
      I recommend you consult with your doctors about what recommendation regarding the best donor is best for you and your individual situation.
      Best wishes for a healthy pregnancy in the future.
      Dr Gail Demmler Harrison
      CMVDOC

  5. Kathleen Muldoon says:

    The most dangerous virus you’ve never heard about is right. As I sit here rocking my cCMV son to sleep, I can’t help but wonder where were the voices of all the mothers who have gone before me shouting out their warnings about cmv when I was pregnant? As a medical educator who focuses on teaching early development and teratogenic effects in pregnancy, where is cmv in the medical and allied health curriculum? The cmv epidemic has to be stoppped. And the only way to do so is by raising our voices. Thank you, dr. Gail!

    • Dr. Gail Demmler-Harrison, Infectious Diseases Dr. Gail Demmler-Harrison, Infectious Diseases says:

      Thank you for your post on my TCH CMV BLOG.
      Raising CMV awareness for both the public and medical community is very important!
      Improving CMV knowledge and education in the medical community can start with medical school education. Here in Houston, we recently conducted and published a study on CMV awareness in medical students, and we are working to improve medical education about congenital CMV. So many obstetricians, pediatricians, and family doctors, as well as support staff and allied health care providers such as nurses, audiologists, speech/language therapists, physical and occupational therapists, do not have adequate medical knowledge base about congenital CMV diagnosis, treatment and prevention. Changes in curriculum would indeed make a difference.
      The efforts of a single dedicated individual, or a small group of dedicated individuals, can make a difference.
      I hope you will help spread CMV awareness.
      Best wishes.
      Dr Gail Demmler Harrison
      CMVDOC

  6. Suzi says:

    Hi. I am a midwife who has recently been told I have CVM. It’s currently in it’s active phase. What are the implications of my position? How long is it contagious in an otherwise healthy person?
    Thanks for your time and expertise

    • Dr. Gail Demmler-Harrison, Infectious Diseases Dr. Gail Demmler-Harrison, Infectious Diseases says:

      Dear Suzi,
      Otherwise healthy adults who have a recent or active CMV infection may intermittently “shed” or excrete CMV in their body secretions (saliva, urine, cervix and semen) off and on for a few months sometimes longer; anyone who is CMV seropositive, at any time, may reactive their own CMV strain and “shed” or excrete the virus from body secretions as well. CMV is transmitted from person to person through close and intimate contact or by sharing food or drink. If you as a midwife practice professional universal precautions, as you would for every patient, there is no risk of your transmitting CMV to your patients.
      I hope information is helpful.
      Best wishes.
      Dr Gail Demmler Harrison
      CMVDOC

  7. Farah Armstrong says:

    Thank you Dr. Demmler-Harrison for writing this informative article and for all that you continue to do as a CMV expert to increase public awareness. I had never heard of CMV until my precious daughter, Madeline Leigh, was born earlier this year. I had experienced what we thought to be a healthy pregnancy and did not have any indications that there was a problem. Unfortunately, Maddie was born severely effected and only lived 12 short days on this earth. I believe that EVERY woman deserves to be educated about CMV, the effects it can have on unborn babies and the prevention measures that pregnant women need to take. I am personally doing everything in my power to educate as many people as I can through a nonprofit organization that I founded earlier this year, Maddie’s Mission.

    • Dr. Gail Demmler-Harrison, Infectious Diseases Dr. Gail Demmler-Harrison, Infectious Diseases says:

      Dear Farah,
      Thank you for your post and for sharing your CMV story on my TCH CMV BLOG.
      The loss of your precious infant daugher Maddie is a tragic reminder of how devastating CMV can be to the unborn fetus and to the newborn infant.
      It is estimated that between 8% to 10% of babies with congenital CMV disease will die in the womb or in early infancy from the effects of severe congenital CMV disease.
      Thank you for your efforts through Maddie’s Mission to spread CMV awareness and knowledge about CMV prevention during pregnancy through recommended CMV precautions that are outlined in my first TCH CMV BLOG post, and endorsed by CMV experts.
      Best wishes,
      Dr Gail Demmler Harrison
      CMVDOC

  8. hassan says:

    my son was diagnosed with congenital CMV. he was born 12/10/2014 with gestation age of 36 weeks and 2 day. post c-section. pt was found to have low blood sugar and was transferred to the special care nursery. an IV was started to give him extra sugar (D10). during his 2 day stay they were unable to meet his demand and was transferred to a hospital here in Boston. umbilical line was started and he has been wean off the extra sugar ( D25). latter he was found to be positive for CMV in his urine. antiviral medication started immediately on day 4 of birth. head ultrasound donned and was negative for calcification. pt also past his hearing and vision exams.
    with all this information would you be able to inform me of what his chances are of having a normal life without any side effects from this virus ?
    I am scared, worried and loosing my mind. please help

    thank you

    • Dr. Gail Demmler-Harrison, Infectious Diseases Dr. Gail Demmler-Harrison, Infectious Diseases says:

      Hello, Thank you for your post on my TCH CMV BLOG.
      A baby with congenital CMV infection who has a normal head cirucmference size ( ie no microcephaly) (you did not mention your baby’s head size), no eye disease ( no chorioretinitis) and no brain calcicfications by CT ( head US is a good test and easy to perform in all newborns, but not the best test for Ca+ of the brain) has a good chance for a normal development as he or she grows older. Antiviral treatment started in the first weeks of life has been shown to significantly improve a baby’s hearing and developmental progress, so that he is receiving antiviral treatment as a newborn is another positive thing in his favor.
      The presence of prematurity and low blood sugar may complicate your baby’s condition and possibly his development.
      It is difficicult to predict the future, and you will need to see how your son grows and develops over the next few months to years. It is important for his hearing, vision and development and growth to be followed carefully thorugh his childhood, so that that therapies can be provided, if he needs them.
      I hope this information is helpful.
      Best wishes to you and to your family.
      Dr Gail Demmler Harrison
      CMVDOC

  9. jessica treakle says:

    Dr. Gail. I have a son who is 7 years old and is happy. He was born disabled as a result of me catching cmv. I love my so to the world and back but I have a question. The man I am with wants another child. Can I have another child and what’s the chances that if I did get pregnant that the child would be infected by the cmv virus? This is the one thing that scares me the most. I love Jonathan and all I’ve ever wanted since b4 he was born was to have two kids. Please help me by answering this one question we all worry about. And thank u for your blog it has helped me learn a lot more about this virus I didn’t know when I first heard about it.

    • Dr. Gail Demmler-Harrison, Infectious Diseases Dr. Gail Demmler-Harrison, Infectious Diseases says:

      Dear Jessica,
      Thank you for your psot on my TCH CMV BLOG.
      The love you profess for your son Jonathan is so touching. I am sure he is a loving child as well. Loving and caring for a special needs child with disabilities is a very special kind of love and devotion.
      If you have already had a child with congenital CMV as a result of your CMV infection during pregnancy you are already “immune” and therefore at no to nil risk of having another baby with severe disabilities from congenital CMV. It is the pregnant woman who catches CMV for the first time during pregnancy who carries the greatest risk of transmitting CMV and CMV associated disabilities to her baby. You are now in the past CMV infection category. CMV will be with your body for your lifetime, but it should remain latent or “asleep”. It may reactivate or “wake up” a little during pregnancy sometimes, and cause a congenital CMV infection in a baby rarely about <<0.01% of thetime- so very rarely, but even then, the babies are usually silently infected and not disabled.
      Therefore in planning for your next pregnancy, rest assured CMV will not cause problems or disabilities or defects in your next baby. For further questions you should consider consulting an obstetrician or maternal fetal medicine specialist with expertise and experience in CMV, to help manage your next pregnancy.
      I hope this information is helpful to you. Best wishes for a healthy pregnancy and healthy baby!

      Dr Gail Demmler Harrison
      CMVDOC

  10. Olivia Martinez says:

    Thank you so much Dr. Gail Demmler-Harrison for all the information you have provided on CMV. You’re work and knowledge on this very common, but seldom heard of, virus is truly inspiring. I was diagnosed with CMV when I was four months pregnant, but fortunately, the test was a false positive and I now have a healthy 8 month old son. During my scare with CMV, you provided me with so much information and I thank you for all your help and all your efforts to make this virus more commonly known to all women who are pregnant or plan on becoming pregnant. I will continue to spread the word to everyone I know and I hope that one day Obstetrician’s will be required to educate women on CMV and the effects it can have on an unborn baby.

    • Dr. Gail Demmler-Harrison, Infectious Diseases Dr. Gail Demmler-Harrison, Infectious Diseases says:

      Hi Olivia,
      Thank you for your post on my TCH CMV BLOG and for your kind words! I am glad to have helped provide you wiht factual information about CMV in pregnancy. I also am so happy all is well with you and your son.
      We can all do better spreading CMV awareness to the public and to medical professionals in our own communities!

      Best wishes
      Dr Gail Demmler Harrison
      CMVDOC

  11. Jessica R. says:

    Thank you Dr. Demmler-Harrison for writing this article. I Found out when I was pregnant with my now 8 month old that I was CMV IgG and CMV IgM antibody negative. Since I work with children my OB did seem surprised, but she failed to explain the seriousness of what it could lead to if i would have gotten exposed while pregnant. Are there any vaccinations or something I can do to gain antibodies to this so I wont be at risk for my next pregnancy? Once again thanks for this informative post.

    • Dr. Gail Demmler-Harrison, Infectious Diseases Dr. Gail Demmler-Harrison, Infectious Diseases says:

      If you are CMV antibody negative then you are susceptible to catching CMV for the first time. The most likely sources are individuals in your own family who are close to you, especially young infants. Occupational exposure to young children may result in CMV transmission in day care centers and other venues where close contact with toddlers on a daily basis, similar to home life, occurs.
      Occupational exposure in other settings, including the health care setting , where universal precatuions and prersonal protective equipment is used, does not result in CMV transmission.
      The best way to prevent a CMV infection during your next pregnancy is to practice the recommended precatuions outlined in my blog and recommended by CMV experts and the CDC.
      Unfortunately, despite a CMV vaccine being on the Institute of Medciine’s list for a needed vaccine for the 21st Century, there is currently no CMV vaccine to protect women during pregnancy.
      Many vaccine companies have a CMV vaccine in their pipeline, but none have brought a licensed CMV vaccine to market at this time.
      Public interest and media attention in a CMV vaccine would help speed up the process, no doubt.
      Writing to your legislature representative or senator, indicating your interest in funding for CMV prevention and a CMV vaccine, would also be helpful.

  12. Egg donor parent says:

    Hello Dr. Demmier-Harrison,

    Thank you for this wonderfully informative resource. I hope you can advise me.

    I am CMV negative and hoping to have a child via donor egg.

    Is it “safe” to work with a donor who is CMV positive? I can’t seem to find anything conclusive. I know that for sperm donors, it’s an issue, but egg donation seems to be a little more grey. Is CMV passed through the ovaries? Vaginal secretions? The uterus? Are donor eggs “washed” to remove any potential risk? I know the risk is in my contracting the virus for the first time while pregnant, and I guess I’m wondering if I could catch it from the donor egg itself and then pass it along to the embryo.

    I very much look forward to your reply. Thank you in advance.

    • Dr. Gail Demmler-Harrison, Infectious Diseases Dr. Gail Demmler-Harrison, Infectious Diseases says:

      Hello,

      The CMV transmission to a CMV seronegative recipient woman from a CMV seropositive donor embryo appears low to nil. But you are correct, it remains grey because our medical knowledge is complete. I am not aware of CMV being documetned to be transmitted via ovaries. CMV is present in cervico vaginal secretions of normal healthy CMV seropositive women and is a normal method of transmission of CMV to the baby during vaginal delivery.
      I am not an expert in the field of reproductive medicine, so it is best to ask the advice of your fertility doctors to see what protocols they follow regarding CMV negative recipients, such as yourself.

      Best wishes for a healthy pregnancy.
      Dr Gail Demmler Harrison
      CMVDOC

  13. Kevin K says:

    Hi Dr. Demmler-Harrison, last year when my wife 32 weeks pregnant our babies heart stopped suddenly and we lost the baby because of IUGR, three months later my wife got pregnant again and then we learned my wife has positive cmv igm and igg, but according to cmv igg avidity test she got cmv at least 4 months before the second pregnancy, until 28 weeks she had positive igm, after 28 weeks igm was negative igg was positive, right now my wife 35 weeks pregnant to our second child and she has negative igm positive igg. According to 2nd trimester ultrasound cmv didn’t effect the baby, can she deliver the baby naturally and after the delivery can she breastfeeding the baby, do we need to make any special tests for the baby after delivery? Thank you very much for all your help to us.
    Best Regards.
    Kevin K.

    • Dr. Gail Demmler-Harrison, Infectious Diseases Dr. Gail Demmler-Harrison, Infectious Diseases says:

      I am so sorry for your loss of your wife’s previous pregnancy, but also I am so glad to hear your wife’s current pregnancy is going well.

      I would suggest your baby be tested at birth ( at least testing should be done in the first 21 days of life) for congenital CMV infection, by sending a saliva and/or urine CMV culture and a urine CMV DNA PCR test (which ever is available in your hospital).
      Doing just CMV antibody testing or TORCH titers is not recommended, because your wife’s CMV IgG antibody will be transmitted passively to your baby and is not diagnostic of an active CMV infection in the baby.
      If your baby is negative for congenital CMV then you will be reassured.
      If you baby is positive for congenital CMV infection, then your doctors will likely want to do further evaluations on your baby.

      I hope this is helpful.
      Dr Gail Demmler Harrison
      CMVDOC

  14. Meredith says:

    Our 11.5 month old son was born deaf in his left ear. Because of this impairment he slept with his hearing side down at all times which of course flattened his head on that side. Because of this I was convinced he needed a helmet and a 4 months demanded a CT scan to check his head shape. Neurosurgery assured us after the CT scan that his head shape would self correct but they wanted us to have an MRI because radiology thought they saw some white matter. A month later at 6 months old he had the scan and they did in fact see the white matter problem. Since then we have seen neurologists at MUSC in Charleston, sc, tested 52 gene panels and been in contact with Dr. Vanderver at Children’s National. No one has any answers for us. All genes have been normal. Meanwhile he is progressing perfectly. He has low muscle tone ( not noticeably) and acid reflux but other than that no symptoms. We live every day waiting for the other shoe to drop and for something to start happening to our sweet boy. Some people have suggested that it could be CMV. I am a teacher and have a toddler so I easily could have contracted it during my pregnancy. Dr. Vanderver has his newborn blood card and says the CMV test was “un-revealing.” Does this sound like CMV to you? Should we demand another test? Thanks for your time.

    • Dr. Gail Demmler-Harrison, Infectious Diseases Dr. Gail Demmler-Harrison, Infectious Diseases says:

      A positive CMV DNA dried blood spot test confirms congenital CMV infection, however a negative result suggests congenital CMV infection is not present, but does not exclude it because there are some false negative results that occur. I do not know what your doctor means by the DBS being “unrevealing” but I assume it means it was negative for CMV DNA.
      One way to exclude the diagnosis of congenital CMV in your son is to perform a CMV IgG antibody test on yourself to determine if you have ever had CMV in your life, and on your son, to determine if he has ever had CMV in his life. If one or both are both negative, then CMV infection did not occur in you or in him and therfore he does not have congenital CMV. However, since CMV is common, it is likely one or both tests will be positive, from many sources, and will only make it possible, not proven.
      At this point you may never know if your son had a congenital infection with CMV (althought it is unlikely if his DBS was negative and he has symptoms associated with congenital CMV).
      You should watch his hearing and his development closely as he grows, no matter what the cause of his hearing loss.

      I hope this information is helpful to you.
      Best wishes.
      Dr Gail Demmler Harrison
      CMVDOC

  15. Victoria says:

    I am planning my second pregnancy and currently have a 1.5 year old child. I learned about CMV and had my OB test me at my last appointment to see if I had any antibodies. I did not, which means I am probably at risk the next time I am pregnant.

    My question is, even with all of the precuations in place— should I ask my OB to test me periodically throughout my pregnancy in case I were to contract it, so that a treatment could be administered? I would love to know what you think, Dr. Demmler-Harrison. Thank you!

    • Dr. Gail Demmler-Harrison, Infectious Diseases Dr. Gail Demmler-Harrison, Infectious Diseases says:

      I am glad to hear you are CMV aware, you know your CMV antibody status, and you will be taking CMV precuations to reduce your risk of acquiring CMV infection.
      Routine repeat CMV serologies in a CMV seronegative pregnant woman is not the routine recommendation of most obstetricians or CMV experts at this time. However, if any abnormalities of fetal growth or fetal development are detected or if you have a febrile illness or mononucelosis like illness during your pregnancy, repeat CMV testing should be performed and would be medically indicated.
      However, most CMV infections in pregnancy are silent and without symptoms in the pregnant woman. Therefore, you may wish to have your CMV IgG and CMV IgM antibody tested once, routinely, more during your second trimester around the time of your 20 week fetal ultrasound anatomy scan. Another CMV test on your blood in the third trimester nearly delivery may also be performed. Some women who are aware of CMV request this testing from their obstetricians for peace of mind. And, if a silent maternal CMV seroconversion i s found, there are management decisions your obstetrician may discuss with you to watch your fetus more closely, determine fetal infection by amniocentesis in some cases, or consider prenatal hyperimmune globulin treatment in some cases.
      If you do CMV seroconvert during your pregnancy, your newborn baby should also be tested for congenital CMV infection by testing the urine for presence of CMV by culture of hte virus or CMV PCR for the virus.

      I hope this information is helpful to you.
      Best wishes for a healthy pregnancy.
      Dr Gail Demmler Harrison
      CMVDOC

  16. Maria says:

    Hi Dr. Demmler-Harrison,

    I work in a school as a speech language pathologist. We just received a new student with lissencephaly, and I have been asked to provide speech services for this child. I am pregnant and only 10 weeks along. I have heard that those with lissencephaly shed the CMV virus, so I would be putting myself at risk to work with this student, however, I do not know that as a fact. Can you provide me any information on if working with this student is safe for me?

    Thanks!!

    • Dr. Gail Demmler-Harrison, Infectious Diseases Dr. Gail Demmler-Harrison, Infectious Diseases says:

      Lissencephaly is a disoder of neuronal brain migration or developmental that occurrs during fetal brain devleopment. Lissencephaly, along with related neuronal migrational disorders pachygyria and polymicrogyria, are associated with many causes. For example, some patients the cause is genetic, some the cause is associated with congential CMV disease involving the brain, and in others the cause is not found or known at this time. Therefore, it is not correct o to automatically assume a child with lissencephaly has congenital CMV infection.

      If you are pregnant, you should assume all young children are actively shedding CMV, including those children without a specific diagnosis. CMV is a common infection in young children, it is usually a silent or asymptomatic infection in the saliva and urine of these children, which can be transmitted to the pregnant woman, and then in some cases, to her fetus. Therefore you should practice CMV precautions around ALL infants, toddlers, and young pre school children during your pregnancy, including those children in your worksplace and those children in your home or extended family or friends.

      Requesting a change of venue for your workplace to not work with one particular child who may or may not even have CMV, just based on one child’s diagnosis, would not likely reduce your CMV acquisition risk, for the reasons I mentioned above: lissencephaly has many causes and CMV infects many other children who are probably present in your workplace and home/community environment. Work environment during pregnancy is an individual decision, encompassing many variables, which you should discuss openly with your employer and your family.

      CMV is ubiquitous and you should assume all children of young age are shedding CMV and you should be mindful of CMV precautions during pregnancy around ALL infants, toddlers, and children.

      I hope this information is helpful to you. Best wishes for a healthy pregnancy.

      Dr Gail Demmler Harrison
      CMVDOC

  17. Kelsy says:

    I’m a 34 year old CMV-seronegative (last tested negative December 4th, but plan to ask to be tested again February 6th) mother of a 2 year old (who is in daycare). I am also 6.5 weeks pregnant with my second child. I am a scientist (in bacterial genetics, so not incredibly helpful), and as they say “a little knowledge is a dangerous thing.” I have been reading and researching as much as I can, possibly driving myself a bit crazy. My previous experience in my Ob’s office was met with ignorance about CMV and irritation about my asking to be tested. I am active duty military, so I do not have a choice in where I am seen for my Ob care. Therefore, I am learning/researching and preparing to not only avoid contracting the virus, but also to push as hard as I can to get the testing/treatment I need. I have some questions I was hoping to get your advice/opinion on.

    I just read that CMV can remain infectious on some surfaces up to 6 hours even when the surfaces appear dry to they naked eye (my phone, a towel we both use to dry our hands after washing, etc.). This last bit of knowledge has tipped the scales for me, and I’m overwhelmed with anxiety/fear. I am so early in pregnancy, with a 2 year old in the house, and now not only having to worry about all of her bodily fluids being in contact with my mucosal areas…I am concerned about surfaces as well. It seems as though this is an impossible battle, and it is up to mere chance if I am to be in infected. Do you have any thoughts on the survival of the virus on surfaces? Also, I can’t find anything about infection through abrasions on skin. I am washing my hands so much that they are dry and cracking, which when I give her a bath, wipe her nose, etc., and this makes me wonder if I could be infected through this route. Even though the virus isn’t technically spread via airborne transmission, is it possible when toddlers cough directly in your face that the virus could land successfully in your mucosal membranes? I’ve read that the rate of transmission increases as the pregnancy progresses (third trimester having the highest rate of transmission), but rates of complications decrease. Have you seen this link with trimester and transmission of the virus to the fetus? So within that 40% transmission rate to the fetus, the rate is much higher if you’re later in pregnancy and much lower if you’re in the beginning?

    Do you think I should test my husband’s CMV status? I need to know if I should be taking precautions with our interactions as well. Would it be beneficial to test my daughter’s saliva? If she’s negative, it doesn’t mean that she won’t be infected, but if she’s IgG positive IgM negative, maybe she won’t be shedding anymore? I know children can shed for years, though, and I would still take the same precautions, so maybe it’s not worth it.

    What is your opinion on gancyclovir and immunogloblulin therapy? When should you use one or the other, or both? What are the adverse events associated with these therapies?

    Thank you so much for all that you are doing for CMV awareness and treatment!

    • Dr. Gail Demmler-Harrison, Infectious Diseases Dr. Gail Demmler-Harrison, Infectious Diseases says:

      If you are pregnant and have close contact with a young child, such as your own two year old daughter who attends day care and is likley to be actively shedding CMV, you would be wise to practice the CMV precautions outlined in my TCH CMV BLOG and also recommended by many other experts and the Centers for Disease Control http://www.cdc.gov/cmv. I am glad to hear you are CMV aware and wish to reduce your CMV transmission risk during your pregnancy.
      If your current medical care plans do not allow you to be tested for CMV antibody status, then just assume you are CMV seronegative at this time and practice CMV precautions. Perhaps with some education your OB, or your general practioner doctor, will perform the CMV antibody testing for you so you can know your CMV status. If your fetus shows any abnormalities during in utero development, then you can proceed at that point for a further CMV workup, which at that time would be medically indicated, as well.
      It is not likely you will acquire CMV from inanimate objects or “fomites” unless they are recently wet with toddler saliva or urine. Since you are not likely to put your child’s toys in your mouth, etc. you ar e not likely to acquire CMV in this way. The most common way is direct saliva contact via kissing, sharing food and drink, putting fingers in mouths, etc. so if you just are mindful of this potential contact, you will be reducing yoru CMV transmission risk. In all things, there must be a balance of caution and practicality.
      It is not recommended to test your 2 year old daughter for CMV. The reason is, if she is CMV seronegative, she may acquire CMV at any time during her day care or other group care activities. Also, even if CMV IgG positive, she may shed CMV persistently for about a year, even though she may be healthy and have antibody. I fyou test her saliva or urine for active CMV shedding, it may be positive at the time, but if it is negative, it may be positive the next month or week. So just assume she is CMV infected and shedding during your pregnancy. Testing does not help determine or predict CMV shedding, unless you can do the testing every 2 weeks, which is of course not practical and not medically indicated and not recommended.
      If your husband exhibits signs or symptoms of CMV infection or CMV mononucelosis, then he should be evaluated and CMV precautions should be practiced. Otherwise it is not routinely recommended to to test the spouse nor to practice CMV precautions with your spouse who is otherwise well and without symptoms. Even though there is a chance he is CMV infected and CMV antibody positive, usually adults with asymptomatic CMV infection shed intermittently and in small quantities of virus and are less likely to transmit than those who are symptomatic and even then, much less than toddlers. Some women have chosen to use condoms and avoid salivary contact with their spouse during pregnancy, but most women do not choose this form of CMV precautions during pregnancy, and most CMV experts do not recommend it.
      It is too early for me to broadly discuss CMV interventions during pregnancy at this time on this post, since we do not even know your CMV status, your fetal status, or if any of these interventions are even a possible indication for you at this time. You however are welcome to view my other CMV TCH BLOG posts about this issue if you wish, as they applied to others. In general, ganciclovir treatment of a pregnant woman is not recommended. CMV hyperimmune globulin treatment of a pregnant women with a recent primary CMV infection may reduce transmission to the fetus and treatment of an already infected fetus with signs of in utero CMV disease may help reduce the affects of CMV on the placental and on the fetus.

      I hope this information is helpful.
      Best wishes for a healthy pregnancy.

      Dr Gail Demmler Harrison
      CMVDOC

  18. SS says:

    Hi Dr,

    I had recent blood test done and it was detected I had CMV (primary infection)
    The comments on the pathology report were as follows:
    Detectable CMV lgM in the presence of low-avidity lgG (c. 50%) is suggestive of recent infection, This result should be considered in conjunction with clinical context and results of further investigations, including repeat serology if clinically indicated.

    I have just discovered I am 6 weeks pregnant (these tests were taken 2 days before potentially conceiving). I am extremely concerned about the health of my unborn especially after reading numerous articles. What is your advice? Please note I had a miscarriage 8 weeks which was just over 2 months ago.

    Thank you for your kind assistance in advance.

    • Dr. Gail Demmler-Harrison, Infectious Diseases Dr. Gail Demmler-Harrison, Infectious Diseases says:

      HI,

      If your CMV serology results indicate a recent CMV infection and you are pregnant, it is best to consult with a maternal fetal medicine specialist or obstetrician familiar with high risk pregnancies.
      You should be followed closely, and your fetus should be followed very closely as well for fetal growth and well being. Repeat serologies may also be performed. But it is most important to assess your baby frequently.
      A primary CMV infection during pregnancy will be transmitted to the fetus approximately 40% of the time, the other 60% of the itme, the virus does not pass the placenta to the fetus. It is not really possible however, to determine which moms will transmit CMV to their baby in utero. Amniocentesis peformed between 18-21 weeks gestation may be indicated to determine if CMV transmission occurred. So ask your obstetrician about whether or not this procedure would be indicated in your specific situation.
      You should also discuss with your obstetrician about CMV hyperimmune globulin infusions, because they may be of benefit in your situation to reduce the risk of CMV transmission to your fetus at this vulnerable time in the first trimester.
      Alternatively, consult http://www.clinicaltrials.gov for the ongoing maternal fetal medicine unit NIH sponsored randomized clinical trial assessing the benefits of CMV hyperimmune globulin in preventing CMV transmission to the fetus in women who have experienced a recent primary CMV infection. You may be eligible to participate in this clinical trial.

      I hope this information is helpful.
      Best wishes for a healthy pregnancy.

  19. manita kumari says:

    there is cmv igG in me at level 3.12 is it serious tell me I m worried suggest me the treatment plz

    • Dr. Gail Demmler-Harrison, Infectious Diseases Dr. Gail Demmler-Harrison, Infectious Diseases says:

      The presence of CMV IgG antibody in blood is usually a normal finding, since most people will have a CMV infection at some time in their life, a positive CMV IgG usually indicates a past infection with CMV and immunity to CMV infections.

      If you are pregnant, however, then a CMV IgM antibody should be done to see if your CMV infection is recent or older and past and resolved.
      No treatment is indicated at this time for just a postiive CMV IgG antibody test.
      If you also have a positive CMV IgM antibody and you are pregnant, you should consult your doctor for further advice and management.

      I hope this is helpful to you.

      Dr Gail Demmler Harrison
      CMVDOC

  20. trilochanpatra says:

    what to do if CMV igG result REACTIVE

    • Dr. Gail Demmler-Harrison, Infectious Diseases Dr. Gail Demmler-Harrison, Infectious Diseases says:

      A positive CMV IgG reactive test result indiates a CMV infection has occurred at some time in your life.
      Most reactive results are normal because most everyone will catch CMV at some time in their life and it usually causes no problems or concerns.
      If you are pregnant, however, please consult your obstetrician or medical doctor for advice.
      Best wishes,
      Dr Gail Demmler Harrison
      CMVDOC

      • trilochanpatra says:

        Thank you for your answer .

        Above test result found during STEM CELL PRESERVATION process in Maternal Blood sample (CMV IgG- Reactive ) . so what are precaution for new born baby and birth mother.

        • Dr. Gail Demmler-Harrison, Infectious Diseases Dr. Gail Demmler-Harrison, Infectious Diseases says:

          The presence of CMV IgG antibody means a CMV infection occurrred at some time in the life of the birth mother. It is usually considered a normal finding since 50% to 80% of normal healthy women will have CMV IgG antibody. Most people will catch CMV at some time and most CMV infections are silent and do not cause problems.
          If your newborn has clinical signs or symptoms of disease, then you should consult your doctor.
          Best wishes.

  21. Beth Norton says:

    Hi Dr,
    I am a healthy 35 year old woman with 2 young children. I had a missed miscarriage last month at 16 weeks, possibly due to a CMV infection. A diagnostic ultrasound showed a thickened and lumpy placenta (~3x thicker than normal), and a maternal-fetal medicine specialist said I likely had a CMV or similar virus. I also previously had the cell-free fetal DNA test at 10 weeks pregnant which showed baby did not have chromosome problems.

    The pathology report on my placenta came back normal, and I had opted against an autopsy on the baby since the baby did not appear to have any problems. My midwife said it was fine to wait for one period before trying to get pregnant, but I did some research and discovered I had both risk-factors for and symptoms of a CMV infection. My 3 year old in daycare began bedwetting when I was 6-8 weeks pregnant and I was handling urine-soaked clothing and sheets at 2am and didn’t do a great job of washing my hands every time. I also had swollen glands in my neck and an increase in fatigue at 12/13 weeks pregnant, which went away after a week.

    I’m wondering if I should get further testing for CMV, or just go on birth control for 6 months as a precaution before trying again. Part of me wants to know what happened, and part of me just wants to be done with doctors for a while (no offense – I really appreciate what you do for CMV families!!!).

    Thank you for your blog!

    • Dr. Gail Demmler-Harrison, Infectious Diseases Dr. Gail Demmler-Harrison, Infectious Diseases says:

      So sorry for the loss of your pregnancy.
      I agree you are at a high risk for CMV infetion, based on your household exposure to young children, who may be shedding CMV.
      Regarding your pregnancy planning, you may wish to do one of the two following options, both of which are reasonable, and both of which you should discuss with your heath care providers.
      1) Wait at least 6 months, then try again – since that is usually sufficient time to resolve a primary CMV infection and the risk of transmission to your fetus during pregnancy will be greatly reduced
      2) Request test for CMV IgG and CMV IgM antibody, and if both are positive, perform CMV IgG avidity testing to determine if you have had a recent or past CMV infection. If you have had a recent CMV infeciton, then refrain from pregnancy until your CMV IgM antibody is negative or near negative, which usually takes 4 to 6 months, sometimes up to 12 months.

      You should practice CMV precautions with your next pregnancy, especially if you are found to be CMV IgG seronegative through CMV antibody testing, and at risk for a primary CMV infection.
      If you are CMV seropositive, you are at a low risk for CMV re infection, but some women opt to practice precautions even if they are already CMV seropositive to reduce this low risk even further.

      Best wishes for a healthy pregnancy next time.
      Dr Gail Demmler Harrison
      CMVDOC

      • Beth Norton says:

        Thank you so much for answering my question. I’m going to go with option #1 and will go on birth control and will try again after August. I do not plan to pursue further testing for CMV, since it’s unlikely to be covered by my insurance (I also do not want to be labeled as a difficult patient). I will discuss with my healthcare provider first to double-check her opinion.

        For my next pregnancy, I will follow your list of CMV precautions. In addition, I will wear gloves while handling urine-soaked clothing and will wash my hands thoroughly afterwards. I was careful around saliva to prevent colds/flu but never knew that toddler urine could be dangerous during pregnancy, never thought to take any precautions around it.

        Thanks again.

  22. EricaA says:

    Hi Dr Gail,
    We are considering adopting a one year old from Vietnam, living in an orphanage since birth. We have been told that all development is normal, including hearing and sight. The child’s blood tests show a CMV IgG of 219.7 and a CMV IgM of 0.39. We are concerned that if this is a congenital infection problems may arise in the future. Can you please advise us what challenges we may be facing if we accept this referral? Thank you so much for your help!

    • Dr. Gail Demmler-Harrison, Infectious Diseases Dr. Gail Demmler-Harrison, Infectious Diseases says:

      The presence of antibody to CMV in the blood of an infant does not prove congenital CMV infection. CMV infection is common and many, and in some countries, most individuals are infected with CMV, and therefore have CMV IgG antibody, but do not have congenital CMV infection.
      If the baby’s head size is normal for age and growth and developmental milestones are normal for age, and there are no problems with vision or hearing, and the neurological exam is normal, then the chances that this infant has symptomatic congenital CMV disease involving the central nervous system or sensory organs is very low, and if there is not central nervous system of sensory organ involvement at birth, the risks of long term neurodevelopmental sequelae are likely to be low, as well.
      You should consult your pediatrician as well for advice about the health of your future adoptive infant.

      Best wishes.

      Dr Gail Demmler Harrison
      CMVDOC

      • EricaA says:

        Thank you so much Dr Gail!

      • EricaA says:

        Hi Dr Gail,
        we received medical information on the one year old little boy in Vietnam who is testing positive for CMV, and his head circumference at just under 12 months old is 43cm (his weight is 8.7kg, and length 76 cm). His overall development in all areas is reported as normal. I’m concerned his head may be a little small…it’s certainly well below the 5th centime but his weight and length aren’t. Any advice? Would a CT or MRI give us more information?Thanks a million,
        Erica

  23. Impatiently Waiting says:

    I had CMV mono-like illness in late August, confirmed as IgG and IgM positive, with very low avidity. At the time we were thinking about starting the infertility process again to try for another child. Since the infection, I have had monthly labs and just now (6 mos later) have 61% avidity (my lab calls >60 high) but still IgG/IgM positive. The lab report didn’t give values, it was only qualitative. This month the lab accidently ran a CMV DNA PCR (lucky me!) which was negative (undetected). My question is, is it safe to start trying? It took us 2 years of treatment to conceive our first child so I don’t want to delay unnecessarily, but if the odds of congenital CMV are higher now then I will wait it out. I have a family hx of autoimmune disease, and have always questioned whether or not I have autoimmune dz as well (especially with some current eye issues), so I fear I may stay IgM positive, maybe falsely positive. Thank you!

    • Dr. Gail Demmler-Harrison, Infectious Diseases Dr. Gail Demmler-Harrison, Infectious Diseases says:

      The laboratory results appear to indicate a resolving primary CMV infection since the CMV avidity index is evolving from low to high index range. It is possible the CMV infection is resolving, albeit slowly. It is also possible there is an element of false positive CMV IgM reaction as well. It is impossible to tell with certainty.
      Women probably should wait at least 6 months, and for some individuals, as long as 12 months, after a primary CMV infection to try to become pregnant. After 12 months, irregardless of the antibody responses, the risks become like the general CMV seropositive population, with only a very slight risk for recurrent infection to the fetus.
      Please also consult your fertility doctors for advice, since they know your case the best.

      Best wishes.
      Dr Gail Demmler Harrison
      CMVDOC

      • Impatiently Waiting says:

        Hello again, thank you for your reply. My subsequent IgG avidity had gone from 61% (lowest “high” reference value) back down to 55% (intermediate), and I am still IgM positive (most recent avidity has not come back yet). It has been about 10 months since my initial infection. I’m guessing the IgM is a false positive, but I don’t know what to make of the avidity going back DOWN?? Should I consider looking for the cause of my false/persistent positive IgM, or my fluctuating avidity levels (like autoimmune or immunodeficiency disorders?). Or would a quantitative IgM be helpful? Thank you!

  24. Clarissa says:

    Hello Doctor,
    I just recently found out at 30 weeks that my cmv test was positive. My IgG is 3.2 and IgM is 2.1. Earlier in my pregnancy, my baby was diagnosed with echogenic bowel. The only tests that were suggested at the time were maternit21 and cystic fibrosis. After much time has passed and ny hug risk doctor couldn’t find anything, I was sent for cmv, parvo and toxoplasmosis.
    Is there a way I will ever know if I contracted this as a primary infection during pregnancy? Is my son’s echogenic bowel due to congenital cmv? Are there treatments for someone like me that’s finding out so late in pregnancy? I have two other healthy children 14 and 9. I have taught middle school for the past 9 years. I have had an otherwise healthy pregnancy thus far. No other problems are coming up on ultrasound. I am monitored every 2 weeks for the echogenic vowel and all my son’s measurements are perfect. What are the chances that he could still have problems after he’s born? Thank you for all of your help. I wish I was in a bigger city with more doctors like you. I live in McAllen and there are very few doctors who can help me.
    -Clarissa

    • Dr. Gail Demmler-Harrison, Infectious Diseases Dr. Gail Demmler-Harrison, Infectious Diseases says:

      Hello,

      The results from your CMV IgG and CMV IgM antibody results you provided are numeric but do not tell me the interpretation. All tests ahve different numeric levels for positive or negative. Are both the IgG and IgM results indicated positive or just the IgG result? A CMV IgG avidiy index if positive would indicate a CMV infection over 16 weeks ago, but still will not tell you if it occurred this pregnancy because you are already 30 weeks gestation.

      Echogenic bowel is one early indication for congenital CMV infection in the fetus in utero, however it is a nonspecific findings which may disappear or which also may eman other things.
      The only way to determine fi your fetus is CMV infected is amniocentesis and test the amniotic fluid for CMV. However, if your baby appears to be developing normally otherwise, then this procedure may not be indicated or recommended by your doctors.

      Your doctor should follow your baby’s development with fetal US to make sure your pregnancy is going well and to plan interventions if needed. At this time it sounds like everything is going well and reassuring.

      Your baby should be tested for congenital CMV at birth with a simple urine test for CMV which can be sent to a reference laboratory, even fro a small town.. If your baby’s urine is CMV positive, then additional evaluations may be indicated. If negative, then you know your baby is not congenitally infected with CMV.

      I hope this is helpful.

      Dr Gail Demmler Harrison
      CMVDOC

  25. Hiwot H says:

    Hello Dr. Gail

    I had CMV Igm positive during my first pregnancy but my Igg avidity test have 83% avidity (my lab calls >65 high) and my boy born with no medical problems at all and he is 1 year and a month old and healthy and active. i have tested again for CMV and the result IgG/IgM positive dose that mean its reactive again and i should get worried as I am 6 weeks pregnant with my second baby and what is the chance to transmit CMV to the fetus.

    Thanks

  26. Jackie says:

    Hello,

    I’m 22 weeks pregnant and just learned my son is CMV positive from a swab done during a Bronchoscopy. I was tested when I was 8 weeks pregnant and it showed that I was negative. At work, I’m a pediatric nurse, I have taken so much precaution and I’m crazy about washing my hands trying to do the best I can. At home I wash my hands to after changing diapers and taking my 3 year old to the bathroom ect. However I wasn’t as good as not sharing my food and drink occionasionaly wiping his nose without sanitizing. After learning he was positive I’m a complete mess. My 3 yr old is in preschool and my one year old just goes to the church nursery on Sunday’s. On my 20 week US baby looked perfect and was measuring 5 days ahead. I’m getting retested on Monday so see if my status has changed. I’m just making myself sick over this. Worried sick about my unborn child worried sick about how could I be so careless and how I could have hurt my baby. Any words of advice ?

    • Dr. Gail Demmler-Harrison, Infectious Diseases Dr. Gail Demmler-Harrison, Infectious Diseases says:

      I am so glad you are CMV Aware and are practicing recommended CMV precautions to the best of your ability. It is not likely an occasional “slip” in CMV precautions will result in CMV transmission. It is a good idea that you are getting good careful prenatal care. My advice is to keep trying your best, work on wellness of mind and body, and try not to worry so much. If you are a born worrier, that is of course hard to do, but try some techniques for relaxation and diversion of your mind to other things. Worry itself is a strain on your system. Knowledge is key to no more CMV, and you are doing just that.

      Best wishes for a healthy pregnancy.
      Dr Gail Demmler Harrison
      CMVDOC

  27. Traci says:

    Hello,
    I just found out that I had CMV when I was pregnant and it was the cause of my preterm delivery in November 2014. On March 26, 2015 I found out that my son tested positive for it. I passed it to him in the womb. I don’t know anything about it, other than what I have read online… and I see that it is a scary thing. I live in a small town and the doctors don’t know much about it. I read that 80% of children born with it don’t have serious symptoms, but 10-15 do. My son was born at 36 weeks weighing 4lbs 2oz. He had low blood sugar and jaundice, but other than that he was perfect. He didn’t have to go to the NICU, and he passed his hearing screening in the hospital… I have so many questions and it seems like no one knows the answer. I don’t understand why they didn’t catch it when he was born… it’s been almost 5 months and I am just now finding out. I read that depending on the type of CMV and the levels, it may not be as serious… but I don’t know the questions to ask my doctor. Any guidance that you have would be helpful, because my doctors just don’t know…
    Thank you.

  28. Worried CMV mommy says:

    Hello Dr. Demmler-Harrison,

    I am so glad that I found your blog tonight. I live in Vancouver BC Canada and have a three and a half month old daughter who was diagnosed with cCMV. I have been to numerous appointments and am working with Dr. Soren Gantt of UBC Pediatrics and BC childrens’ hospital. I had a very smooth pregnancy and was not ill for any duration of it. I, like so many others, have never heard of CMV until my baby was born. She was born vaginally and without any medications on December 19th 2014 and weighed in at 4 lbs and 11oz, head circumference of 30.5cm at the end of 37 weeks so she is considered full term. I had the onset of preclampsia and my pressure was over 160 at one point when in the assessment room but ws otherwise normal throughout my pregnancy. Other than being small, there were no other unusual symptoms. We went home from the hospital only to get a call two weeks later advising that more testing needed to be done as they suspected she may have CMV infection! Her urine sample tested positive for CMV within two and a half weeks of life and there was Cmv on the placenta pathlogy. She was diagnosed as symptomatic based on symptoms of IUGR and microcephaly and we elected to start oral vanganciclovir treatment within the first month of her life and will be continuing for six months’ time. She has mild neutropenia but her neutrophil count is on the rise I was advised and her blood is monitored closely with tests every other week. I was told at each of my weekly family doctors’ visits that my fundal height measured perfectly so was not aware that she was experiencing IUGR at all. I am 33 years old and my first child. My blood test sample that was taken when I found out I was pregnant two weeks in was retested for CMV antibody after her birth and it showed that I was positive for IGG and negative for IGM. My family doctor advised that it means it was an old infection. My baby has passed her ABR and OAE audiology testing, confirmed no CMV retinitis with ophthamalogy, head ultrasound showed no abnormalities. We adjust her antiviral dosage every two weeks based on her weight. I am very diligent with giving her antiviral every twelve hrs. Is there a maximum dosage that should be given to infants? She weighed 10 lbs 9 oz, head 38.5cm, and height at 60cm at three mons old which was on march 19th 2015 and her dosage is now at 1.5ml every twelve hrs. Her 20wk ultrasound while I was pregnant had normal fetal measurements and no abnormalities. I understand that I probably had a recurrent CmV infection which is rare but also that we still need to monitor her by audiology closely until she is six years old. Dr. Gantt advised that regardless of whether it is recurrent CMV or not, it does not change how we treat my daughter. I understand recurrent infection probably attributed to her relatively mild presentation of Cmv symptoms at birth but doesnt preclude her from delayed onset of hearing loss. Can you please advise your thoughts on her outlook and whether or not there could be delayed onset of mental impairment or ocular degeneration due to cmv? What are the stats for development of sequelae for recurrent infections of cmv? Would the risk of sequelae be mainly hearing loss and does that risk remain the same up until she is six years old or older? does the risk increase or decrease with time? Also, is her head size ar birth considered to be microcephaly or just smaller because she was small in general? The pediatrician advised that her head size is normal now and that microcephaly at birth doesnt necessarily mean she will have mental impairment because of a smaller brain as she grows – is this true for cCMV children though? My family doctor told me that most asian babies tend to be on the smaller side anyways and if I had one more week of gestation that my daughter would’ve likely been over five lbs. so nothing that would have been out of the ordinary. Other than Dr. Gantt of ID, there seems to be no one else that understands CMV in my area that I can discuss this with. Your advice would be much appreciated.

    • Worried CMV mommy says:

      Also, I am not immuno suppressed or taking any medications so not sure why the CMV transmitted to my baby. My CMV IgG is positive and my CMV IgM is negative based in the blood test done when I was two weeks pregnant. Have not yet tested the last blood test done at 35 weeks gestation (blood test ordered because I had high blood pressure that week even though my blood pressure always been normal throughout the pregnancy). I am healthy, active even late into pregnancy, and ate well before and during my pregnancy so not sure why this has happened to me with <1% probability of recurrent infection occurring??

      • Dr. Gail Demmler-Harrison, Infectious Diseases Dr. Gail Demmler-Harrison, Infectious Diseases says:

        CMV recurrent infections may happen in otherwise healthy women around < 1% of the time. They are unusual and usually do not cause signs or symptoms in healthy people.

        Dr Gail Demmler Harrison

        • Worried CMV mommy says:

          Hi Dr. Demmler-Harrison,

          Thank you for your reply. I was actually concerned about my cCMV baby as opposed to recurrent CMV infection in a healthy adult. My main questions were in the post prior to the one you replied to. You had advised in prior posts that the babies born with cCMV from recurrent infections are usually not affected by the disease but my baby per my previous posts’ situation ended up being symptomatic from IUGR and microcephaly. Could you please advise regarding my questions in my prior post? I am concerned about the outlook for her and Probability of developing sequelae for a cCMV baby born of a recurrent infection. Your help with the questions in my prior post would be much appreciated. Thanks so much in advance

          Worried CMV mommy

  29. Worried CMV mommy says:

    Also, I have sent you an email as there are some more personal questions that I would appreciate your advice on. Look forward to your reply. Thanks so much and great blog on cCMV!!

  30. Al says:

    Hi there

    I recently got my bloodwork back and I tested postive for IGM and IGG. The both tested postive.
    What does this mean?? And what are the chances of the baby bit being healthy.

    Any advice would be great!!
    Thanks

    • Dr. Gail Demmler-Harrison, Infectious Diseases Dr. Gail Demmler-Harrison, Infectious Diseases says:

      A positive CMV IG G and CMV IG M antibody test usually indicates a recent CMV infection, usually within 4 months, but possibly earlier or later. The duration of CMV IG M antibody is very variable. A CMV IG G avidity index may be helpful in timing your CMV infection. Not all primary CMV infections or near recent CMV infections are transmitted to the fetus. In fact, only about 40% will be transmitted, so most of the time the mother’s placenta is able to block the CMV infection from the fetus. Your obstetrician should follow the development of your fetus carefully. You may wish to ask about enrollment in clinical trials on some of CMV hyperimmune globulin for reducing the transmission of CMV across the placenta. This clinical trial is on http://www.clinicaltrials.gov.
      I hope this information is helpful.
      Best wishes for a healthy pregnancy and healthy baby.
      Dr Gail Demmler Harrison
      CMVDOC

      • Al says:

        Thank you so much for
        Your response.

        I have been monitored very closely with biophysicals and ultrasounds. I have has 7, would anything show up on the ultrasound to prove the baby was infected?? Or
        Do you have to wait until
        Birth.

        Thanks

        • Dr. Gail Demmler-Harrison, Infectious Diseases Dr. Gail Demmler-Harrison, Infectious Diseases says:

          A fetus may have a silent asymptomatic congenital CMV infection and if that is the case, then no abnormalities will be seen on fetal ultrasounds or monitoring measurements. However, if symptoms arise, these signs may be evidence on fetal scans and measurements.
          The best way to determine if congenital CMV infection is present is to test the newborn for CMV infection at birth, which must be done within the first 21 days of life. CMV PCR tests or CMV culture tests on the urine, or a saliva collection, if properly done, is also acceptable.

          I hope this information is helpful to you.

          Dr Gail Demmler Harrison
          CMVDOC

  31. LL says:

    Hi Dr. Gail Demmler-Harrison,

    Following my prior post, I am anxious to hear any advice you may have regarding the probability of development of sequelae in symptomatic cCMV babies born of a maternal recurrent infection

    Would also really appreciate your reply on:
    – whether the risk of sequelae for cCMV babies involves mainly hearing loss or also may involve brain and eyes? What if all three areas hearing, eyes, and brain were normal at birth?
    -Is there a increasing or decreasing risk of developing sequelae as she gets older?
    – does the risk of delayed onset mainly involve first school years until 5 or 6 years old or should we monitor until teens/adulthood?
    – Is there any benefit to extending the valcyte treatment beyond six months from current research if it was already started in the first month of life?
    – does it matter whether it was a recurrent infection or reactivated infection in affecting the probability of developing delayed onset of symptoms? If so, how do we find out the difference in postnatal testing?
    Not sure if this blog is mainly for questions for cmv while expecting only? I unfortunately did not know about cmv until my baby was born :( I am frustrated and sad because I thought that I had immunity already since It was not the first time I had cmv while pregnant but the virus still ended up crossing the placenta and affecting my baby to the point where she experienced interuterine growth restriction.

    Thanks in advance for your advice and help

    Much Appreciated

    • Dr. Gail Demmler-Harrison, Infectious Diseases Dr. Gail Demmler-Harrison, Infectious Diseases says:

      Hello and thank you for your post and questions about the outcomes of children born with congenital CMV. Look for my next blog post coming up soon. In my next blog post I will talk about babies born with congenital CMV.Until then, I have inserted a response to each of your questions, to the best of my ability. But in general it is also best to let the child tell you how he or she will develop over time. Experts can provide estimates but it is in the end the baby or child that will tell you how they will do and what are their strengths and weaknesses. Also, the developing child is very open to new things, and through interactions and therapies, and many can continue to learn and do well.

      There are not very many studies or data available on specifics of outcomes long term in symptomatic congenital cmv born as a result of a maternal recurrent cmv infection.

      – whether the risk of sequelae for cCMV babies involves mainly hearing loss or also may involve brain and eyes? What if all three areas hearing, eyes, and brain were normal at birth?
      If all areas of hearing and eyes and brain were normal at birth, then it is likely the only long term outcome of concern would be hearing, since hearing loss in any form of congenital cmv infection can be progressive or later in onset. I would however recommend your baby have development, growth, hearing and vision checked on a regular basis. The most important would be hearing.

      -Is there a increasing or decreasing risk of developing sequelae as she gets older?
      The only increasing risk would be progressive or later onset hearing loss for congenital cmv.

      – does the risk of delayed onset mainly involve first school years until 5 or 6 years old or should we monitor until teens/adulthood?
      The greatest time of hearing loss later onset and progression is the first 3-6 years of life, but progressions in established hearing loss and even newer onset hearing lose may rarely occur in adolescence and early adulthood, so the hearing loss follow-up in individuals with congenital cmv, of any form of congenital cmv, should be lifelong I think.

      – Is there any benefit to extending the valcyte treatment beyond six months from current research if it was already started in the first month of life?
      While it is possible longer antiviral treatment would be beneficial, there is no known benefit to extending valganciclovir (valcyte) beyond the first 6 months of life, based on our current knowledge form clinical trials.

      – does it matter whether it was a recurrent infection or reactivated infection in affecting the probability of developing delayed onset of symptoms? If so, how do we find out the difference in postnatal testing?
      Good question, and no real hard data to tell you for sure, so I would suggest careful follow-up in all cases of children with congenital cmv, regardless of the type of their cmv infection.

      This blog is for all questions related to congenital cmv, and though my previous posts have been related to cmv in pregnancy, my next upcoming blog post will be on newborns and children with congenital cmv. Thank you.

  32. LL says:

    Thank you so much for your response

    I wonder whether most of the patients you have been looking after are mainly from primary CMV infections? It would be interesting to have more information on cCMV babies born of recurrent infections as well in your next post.

    In speaking with the audiologists at BC children’s hospital here, they have not treated any cCMV children really other than my baby. They are in the process of setting up their protocols, as they don’t have any at the moment, and starting their CMV program. Would you be able to pass on the contact of the audiologist working with you on cCMV children in Texas to me so I can refer the audiologists here to him/her to exchange ideas on current protocols? It would be beneficial to all children here in BC who may be diagnosed with cCMV to have an established audiology protocol that is followed.

    Also, why is it that the greatest risk of hearing loss is between 3-6 years of age as you mentioned as opposed to the first three? Does the virus become active again after laying dormant from the valcyte treatment?

    Other than being small at birth, she had no other symptoms characteristic of cCMV children. She was born in the third percentile at birth but is now between the 10th and 25th percentile. Only a head US was done which showed as normal but no CT scan as it was deemed too much radiation for a newborn.

    What is the usual probability of hearing loss sequelae in asymptomatic cCMV children born of a maternal recurrent infection, probability of it for asyptomatic cCMV children born of primary infection, and what of the probability of sequelae in symptomatic cCMV children born of primary infection? Since there are no stats for my case of symptomatic of recurrent, just seeing what the stats are for the other categories. Are the stats divided betwen those who elected for valcyte treatment as opposed to none?

    You are doing such great work, can’t tell you how much I appreciate the in depth information on your blog that I was not able to find anywhere else in scouring the internet.

    Thanks so much

    • Dr. Gail Demmler-Harrison, Infectious Diseases Dr. Gail Demmler-Harrison, Infectious Diseases says:

      If you would prefer, you may have your doctors email me for particulars about what is actually known about congenital CMV and recurrent maternal infections. My next series of blog posts coming up later this year will concern outcomes in the newborns with symptomatic and asymptomatic congenital CMV.

      Recurrent maternal infections are usually not thought to be of as great a concern as maternal primary infections during pregnancy, but of course there are always exceptions.

      Dr Gail

      • LL says:

        Hi Dr. Gail,

        Thanks for all your time reading my post and willingness to share information you have about congenital CMV, recurrent maternal CMV infections and probability of sequelae of hearing loss (unilateral/ bilateral). My doctor, Dr. Heather Chang, has your contact info now and will be reaching out to you shortly via email. I appreciate your offer to have my doctor contact you. Any advice you may have regarding the questions in my last post would be wonderful.

        Thank you so much again for all your help. I am so grateful for your expertise and help

  33. Fiona says:

    Hi Dr. Demmler-Harrison,
    thank you so much for starting this blog – it has been the best resource in terms of getting information about CMV risk and pregnancy! Myself and my husband are hoping to try for our second baby – I had a miscarriage in February and we were really hoping to try again ASAP. However my husband came down with a bad dose of confirmed CMV-hepatitis and was hospitalised for 1 wk (IgM positive, IgG positive, low IgG avidity). He started presenting with symptoms on March 15th. Our 18mth toddler attends daycare and is assumed to be CMV positive and have passed it on to my husband. I in turn have been tested and typically have no immunity (negative for both IgM and IgG). Given my husband (and most likely me?) was most likely exposed in minimum February I’m just wondering about the best strategy moving forward? I was thinking about getting re-tested in July and see if I have seroconverted? And also to get my husband checked at that point for IgG avidity and CMV PCR in his blood? If I am still negative at that point and my husband is negative for IgM and CMV PCR do you think we would be safe to try again? Or should we just wait till he is 6mths post infection? If he is negative on all fronts is the ‘six months’ wait just precautionary?
    Also I would appreciate your advice as to whether I should be actively trying to get the virus now (thinking CMV party instead of chicken pox party!) or should be avoiding contact with both husband and toddler as much as possible and stay seronegative? I’m just afraid that myself and my husband will be clear but my toddler will be shedding for a long time and I’ll be at high risk of infection from him. Also do some people seem to have an innate immunity against this virus without antibodies? My sister is also seronegtive (she is pregnant and in her 3rd trimester and was minding my toddler when husband was in hospital so she was also tested). However she has two young children who have gone through daycare and she has managed not to pick it up off them so I’m feeling hopeful that she doesn’t come down with symptoms. I would appreciate any advice you have in this regard – our doctors are wonderful but they don’t have these specific answers unfortunately.Thanks in advance for your time!

    • fiona mcgillicuddy says:

      Dear Dr.,
      I just wanted to follow up on this post and update. I was just retested for cmv and am now igm and igg positive with low avidity index. I am just so thankful to your blogs for raising awareness about this disease as we would have otherwise been actively trying for a baby. Do thankful my husband presented with symptoms or we would have been completely unaware of our high risk situation. I think our case highlights that it is important for both parents to get their cmv status tested before trying for a baby – particularly with toddler in daycare!

      • Dr. Gail Demmler-Harrison, Infectious Diseases Dr. Gail Demmler-Harrison, Infectious Diseases says:

        Thank you–another baby saved from CMV thorugh CMV Awareness!

  34. Pankaj Kumar says:

    I have got a biggest gift of life with a baby boy just 2 months back. I have also gone for stem cell banking with LifeCell. They have send us a report of maternal test, there i see that the CMV IgG* test is Reactive. Now my question is that, will it create any problem to the baby because my wife is feeding him or will it be problem to the baby mother. So i worried about this, i dnt know what should i do now. Should us stop feeding the baby or else go for treatment or what to do now?
    Please please help us as soon as possible.

    • Dr. Gail Demmler-Harrison, Infectious Diseases Dr. Gail Demmler-Harrison, Infectious Diseases says:

      The presence of CMV IgG antibody is common and does not necessarily mean anything is wrong. Most women who are healthy will be CMV IgG antibody positive, between 50% to 80%, so it is not uncommon. If your baby is healthy, then breast feeding is encouraged even if your cord blood test is CMV IgG antibody positive.

      Best wishes.
      Dr Gail Demmler Harrison
      CMVDOC

  35. Claire Edwards says:

    I am currently 25 weeks pregnant with twins. I am CMV negative and my egg donor was CMV positive. I have just developed a cold sore. Should I be concerned? I have had cold sores before. If the donor is positive does that mean the babies are already positive and shouldn’t be affected?
    Thank you.

    • Dr. Gail Demmler-Harrison, Infectious Diseases Dr. Gail Demmler-Harrison, Infectious Diseases says:

      CMV infection is not associated with “cold sores”. Other viruses, and noninfectious causes, are more common causes.

      The role of a CMV seropositive egg donor in transmitting CMV to the babies is not well defined, but if the egg donor had an old previous resolved inactive or latent CMV infection, then the twins should not be at risk for congenital CMV disease. I hope this information is helpful.

      Best wishes for a healthy pregnancy,
      Dr Gail Harrison (Demmler)
      CMVDOC

  36. me says:

    Hi doctor,

    I got igm positive, n igg negative.if I check in 12 week amniocentesis and if the result is negative to the fetus. And any chance the fetus still get infected after a few month?. About the hearing loss of the children n blind In age 3-6 years.. Is this possible happend if we check the fetus is negative n still happening this or this will might happens because the amniocentesis is positive
    . I’m 7 week but the doctor in here recommended to terminated. So I can pragnent again with health baby without worry in just 2 month after terminated. Is that true once we get this virus , we won’t get it for 2nd time.

    Thank u

    • Dr. Gail Demmler-Harrison, Infectious Diseases Dr. Gail Demmler-Harrison, Infectious Diseases says:

      A CMV IgG antibody negative CMV IgM antibody positive results may mean
      1) a recent CMV infection with evolving serologic response to IgG against CMV
      2) a false positive IgM reaction

      A repeat set of CMV tests should be done in 2-4 weeks, to see if you seroconverted your CMV IgG antibody. If you do, then it is a recent primary CMV infection. If you do not, then a false positive IgM is more likely.

      I hope this is helpful information.
      Best wishes.
      Dr. Gail Demmler Harrison CMVDOC

  37. sam says:

    Hi Doctor,
    We lost our first daughter because of multiple organ failures suspecting the primary cause as Cmv. She was cmv igg and igm positive. My wife is cmv igm positive (116). What are the precautions and tests we need to take before planning for the next child? Is there a chance for the next child to get this infection?

    • Dr. Gail Demmler-Harrison, Infectious Diseases Dr. Gail Demmler-Harrison, Infectious Diseases says:

      The CMV precautions recommended for all pregnant women are outlined in my previous blog post titled “What Every Woman Should Know…” as well as at http://www.cdc.gov/cmv website.
      Congenital CMV infection from a recurrent maternal CMV infection may occur, but is less common and almost always less serious than a primary CMV infection.

      I hope this is helpful information.
      Best wishes,
      Dr. Gail Demmler Harrison CMVDOC

  38. zubair ahmed says:

    My wife is 25 years old and I AM 32 YEARS OLD after 1 year of our marriage she conceived , unfortunately she had a miscarriage. After that we consult our doctor she recommended thyroid, torch and aca test.
    iN THYROID TEST SHE HAD 2.58 uIU/mL
    IN TORCH TEST SHE HAD
    TOXOPLASMA ANTIBODY IGG <3.0 IU/mL NEGATIVE
    TOXOPLASMA ANTIBODY IGM <3.0 IU/mL NEGATIVE
    RUBELLA ANTIBODY IGG <41.2 IU/mL POSITIVE
    RUBELLA ANTIBODY IGM <10.0 AU/mL NEGATIVE
    HERPES SIMPLEX VIRUS I&II IGG 9.0 INDEX VALUE POSITIVE
    HERPES SIMPLEX VIRUS I&II IGM 0.68 INDEX VALUE NEGATIVE
    CYTOMEGALOVIRUS IGM ANTIBODY <5.0 U/ml NEGATIVE
    CYTOMEGALOVIRUS IGG ANTIBODY 458.8 U/ml
    WHICH OUR DOCTOR THINK IS NOT RIGHT
    AND
    ANTI CARDIOLIPIN ANTIBODY IGG 3.10 U/ml
    ANTI CARDIOLIPIN ANTIBODY IGM <2.0 U/ml
    AFTER CONSULTING OUR DOCTOR SHE RECOMMENDED 10 DAYS MEDICINE
    OF Ganciclovir Sodium 250 MG DOSES 2 TABLETS IN MORNING AND 2 IN EVENING FOR DAYS AND NOT TO CONCEIVE FOR 03 MONTHS
    PLEASE GIVE US YOUR VALUABLE OPINION

  39. riyaan says:

    Thanks mom for your efforts to aware cmv
    My wife gave birth baby boy he is healthy but when our life cell preservation test showed cmv igg positive iwas worried. I don’t know what to do..now my baby is 2month old..Please help giving advice

  40. Mandi says:

    Hi! I have a big question. Our daughter was diagnosed with mono and cmv at the same time at age 5. She had a very swollen liver and spleen for about 7 months. We have battled severe chronic fatigue, random fevers lasting two weeks, she is immune compromised since the event. She ruined her tonsils through this event and were removed. She is now 8 and we deal with a lot. Fatigue = horrid emotions. She can’t just live that totally normal childhood. Missing a ton of school still from getting sick. Our doctors know nothing of the disease so they just ignore it. We need help. Any clinics you know of willing to see her? Can we help her to get better? Any input, clinics, doctors etc would be great!.

    • Dr. Gail Demmler-Harrison, Infectious Diseases Dr. Gail Demmler-Harrison, Infectious Diseases says:

      Thank you for your post, but this blog focuses on diagnosis, treatment and prevention of congenital CMV infection. However, I can say that CMV mononucleosis can cause fatigue and lack of well being for many weeks to a few months. If this fatigue lasts more than that, then consultation with a specialist is in order. Post viral syndrome fatigue or a chronic fatigue syndrome can occur but is usually seen in adolescents, not early grade school age children. It is possibly something else, as well. Recommended specialists may be a pediatric infectious diseases specialist or an immunologist at a pediatric hospital or medical center near you.
      I hope this information is helpful.

      Best wishes.
      Dr Gail Demmler Harrison
      CMVDOC

  41. zubair ahmed says:

    DR I FORGOT TO RIGHT IT IS POSITIVE
    CYTOMEGALOVIRUS IGG ANTIBODY 458.8 U/ml is ;positive

  42. Roseanne Paiz says:

    Hi my daughter is currently in the Children’s Hospital in Los Angeles. She currently has CMV. The Infectious and Disease doctors and her pediatric doctors told us that it would be difficult for her platelets to raise since the valganciclovir and the virus wouldn’t be any help since they both have the effect of lowering the platelets. She has them at 67 currently but she maintains them higher than 50. The dietitian wants her to gain 20 grams a day and so my question is can either the medicine or the CMV make it difficult for her to get to that weight goal. She is gaining weigh but its only 10 grams a day.

    • Dr. Gail Demmler-Harrison, Infectious Diseases Dr. Gail Demmler-Harrison, Infectious Diseases says:

      Randomized clinical trials published in peer review literature have shown that infants with symptomatic congenital CMV infection benefit from antiviral treatment with valganciclovir orally if they are stable or IV ganciclovir if they are seriously ill. CMV active infection may cause a baby to not feed well. Treatment may help over all well being and feeding. Low platelet count is a sign of congenital CMV disease and often with antiviral treatment it will improve. Your doctors may wish to see how your baby does on the treatment and monitor platelets carefully. They know your baby’s case the best, so consult with them. The most common side effect is neutropenia (low bacteria fighting white blood cells) which occurs in about 20% infants treated with oral valgancicovir and 60% of infants treated with IV ganciclovir. Low platelets (thrombocytopenia) occurs less commonly than neutropenia.

      Best wishes.
      I hope this information is helpful.

      Dr Gail Demmler Harrison
      CMVDOC

  43. Maire Murphy says:

    Hello Dr. Gail. you were very helpful to a friend of mine earlier this year in relation to CMV results in an adopting file and I now face a similar question with regard to Hep B. I know this thread is CMV related but I am hoping you can shed some light on this infectious disease. The blood test shows HBsAg : 0.547, HBsAB IgG : 141.488 H, HBeAg : 7.504 , HBeAb IgG : 38.654 and finally HBcAb 1gG : 42.193 I do not know if you can shed any light on this but I would welcome any possible advise. MaireM

    • Dr. Gail Demmler-Harrison, Infectious Diseases Dr. Gail Demmler-Harrison, Infectious Diseases says:

      Thank you for your post but this blog is devoted to CMV in pregnancy and infants and children – please consult an infectious diseases expert in your area. I am sure they can provide insight for you.

      Best wishes,
      Dr Gail Demmler Harrison
      CMVDOC

  44. Maureen says:

    Dear Dr. Gail
    I am 8 weeks pregnant now. I knew i was CMV negative 6 months before the pregnancy so immediately upon learning I am pregnant at 4 weeks, i checked for CMV given i have two years old twins at home. Unfortunately, I found out in week 4 that i became igg and igm positive and was infected with primary CMV very recently. I repeated the test at week 6 and the avidity was 10% which teaches on periconceptual primary infection.
    What are the chances my baby would be infected with CMV as well?
    In addition, I am moving to NYC and it is crucial for me to consult and be monitored by a gynecologist who understands well the CMV infection and risks. I also believe it is critical to do the scanning by an expert who already had experience on CMV babies. Do you have any recommendations for me?
    Thank you very much
    Maureen

    • Diana says:

      Dear Maureen and Dr Gail,

      I am in a similar position, 8 week pregnancy with positive IgM and positive IgG and low avidity, my doctor believes I got my primary infection a week or two before becoming pregnant.

      I wanted to know if after taking an amniocentesis exam, assuming it comes negative for CMV in the baby, I could be at ease that my baby will not get congenital CMV later in my pregnancy.

      I hope everything turned out well for you Maureen.
      All the best.

  45. cassaundra says:

    At birth my twin daughter was tested for Cytomegalovirus result said she had less than 300 copies. How do I know if she has it or not.

    • Dr. Gail Demmler-Harrison, Infectious Diseases Dr. Gail Demmler-Harrison, Infectious Diseases says:

      You did not specify the sample on which the CMV test was done.
      If the CMV DNA test results are not detectable or below a detectable limit of 200 or 300, depending on the cut off values of the test performed, and if the test is done before 21 days of life in urine or saliva, then a baby does not have congenital CMV.
      If the CMV DNA test results are not detectable or below a detectable limit of 200 or 300, on blood or plasma, then congenital CMV is possible because not all babies with congenital CMV have detectable CMV in their blood. I hope this is helpful
      Best wishes.
      Dr Gail Demmler Harrison
      CMVDOC

  46. Cyrus Rustom says:

    Hi,
    My wife is currently 16 weeks pregnant and had a cmv check this past Monday private ly due to NHS not checking for cmv. The results are igg 179 au/ml reactive and igm equivocal. The comments say this suggests a recent infection but cannot prove it and we have been advised to return in 14 days to check if igg has risen (indicating an infection). My question is , has my wife previously had cmv as suggested by igg count or could that be elevated due to a primary infection? I’ve phoned our consultant but still no reply. We are sick with worry. When we return for blood test is this avidity test or something different. Thank you so much for your time.

    • Dr. Gail Demmler-Harrison, Infectious Diseases Dr. Gail Demmler-Harrison, Infectious Diseases says:

      A CMV IgG result and a CMV IgM equivocal result may mean one of several things:
      A resolving primary (first) CMV infection that may have occurred weeks to months ago
      An old CMV infection with a recurrent/reactivation/reinfection with a mild increase in CMV IgM
      An old CMV infection with a false positive detection of CMV IgM antibody.

      Once a CMV infection occurs, CMV IgG antibody will rise pretty quickly, usually within a couple of weeks, and stay for life. The CMV IgM antibody will also rise at or about the same time and last a few weeks to a year or more.

      Doing a CMV IgG avidity assay will help determine if the CMV infection occurred more than 4 months ago (high avidity) or less than four months ago (low avidity). It may be helpful to do that test now, since your wife is just 16 weeks pregnant, to tell if a current new primary CMV infection occurred during the pregnancy. A repeat CMV IgG antibody and CMV IgM antibody is also helpful to look at a trend, but CMV IgG avidity assay would be the most helpful.

      I hope this is helpful information
      Best wishes.
      Dr Gail Demmler Harrison
      CMVDOC

      • Cyrus Rustom says:

        Thanks for your swift response. Will look into it. Ta
        Cyrus

        • Cyrus Rustom says:

          Just a quick note, my wife suffers from colitis would the fact she has an immune disease make a false positive more likely? Ta

          • Dr. Gail Demmler-Harrison, Infectious Diseases Dr. Gail Demmler-Harrison, Infectious Diseases says:

            Yes, it is possible. Individuals with auto immune disorders may have false positive reactions on serology tests, such as CMV IgM antibody levels.

            Dr Gail

  47. Cyrus Rustom says:

    Cheers, all the best x x

  48. AC says:

    Hello,
    Thank you for providing us information on CMV.

    I have been tested for CMV (2 years ago) and the test showed that I have not had a prior infection. I am 32 weeks pregnant. My 2 year old son recently developed a fever, runny nose, etc. I take the precautions you have mentioned around him, but my husband does not (and I do not take precautions around my husband). I am just curious whether it is recommended that any of us be tested for CMV and if we need to change any of our hygiene practices.

    Thank you very much for your time.

    • Dr. Gail Demmler-Harrison, Infectious Diseases Dr. Gail Demmler-Harrison, Infectious Diseases says:

      If you are pregnant and CMV seronegative, then practicing CMVprecautions around all toddlers, and young children, especially your own in your own household, is recommended by CMV experts and state and national public health officials. I am glad to hear you are CMV aware, know your CMV serostatus, and are actively practicing CMV precautions to reduce your CMV transmission risks.

      You ask a very good question regarding CMV precautions for other close family members and partners of pregnant women. While not officially recommended, because clinical trials providing the evidence based medicine are not available, it would be a reasonable option to have your husband practice CMV precautions around your toddler and other young children while you are pregnant. It is good general hygiene also.
      Transmission of CMV form a husband to wife has been documented and may occur, especially if the husband has a proven active CMV infection. CMV may be shed in saliva, urine and semen during an active CMV infection in men.
      If your husband develops a febrile illness, especially a mononucleosis like illness, then it is likely to be CMV as one of the potential causes, and he should be evaluated and you should definitely practice precautions at that time with him, if he is diagnosed with an active CMV infection. If he is otherwise well, it is likely he is not actively CMV infected even though it is possible.
      If your husband is well, and you both elect to practice CMV precautions during your pregnancy around your toddler that would certainly be a reasonable thing to do. If your husband is well, the practice of precautions with him would be an individual choice, since evidence based studies to formally recommend this type of behavior precaution is not yet available. It is a possible target for further research at this time.
      No formal CMV testing is really recommended for otherwise well spouses/partners or children.
      I hope this information is helpful.
      Best wishes for a healthy pregnancy and healthy baby!

      Dr Gail Demmler Harrison
      CMVDOC

      • AC says:

        Doctor,
        Thank you so much for answering my questions.

        I have now caught my son’s illness, which seems like the common cold. I do not know whether to get tested for CMV, as I am trying to balance precaution with not wanting to overreact every time I get a cold. The symptoms are congestion and sore throat, though he had a fever but I have not yet had one. I would appreciate your advice as my OBGYN has been very dismissive of CMV concerns in the past.

        I am 33 weeks pregnant with no issues so far.

        Thank you again!

  49. Kate says:

    Dear Dr Gail,
    Thank you so much for the information on this blog. I am a healthy 31 year old with a 2 year old son and a year ago (July 2014) I lost my second baby at 10 weeks gestation after acquiring a primary CMV infection in early pregnancy. I have been given conflicting advice regarding when it is safe to conceive again (from 1 – 4 years). 3 weeks ago, I was told I still have detectable CMV IgM (although lower than it was when last tested in October 2014 but I don’t know either number). My GP has organised 2 viral load blood tests 2 weeks apart and the first has come back negative. I’m told that if the second is also negative, then it should be safe to conceive again. Is this the case, even with persistent CMV IgM? I don’t think my CMV IgG have been tested since the primary infection was diagnosed a year ago. We are keen to have another baby as soon as safely possible but of course do not want to put them at risk of any complications from this CMV infection.
    Thank you for your time and help,
    Kate

  50. Laura says:

    If cmv igm is considered negative under 0.2, why would it be present at levels under that at all? For example, why would anyone have igm level of 0.18 and be considered negative?
    Thanks

    • Dr. Gail Demmler-Harrison, Infectious Diseases Dr. Gail Demmler-Harrison, Infectious Diseases says:

      Each test performed in a laboratory has a “cut off” value that is considered a true meaningful value for positive and for negative results. There is often “background” signals from various tests, especially those tests that are automated by machines. This “background” signal may come form the patient’s serum or form the reagents or test materials themselves. To avoid inconsequential and meaningless background signals, a test developer determines through clinical trials comparing their new test with another validated test, what is the “true cutoff” values for their test.
      If there is any question about a test value that is read “negative” by the cut off value, a repeat test in 2 weeks would be reassuring if the same values are there and still in the cut off ranges as negative. If a change in the value occurs, then it can be determined the level was “on the rise” but not yet high enough for a meaningful true cutoff value as positive.
      A test is just a test. The true meaning of test results also entails a clinical correlation with the patient’s individual clinical history and physical examination and imaging studies, to make the interpretation the most accurate for the patient. You may wish to consult with your doctor as well to help interpret the meaning of your test results.

      I hope this information is helpful to you.
      Best wishes.
      Dr Gail Demmler Harrison
      CMVDOC

  51. Gul says:

    Hi
    So good to see this blog. Really informative stuff.
    I ll be starting my residency as a pediatrician and we are planning to have a baby. But I am really concerned about my job as working in a children’s ward or emergency can be really dangerous as we are potentially exposed to all kinds of germs and infections. What would you suggest in this regard? Is pregnancy safe working as a pediatrician? Sounds really stupid as there are many women working as doctors and are mothers but I am too much worried about this issue as I ll be working as a junior doctor and I can overlook things. Your recommendation will be really helpful!!
    Thankyou so much.

    • Dr. Gail Demmler-Harrison, Infectious Diseases Dr. Gail Demmler-Harrison, Infectious Diseases says:

      Hello,

      The universal precautions recommended for all levels of patient care are sufficient to prevent CMV transmission from patient to health care worker in the hospital. CMV requires close contact for transmission, which is not likely to occur in the hospital setting. It is however likely to occur in the home setting, so review CMV precautions for pregnant women in my blog and on public health websites. Your obstetrician will also provide you, if you become pregnant, recommendations to reduce your risk for acquiring infections and other conditions harmful to your fetus.
      In addition, additional protective measures will be recommended and required in the hospital setting when health care workers care for patients with infectious diseases that are easily transmitted person to person.
      Many health care workers, including doctors, and pediatricians, have healthy pregnancies and babies during their medical training.
      Best wishes for a healthy pregnancy in the future.

      Dr Gail Demmler Harrison
      CMVDOC

  52. Anne Bate says:

    Hi Dr. Gail,
    I had CMV testing at 20 weeks pregnant and I was told my CMV Igm and Igg were normal levels but two weeks later Igm was elevated from 20 to 48 and Igg is normal level.I have normal fetal ultrasound at 20 weeks and at 25 weeks.What does my CMV test result mean?

    • Dr. Gail Demmler-Harrison, Infectious Diseases Dr. Gail Demmler-Harrison, Infectious Diseases says:

      Hello,
      I am happy to help but I am not sure what “normal” interpretation on the CMV tests means. Were they positive or negative? Normal is not a value or interpretation.
      All women should know about CMV and be aware of the recommended CMV precautions to reduce CMV risks during pregnancy.
      Also, your obstetrician should guide your prenatal care.
      Best wishes.
      Dr Gail Demmler Harrison
      CMVDOC

      • Anne Bate says:

        Hi Dr.Gail,
        Thank you for taking time responding.It is greatly appreciated.My first Cmv test results were- IGM negative,IGG positive(>10)then 2 weeks later another CMV test done and results were- IGM positive,IGG positive (>10).I had normal fetal ultrasound.My CMV PCR result showed not detected.Avidity test done and still waiting for the result.My questions are:
        1.does my Cmv test results show primary infection or recurrent infection?
        2.Do I need to have anmiocentecesis done?
        3.what is the chance that my baby is infected?
        Thanks so much..

  53. Annie OKeeffe says:

    Dear Dr Gail,
    Apologies for follow up email to earlier one this morning.
    Our referral for a 10 month old little girl from Vietnam shows IgG >250 and IgM negative (0.19).
    I forgot to mention her head circumference is 43cm (16.9 inches), weight is 7kgs (15.4llb) and height is 68cm (26 inches).

    I am a little concerned about her head circumference. She also had pneumonia at the time of her medical and is anaemic. Your advice on what we might expect if we accept this placent would be greatly appreciated.

    Many thanks in advance. Your blog is a Godsend.

    • Dr. Gail Demmler-Harrison, Infectious Diseases Dr. Gail Demmler-Harrison, Infectious Diseases says:

      A positive CMV IgG antibody and negative CMV IgM antibody at age 10 months means congenital CMV infection is possible, and probably likely, but does not, as you indicated, definitely prove a congenital CMV infection, since CMV is also transmitted perinatally through the birth canal or by breast feeding, and also sometimes by person to person, post natal transmission, although that form of transmission is usually in toddler age children who have become mobile and are able to interact actively with other toddlers and facilitate CMV transmission.
      Most congenital and perinatally acquired CMV infections are asymptomatic and do not cause any problems. However, if you think her head circumference is below the expected value for her age, then a simple non enhanced, CT scan of the brain may be in order, to identify possible causes, or to find Ca+ in brain. Also, I would recommend a thorough eye exam by a pediatric ophthalmologist for retinitis, optic nerve hypoplasia/eye/vision problems, and a full diagnostic ABR hearing test or at least a simple hearing screen, to identify senosrinueral hearing loss, which is common in congenital CMV infection.
      Is her muscle tone normal? Is her development normal so far? Is she meeting her expected milestones, trying to sit up, babbling, smiling, reaching for objects, etc.?
      Best wishes!

      I hope this information is helpful!
      Dr Gail Demmler Harrison
      CMVDOC

      • Annie O'Keeffe says:

        Dear Dr Gail,

        Thanks you so much for your really detailed and helpful reply. We greatly appreciate your advice and you taking the time to reply. With every good wish.
        Annie

  54. Maggie says:

    Dear Dr Gail,

    I already have a 2 year old who was an IVF baby and was tested for CMV at that time with the results coming back negative. Last week I was advised that I was 6 weeks pregnant which came as a huge shock since we didn’t think natural conception was possible for my husband and I.

    The reason I am writing is because about 2 weeks ago I had a moment with one of the child care workers at my daughters day care. We found ourselves in a romantic moment and there was a lot of heavy kissing involved but nothing else.

    I have been wracked with guilt about that moment ever since but now that I have found out I am pregnant I am even more worried in case I have put my new unborn child in harms way. I would like to know how common adult to adult transmission is. Especially through kissing, and especially kissing someone who works with children. Also, if I was infected how long do I need to wait to have a test to know?

    Very worried, Maggie

  55. Diana says:

    Dear Dr Gail,

    I am 8 week pregnant diagnosed with primary CMV last week (negative cmv 2 years ago, now positive IgM, positive IgG, low avidity), my doctor believes I got the infection 1 to 2 weeks before getting pregnant.

    My doctor is recommending that I wait until amniocentesis on week 20 to see if the baby has congenital CMV. I wanted to know if the cmv result for my baby comes negative on that test, if I can be at ease that the baby will not get congenital acv later in the pregnancy.

    Thank you for such a womderful and helpful blog.

    Diana

    • Dr. Gail Demmler-Harrison, Infectious Diseases Dr. Gail Demmler-Harrison, Infectious Diseases says:

      Thank you for your comment.
      The CMV serologies you indicate most likely represent a recent primary CMV infection, with about a 40% risk of CMV transmission to the fetus. So, good news perspective, most primary CMV infections during pregnancy do not transmit to the fetus.

      Most experts agree the best time for the most accurate time for predicting a congenital CMV infection at birth is to perform an amniocentesis is 20 weeks gestation. If the amniocentesis performed at 20 weeks geataion is negative, after a CMV infection documented early in pregnancy, then, yes, it should be re assuring that fetal CMV infection did not a occur, and will not occur later in pregnancy.

      However, to be absolutely sure, since the studies that show these correlations only include a few hundred women with similar circumstances, a CMV culture or CMV PCR on your baby’s urine should be done, for complete peace of mind. Also, of course your fetus should be closely monitored throughout your pregnancy.

      Best wishes.
      Dr Gail Demmler Harrison
      CMVDOC

  56. Holly says:

    Thank you so much for posting this blog. I’m currently pregnant with our second son. We have a 2 year old little boy, and last year suffered a miscarriage at 8 weeks pregnant. We were very excited to get pregnant again this time around. At 4 weeks pregnant my son did have a 2 day fever that didn’t appear to have any other symptoms. It was a heat wave in June so I thought maybe he was overheated. His pediatrician suspected roseola, but he never developed the rash that was suspected. His fever broke after those 2 days and he was fine. The pregnancy started out fine this time around, I did suffer from a pretty severe sinus infection at 9 weeks which I went on a 7 day antibiotic.

    At our 20 week ultrasound we learned our baby had an echogenic bowel. I am not a CF carrier, so we did the testing for CMV, toxoplasmosis, parvovirus, and did the verify maternity screen for Down’s syndrome, etc. The verify test came back negative, but I tested positive for CMV, but my doctors told me it was a very old infection due to my high antibody levels and they weren’t worried about a primary infection.

    I’ve been doing growth scans every 4 weeks, and at our 28 week ultrasound they found his brain ventricles were on the high end of normally dilated. They measured at 10mm. They now suspect a CMV reactivation, but what I’ve been reading the chances of that are so low. They also said his bowel was getting better, but that doesn’t mean he might not have CMV since the marker had already showed up. We will continue to do growth ultrasounds to check his growth and the ventricles. But I can’t help but worry myself sick.

    What are the chances this could be CMV reactivation, and if so would he be showing these 2 markers. I guess technically the brain ventricles are not considered a marker yet, but serious enough for them to mention it, since he already has the bowel marker.

    The doctors keep pushing an amino but I feel it’s too risky right now, because there’s still a chance he’s fine and I don’t want to risk preterm labor. Is is possible normal babies have echogenic bowel that seem to be resolving in addition to larger ventricles?

    Just looking for some reassurance

    Thank you!

  57. Erica says:

    Dear Dr. Gail,

    Your blog posts are really helpful so a big thanks for taking the time to do this. I lost a baby to congenital CMV a few months ago. Following ultrasound abnormalities seen at 16 weeks, the baby was diagnosed by CMV PCR amnio. I recently had a CMV IgG avidity test done to determine if my body is producing high avidity IgG as I would like to determine when it is safe to get pregnant again. The test came back negative so I will need to undergo some other tests. Are there reasons why neither low nor high CMV IgG avidity have been detected in my blood? Hoping for some insights.

    Thanks in advance for your input.

    Erica

  58. Paula Kay says:

    Dear Dr.Harrison,
    My name is Paula, I was just wondering if my full~term stillborn baby daughter’s Kimberly Danielle research paper work would be of help to you? She tested positive for cmv “286” from St.Johns Mercy, St.Louis Missouri. Kimberly was born 9~4~1991 When I deliver Kimmy that Sept. in St.Louis several Dr’s came to speak with us about Cmv in the area & they said Cmv was so high that year, they seen several stillborn cases that year alone! Some of them said it was turning into a large red flag, all of a sudden in St. Louis some of the highest numbers they had ever seen so far~ Please let us help with Kimmy’s info if you think it would help. Thank you for your research toward Cmv

    • Dr. Gail Demmler-Harrison, Infectious Diseases Dr. Gail Demmler-Harrison, Infectious Diseases says:

      Thank you for you post on my CMV blog. You may contact us on our website or by email to my assistant Cindy, who will email you to join our parent – to – parent support network and send us your child’s story and information.

      Dr Gail Demmler Harrison
      CMV DOC

  59. Carrah says:

    Dear Dr.Harrison, thank you for providing reliable CMV information. I am currently 20 weeks pregnant and not immune to CMV (tested very early pregnancy). I had my sons urine tested and he is shedding CMV. I have practised very strict hygiene – no food sharing, vigilant hand washing. My son has had a chest infection which I have now caught. I have read conflicting information as to whether CMV can spread through the air. I have not been able to avoid his coughs and sneezes and now that I am ill am distressed I may have caught it. Secondly is there any evidence that catching CMV later in pregnancy results in less severe disabilities? Thanks in advance.

  60. Carrah says:

    Dear Dr.Harrison, thank you for providing reliable CMV information. I am currently 20 weeks pregnant and not immune to CMV (tested very early pregnancy). I had my sons urine tested and he is shedding CMV. I have practised very strict hygiene – no food sharing, vigilant hand washing. My son has had a chest infection which I have now caught. I have read conflicting information as to whether CMV can spread through the air. I have not been able to avoid his coughs and sneezes and now that I am ill am distressed I may have caught it.

  61. Iagp says:

    Dear Dr. Gail,
    I’m so glad I found your post and thank you for sharing such important information. I’m from Spain and 18 weeks pregnant. At 10 weeks I got a TORCH test and the doctor said it was all ok except my platelets were a bit low and I should have a new blood test to follow this.
    We did not pay more attention to it and continue happy with out pregnancy until we had to change doctors and she told us this is something that needs to be checked further and if I continue having the IgM positive I should have an amnio. I’m freaking out because I had a mild flu when I was 3 weeks pregnant and I’m afraid it was CMV and my baby can be at risk.

    Test results 2/11/2015
    IgG = positive
    IgM = “weak” positive
    IgG avidity = high
    Platelets = 129 (normal is 150-450)

    Test results 2/12/2015
    IgG = positive
    IgM = “weak” positive
    Avidity test was not done
    Platelets= 149 (normal 150-450)
    Anti platelets antibodies= not detected (lower than 1:20)

    I have done another blood test on the 16/12/15 for IgM, IgG and avidity and I’m waiting for the results, but I do not see how they will turn “negative” for IgM only 2 weeks after the previous done on the 12/12.
    Could you please help me understand what does this “weak” positive means? On the results there are no numeric values, only words.
    Do you consider I should get an amnio if the result comes back positive again for IgM? What’s the actual risk of my baby being infected with these results?
    Should I seek advise from an infectious disease physician in Spain?

    • Iagp says:

      Hello doctor, I have now the results from the latest blood test done at 16 weeks. Could you please help me interpret all of these results?

      CMV IgG => 118 >14 U/ml positive
      CMV igM => 6,21 87% >40% high avidity

      Many thanks!!!

      • Dr. Gail Demmler-Harrison, Infectious Diseases Dr. Gail Demmler-Harrison, Infectious Diseases says:

        A positive CMV IgG antibody with a high CMV IgG avidity indicates a CMV infection occurred at least 4 months ago, possibly longer.
        I am not able to interpret the CMV IgM antibody level without an interpretation of the meaning of the value provided.
        I hope this is helpful.

        Best wishes.
        Dr Gail Demmler Harrison
        CMVDOC

    • Dr. Gail Demmler-Harrison, Infectious Diseases Dr. Gail Demmler-Harrison, Infectious Diseases says:

      A positive CMV IgG and CMV IgM antibody with a high avidity index indicates a CMV infection occurred prior to 16 weeks ago—it is possible you experienced a primary CMV infection during or just before this pregnancy, but it is difficult to tell for sure.

      Only approximately 40% of primary CMV infections will transmit to the fetus. Only approximately < 1`% of previous/recurrent CMV infections will transmit to the fetus. So optimistically speaking, most of the time, CMV transmission does not occur.

      A low platelet count is associated with CMV infections, but also many other conditions, so it is difficult to tell for sure it is caused by CMV in your case.

      By TORCH tests "OK" what did that mean? Were CMV IgG antibodies negative or positive at that time?

      A fetal ultrasound should be performed regularly to assess placental size and fetal well-being. If something is not normal, then further investigations should be done for CMV in utero and other conditions.

      However, if the fetal ultrasound is normal, then an amniocentesis to determine if CMV in utero is present is likely not going to change management of your pregnancy, and since it carries some fetal risk, and it is not clear how it would change management of your pregnancy, your doctors may not wish to do the procedure.

      Since you are already with high CMV avidity index and a normal fetal ultrasound, focus on wellness and careful fetal monitoring.

      Also test your baby at birth, or within the first 21 days of life, for congenital CMV with a CMV urine test by using methods of CMV culture or CMV PCR. If negative, CMV transmission did not occur. If positive, then your baby may need further evaluations or treatment if disease is present.

      A second opinion from a maternal fetal medicine specialist or a infectious diseases specialist may be in order to make sure all your concerns are addressed and all management options have been explored.
      There is also a CMV group on social media in Spain that may be of help.

      I hope this information is helpful.
      Dr Gail Demmler Harrison
      CMV DOC

      • Iagp says:

        Thanks for your reply Dr. Gail. On my 10th week of pregnancy when TORCH was done, the CMV results where IgM= weak positive, IgG= Positive and IgG avidity = High. The ones at 16 weeks are the same, but the IgM has now turned to “Negative”, the avidity continues being “High” with an 87%. I’m 20 weeks pregnant now and my doctor suggest the infection most probably occurred before I got pregnant. What do you think?

    • Dr. Gail Demmler-Harrison, Infectious Diseases Dr. Gail Demmler-Harrison, Infectious Diseases says:

      A positive CMV IgG and CMV IgM antibody with a high avidity index indicate a CMV infection occurred prior to 16 weeks ago—it is possible you experienced a primary CMV infection during or just before this pregnancy, but it is difficult to tell for sure.
      Only approximately 40% of primary CMV infections will transmit to the fetus. Only approximately < 1`% of previous/recurrent CMV infections will transmit to the fetus. So optimistically speaking, most of the time, CMV transmission does not occur.
      A low platelet count is associated with CMV infections, but also many other conditions, so it is difficult to tell for sure it is caused by CMV in your case.
      By TORCH tests "OK" what did that mean? Were CMV IgG antibodies negative or positive at that time?

      A fetal ultrasound should be performed regularly to assess placental size/ and fetal well being. If something is not normal, then further investigations should be done for CMV in utero and other conditions.
      However, if the fetal ultrasound is normal, then an amniocentesis to determine if CMV in utero is present is likely not going to change management of your pregnancy, and since it carries some fetal risk, and it is not clear how it would change management of your pregnancy, your doctors may not wish to do the procedure.
      Since you are already with high CMV avidity index and a normal fetal ultrasound, focus on wellness, and careful fetal monitoring.
      Also test your baby at birth, or within the first 21 days of life, for congenital CMV with a CMV urine test by using methods of CMV culture or CMV PCR. If negative, CMV transmission did not occur. If positive, then your baby may need further evaluations or treatment if disease is present.

      A second opinion from a maternal fetal medicine specialist or a infectious diseases specialist may be in order to make sure all your concerns are addressed and all management options have been explored.
      There is also a CMV group on social media in Spain that may be of help.

      I hope this information is helpful.
      Dr Gail Demmler Harrison
      CMV DOC

  62. li-N says:

    Hi Dr. Gail
    I was wondering if you can get cmv from dry spit or urine? If i have touched someone who is infected with cmv and they had dry body fluids such as saliva or urine and then touched my month/nose/eyes (if i have never had cmv before)?

    Thanks

    • Dr. Gail Demmler-Harrison, Infectious Diseases Dr. Gail Demmler-Harrison, Infectious Diseases says:

      CMV is most often transmitted from close intimate contact with bodily fluids, such as kissing or sharing food. drink or utensils, directly between individuals. CMV will not “survive” for very long outside of the body on surfaces, and is usually not recoverable or transmissible if the bodily secretions have dried. It also is not “airborne”. Therefore the risk is very very low to nil for transmission from touching dried body secretions.

      I hope this information is helpful. Please review the recommended CMV precautions if you are pregnant and CMV seronegative, to reduce risks for CMV transmission during pregnancy and consult your doctor if you have concerns.
      Best wishes.
      Dr Gail Demmler Harrison
      CMV DOC

    • Dr. Gail Demmler-Harrison, Infectious Diseases Dr. Gail Demmler-Harrison, Infectious Diseases says:

      CMV is most often transmitted from close intimate contact with bodily fluids, such as kissing or sharing food or drink or utensils, directly between individuals. CMV will not “survive” for very long outside of the body on surfaces, and is usually not recoverable or transmissible if the bodily secretions have dried. It also is not “airborne”. Therefore the risk is very very low to nil for transmission from touching dried body secretions.
      I hope this information is helpful. Please review the recommended CMV precautions if you are pregnant and CMV seronegative, to reduce risks for CMV transmission during pregnancy, and consult your doctor if you have concerns.
      Best wishes.
      Dr Gail Demmler Harrison
      CMV DOC

  63. L says:

    I’m currently 21 weeks along, and I have a two-year old daughter. A couple of weeks ago, I tested just barely positive for CMV IgM (1.2 with 1.0 being considered positive), with negative CMV IgG. We repeated the tests a week later and sent out to two different labs– one lab came back with everything negative (IgM, IgG, and viral load by PCR all negative) and the other lab had CMV IgG and viral load negative but again a just barely positive CMV IgM. The fetus shows no sign of anything by ultrasound at this point. The current plan is to repeat all tests again in two more weeks.

    Have you seen elevated “background” levels of IgM like this, in the absence of any IgG or viral load? I’m pretty confused as to what is going on.
    Thank you so much.

    • Dr. Gail Demmler-Harrison, Infectious Diseases Dr. Gail Demmler-Harrison, Infectious Diseases says:

      The CMV test results are most consistent with a false positive or cross-reactive CMV IgM result. It occurs rather commonly and may be transient or persistent. It also may be lab dependent.
      A true primary CMV infection in a normal healthy individual produces both CMV IgG and IgM responses close in time together.
      I hope this information us helpful,

      Best wishes for a healthy pregnancy.
      Dr Gail Demmler Harrison
      CMV DOC

      • L says:

        Thank you, Dr. Demmler Harrison. A false-positive or cross-reactive result is exactly what my doctors and I have been hoping for. We’ll repeat the tests soon as planned, but knowing that you’ve seen these sorts of results as false positives before will help me get through the wait of the next couple of weeks with less anxiety. Thanks again for this blog and all the information you are getting out there about CMV.

  64. Erica says:

    Dear Dr. Harrison,
    Can you recommend a CMV Infectious Disease Specialist in the San Francisco area?
    Thanks,
    Erica

  65. Nicole says:

    Dear Doctor Gail Demmler-Harrison,

    On my 20 week US the doctors discovered an echogenic bowel and did all the appropriate bloodwork. My CMV bloodwork came back as follows:

    IGG – Positive
    IGM – Negative
    Avidity – Low .26

    Obviously the low avidity is concerning, however the fetal medicine doctor seemed to think that it was a past infection because I was IGM negative, even though the avidity is low. We had an amnio done and the results were negative for CMV. My questions are:

    Can you be IGM negative and have low avidity and not have a primary infection?
    How sensitive are the amnio tests?
    I am of course concerned that I had a false negative. We had a repeat US and the baby is measuring in the 51 percentile and the echogenic bowel seems to be improving.

    Thank you.

  66. Nicole says:

    Hello,

    I was hoping you could answer a few questions for me. At my 20 week US the doctors discovered an echogenic bowel. They did all the appropriate bloodwork and my CMV results were as follows:

    IGG – Positive
    IGM – Negative
    Avidity – Low .26

    The fetal medicine doctor did not seem concerned about the low avidity since I did not have any IGM antibodies. However I am still concerned. We also did an amnio which came back negative for CMV. The follow up US showed that the echogenic bowel is disappearing. My questions are:

    – Should the low avidity be concerning if there isn’t IGM antibodies?
    – Doesn’t low avidity mean a recent primary infection? It doesn’t match with a negative IGM then.
    – The amnio was done at 21.5 weeks…could there be a false negative?

    Thank you.

    • Dr. Gail Demmler-Harrison, Infectious Diseases Dr. Gail Demmler-Harrison, Infectious Diseases says:

      Fetal echogenic bowel is associated with congenital CMV infection in utero, but also may be associated with other anomalies.
      A positive CMV IgG antibody with a negative CMV IgM antibody and a low CMV avidity IgG index is unusual. Most of the time an avidity index IgG is done to help time the CMV infection within 4 months in a woman who has both CMV IgG and IgM positive. Some women will quickly resolve CMV IgM antibody within 2-12 weeks, but most will last longer. It is difficult to tell what is the situation with your test results. You are correct, they do not make sense in the usual way. Some labs differ in their CMV IgG avidity methods.
      An amniocentesis performed at 20+ weeks is generally reliable with very very low false negative rates, compared to results at birth.
      No test is perfect however.
      Your fetus should be watched carefully with serial fetal ultrasounds, and also tested at birth for congenital CMV by testing urine or saliva for CMV DNA or CMV culture, just to be sure.

      I hope this information is helpful.

      Dr Gail Demmler Harrison
      CMVDOC

  67. KM says:

    Hi

    I am planning a pregnancy and already have a toddler. All the cmv advice talks about washing your hands which I do. But the other day I had to remove some wet trousers from my daughter after she wet herself. I then washed my hands but realised that I had scratched my finger on a door about 15 minutes before. Can you get cmv through broken skin? Would the wet trousers still be contagious after a 10 minute walk home in the cold?

    Thanks

    • Dr. Gail Demmler-Harrison, Infectious Diseases Dr. Gail Demmler-Harrison, Infectious Diseases says:

      I am glad to hear you are CMV aware and are practicing CMV precautions to reduce your risk of CMV transmission during pregnancy planning.

      The scenario you provided carries nil risk of CMV transmission. Washing hands is all that is required. CMV does not stay “viable” on surfaces for very long, and a small scratch on your hand does not enhance your risk of CMV transmission.

      It is also important to remember, not only hand washing after contact with urine, but also avoid kissing or sharing food or drink and washing hands after wiping runny noses is important, since CMV is in both urine and saliva an d nasal secretions.

      Best wishes,
      Dr Gail Demmler Harrison
      CMVDOC

  68. A Concerned Parent says:

    Dear Dr Gail, thanks for the many informative responses.

    The cord blood collected at the point of my daughter’s birth tested reactive for CMV ( IgG positive at 76. Non-reactive levels are less than 6 AU/mL). The advice given then was that it was nothing to be concerned about since it reflected a previous infection which is common across the population.

    Out of curiosity, we followed up with a CMV screening on our daughter 3 months after she was born. The doctor did a urine test (DNA extraction. PCR) and the result showed positive (2.4E+05 copies/mL urine. Negative/Borderline results are benchmarked at 120 copies/mL urine). We were pretty surprised with the positive result.

    My daughter is a full term baby and no abnormalities were detected during screenings during pregnancy. From birth, she was breast fed by direct latch. She is 18 months now, and hitting all her development milestones. Consultation with the eye and ear doctors at 18 months showed no abnomalies. I also work in a low risk job which does not require me to come into contact with kids’ secretions. This is also my first child.

    We have the following questions:

    1. Based on this information, is it possible to deduce whether her CMV was acquired congenitally or perinatally?

    2. If it is not possible to deduce, what is the likelihood that it is caused by congenital factors?

    3. Are there any further meaningful tests that could be done at this point to ascertain with certainty if it is congenital or perinatal?

    4. Should we be concerned on any follow-on CMV effects on my daughter? If yes, what are the specific tests to monitor the well being of my daughter?

    5. Is it safe for me to have a second child?

    6. Any further advice that you may have?

    Thank you for your time, and I wish you well.

    • Dr. Gail Demmler-Harrison, Infectious Diseases Dr. Gail Demmler-Harrison, Infectious Diseases says:

      1. It will be difficult because the time to detect and diagnose congenital infection is at birth within the first three weeks of life and the first CMV urine test done was at 3 months, past this diagnostic window. Babies with congenital CMV will shed CMV in their urine and saliva for years.Perinatal CMV infection from delivery or breast feedings is normal and natural and occurs in at least 1/3 of CMV seropositive mothers. Babies with perinatal CMV will shed CMV in their urine and saliva also for a period of time. If the first CMV test is done at 3 months, it is not possible to determine form that one test which type of CMV infection is present.

      2. 0.5% to 1% of all newborns are congenitally infected with CMV and most are without symptoms and have no problems. So it is possible.

      3.Retrieve the newborn dried blood spot Guthrie card, if you can, and ask a reliable lab to do a CMV DNa PCR on the available spots. If positive, then congenital CMV infection was present, if negative, it is less likely, but false negatives do occur.

      4. If your daughter is doing well then no tests are really needed. For peace of mind, you may wish to formally test her hearing. If her newborn dried blood spot is positive for CMV, then definitely regular hearing evaluations are indicated.

      5. Yes, of course.

      6. If you have “CMV awareness” on your mind now, then consider testing your next child AT BIRTH with a simple urine CMV test to determine for sure if congenital CMV infection is present.

      I hope this information is helpful. Best wishes.
      Dr Gail Demmler Harrison
      CMVDOC

  69. Jackie says:

    Thank you for posting the blog Dr Gail. I had no idea this was a risk to pregnancy until I was sent to a high risk ob because of the echogentic bowels at 20 weeks. I am 23 weeks now and I ended up opting to doing the amino, which showed positive to CMV to the baby, I am heartbroken something so serious is happening and I had no idea anything about it previously. The blood results came back igg positive and igm negative, the Dr told me most likely the infection happened during the first trimester. Showing the bowels and being positive on the amnio does this mean she will have health issues going forward or are there still chances she can live a healthy life and is there anything we can do to stop further harm? Thank you

    • Jackie says:

      Also the amnio that was done did have a very little bit blood mixed in it, would that affect the virus amnio test or put the baby at greater risk?

      • Dr. Gail Demmler-Harrison, Infectious Diseases Dr. Gail Demmler-Harrison, Infectious Diseases says:

        Please ask your doctor about your specific questions regarding your amniocentesis and your fetus, as your doctor is the health care professional who knows your case the best.

        However, in general, It is common for the amniotic fluid obtained by amniocentesis to sometimes have blood tinge to it. It is possible, but not very likely the blood mixed in the amniotic fluid may affect the test, but not to a significant degree, since a fetus congenitally infected with CMV in utero will shed very large quantities of CMV in to the amniotic fluid, whereas a small amount of blood tinge may not have much if any at all active CMV virus at the time of testing.

        I hope this information is helpful to you.
        Dr Gail Demmler Harrison
        CMV DOC

  70. LI-N says:

    Hi Dr Gail
    I read about CMV that “Transmission can occur during any close contact that allows the transfer of infected body fluids. Most commonly the virus is spread in respiratory droplets when coughing or sneezing” Most of the places says that CMV is not airborne at that article its says could be transmitted through coughing or sneezing. I wanted to know what are the odds for a transmission to happen that way? could it be transmitted from someone sneezing or coughing sitting in the same room or the same car?

    • Dr. Gail Demmler-Harrison, Infectious Diseases Dr. Gail Demmler-Harrison, Infectious Diseases says:

      CMV is transmitted through close direct contact with saliva or nasal secretions or less commonly through contact with urine or genital secretions. If a young child or other actively CMV infected person directly sneezes on a person then transmission is possible. CMV does not however survive very long outside the body or on surfaces. It is not spread by droplets in the air across the room like measles or chickenpox.
      I hope this information is helpful. Best wishes.
      Dr Gail Demmler Harrison
      CMV DOC

      • li-N says:

        Thank you for the answer. I have another quetion. It says that children can shed cmv for prolong time. My son who is now 2 and a half years old had cmv blood results in september 2014 with igg 175.6 and igm negetive. Now i am 20 weeks and I have been negetive to cmv till now (checking every month). Can it be possible he is still sheding cmv. He was sneezing the other day in my face and some of his spit came into my mouth.

        • Dr. Gail Demmler-Harrison, Infectious Diseases Dr. Gail Demmler-Harrison, Infectious Diseases says:

          CMV shedding from urine and saliva may last many months to years. For a child who is congenitally infected, the usual time to continuously shed CMV is at least 1-3 years routinely, and some even longer until school age. For acquired CMV infection in toddlers who catch the virus, say in day care or group settings, the usual time for CMV shedding is a little over a year.
          I hope this is helpful information.
          Dr Gail Demmler Harrison CMVDOC

          • li-N says:

            Thank you again. One more question. How long does it take to detect and show up on blood test from contagion?

          • Dr. Gail Demmler-Harrison, Infectious Diseases Dr. Gail Demmler-Harrison, Infectious Diseases says:

            The incubation period for CMV transmission between people, through contact with saliva or urine or other body secretions, is usually estimated to be around 2-3 months, sometimes shorter, or longer. The incubation period for CMV transmission from blood products or organ transplantation is usually much shorter, around 2 weeks. These are only estimates.

  71. Allie says:

    Hi Dr. Gail,

    How long does CMV stay on surfaces? I’m CMV negative and acting like my daughter is CMV positive – taking precautions, etc. I just wonder if she puts her slobbery hands on doorknobs and TV remotes, etc. how long does it stay there? What are the risks of me then picking up a TV remote thirty minutes later and then wiping my eye? Just curious how cautious I need to be and how often I need to wipe things down since I’m in contact with everything she is in contact with. Thank you.

    • Dr. Gail Demmler-Harrison, Infectious Diseases Dr. Gail Demmler-Harrison, Infectious Diseases says:

      Hello Allie,

      Thank you for your comment on my post about CMV.

      CMV is a large enveloped DNA virus with a “smushy outer layer” that does not survive well outside the body. It does not survive long on surfaces outside the body. Therefore, the scenarios you provided are a low to nil risk for CMV transmission. You may wish to periodically wipe off, with disinfectant wipes, the household items and their surfaces your daughter puts in her mouth and drools upon, for CMV and also for other health reasons. The residual disinfectant that dries on the surfaces may also reduce chances the virus survives on the surface.

      Continue CMV precautions, because direct contact with saliva by kissing, sharing food and drink and utensil, is the most often mode of transmission from toddler to mom.

      I hope this information is helpful.
      Best wishes for a healthy pregnancy.
      Take care,

      Dr Gail Demmler Harrison
      CMV DOC

  72. Allie says:

    Hi Dr Gail,
    I have one more question for you. How quickly do CMV antibodies show up on a CMV blood test after an exposure to CMV? Does it take a week to show up or months? Thank you.

    • Dr. Gail Demmler-Harrison, Infectious Diseases Dr. Gail Demmler-Harrison, Infectious Diseases says:

      CMV IgG and IgM antibodies may show up as soon as two weeks after exposure, especially if the exposure was from blood transfusions, and up to 3 to 4 months in a person to person exposure, or other exposures such as newborns with breast milk associated CMV infection. Very variable.
      Dr Gail Demmler Harrison
      CMVDOC

      • Allie says:

        Thank you for your response. When does a person become contagious then? Is it only once the person has a positive CMV test (which could be 3-4 months after exposure)?

        I tested negative a few weeks ago, and I’m getting my daughter tested this week because she was in contact with a little girl with CMV about 6 weeks ago and I’m trying to get pregnant. If she tests negative can I assume she is not contagious?

        Thank you.

  73. Amy says:

    Hi Doctor ,

    Thank you for educating us all with such valuable information. I currently am 6 weeks pregnant and worried because I was tested with my first pregnancy and am CMV negative. My son is 15 months old and in daycare, sick all the time. I still am nursing him at night. My question is if it would be possible to contract CMV from nursing him if he is shedding the virus? I am following all other precautions you have mentioned, and I hopefully will be able to get an OB appt soon and plan on asking to be retested for antibodies. Do you know of any cases where cmv was transmitted from baby to nursing mother?

    Thank you so much for your advice and help!

    Amy

    • Dr. Gail Demmler-Harrison, Infectious Diseases Dr. Gail Demmler-Harrison, Infectious Diseases says:

      CMV is not transmitted to the nursing mother from the nursing infant/toddler retrograde through breast feeding. CMV is commonly transmitted from the nursing mother to the nursing infant/toddler however and it a normal natural way to transmit CMV without consequences to the infant/toddler. You should perhaps wash your hands carefully if any body secretions such as drool or runny nose form your toddler gets on your hands. Other than that, continue to breast feed your toddler, while observing all the usually recommended tips and precautions provided to reduce transmission from toddler to pregnant mom.
      I hope this information is helpful.
      Best wishes,
      Dr Gail Demmler Harrison
      CMVDOC

  74. esther says:

    Hello,

    I was CMV positive (primary infection) at the beginning of pregnancy. a detailed ultrasound during pregnancy showed a large difference in size of the two ventricles in the brain. a urine test for the baby immediately after birth was negative for CMV. but a one month ultrasound of the brain showed the same asymmetry also some calcification. my pediatrician said that even if the virus was not present at birth, the baby still could have been infected in utero, and just shed it off before birth, making the test negative. is this possible? i can’t find any sources online that mention this… thank you for any insights…

    • Dr. Gail Demmler-Harrison, Infectious Diseases Dr. Gail Demmler-Harrison, Infectious Diseases says:

      Babies who are born with congenital CMV and therefore also infected in utero as a fetus, will shed CMV in their urine for years. The situation your describe is not known to happen. A negative CMV urine test at birth, tested by a reliable laboratory, using a reliable test, performed in the first 21 days of life, excludes congenital CMV. Perhaps other causes for your baby’s asymmetric ventricles should be evaluated?

      Dr Gail Demmler Harrison
      CMVDOC

  75. Christianna says:

    Thank you for your article and continued support for this community as well as raising awareness. I have been a teacher of the Deaf and Hard of Hearing for the past 7 years, and I have always been under the impression that I should avoid children with a CMV diagnosis while I was pregnant, however, i knew I had been working with children with this infection since my first year of my profession! I couldn’t believe that it wasn’t until after I became pregnant that I learned I could already have the infection. I could have kicked myself for not getting testing until after conceiving. At my 8 week ultrasound, I requested a CMV blood test. At 10 weeks, I was told it came back positive with IgG antibodies, but no IgM antibodies. The nurse informed me that this would mean I did not have the infection within 2 weeks of the test, but cannot say much about when I was infected before that point. They scheduled me for am amnio, but not until I am 16 weeks pregnant. My questions are:

    1. Can the level of IgG antibodies tell how recent the infection was?
    2. Should I be doing follow up blood work to determine change in levels of IgG antibodies?
    3. What are the odds that I was already infected? The odds that it will infect my baby?
    4. What will be the validity of the amniocentesis?

    I appreciate any input you can give!

    • Dr. Gail Demmler-Harrison, Infectious Diseases Dr. Gail Demmler-Harrison, Infectious Diseases says:

      CMV IgG antibody remains for life and the level of the titer positive does not predict the timing for most patients CMV IgM antibody remains positive longer than other infections, after a first or primary infection, usually for 4 to 6 months ( not just 2 weeks like many infections , although it can range from a few weeks to up to a year). CMV IgM antibody may also rise slightly during a recurrent CMV infection as well, from reactivation or reinfection, but usually not as high as with a primary or first CMV infection.
      In most people, CMV IgG and CMV IgM antibody will rise at the same time or within days to a week of each other. If they do not rise together, then the IgM rises first and the IgG follows, not the other way around.
      A repeat of your CMV IgG or CMV IgM serology therefore is not likely to provide any further information on the timing of your CMV infection.
      You most likely acquired CMV infection at least 4 months ago probably longer, but it is difficult to tell.

      An amniocentesis will provide information about CMV transmission to the baby and CMV in utero infection of your baby. In a primary CMV infection the risk is 40% transmission, for an old infection, the risk of a recurrent infection getting to the baby is very low < 0.1%. Amniocentesis is most accurate when done after 20 weeks gestation when compared to predicting CMV infection in the newborn. However most of those data are in women who experienced a primary CMV infection, not an older CMV infection.

      I hope this information is helpful.
      Best wishes.
      Dr Gail Demmler Harrison
      CMVDOC

  76. Allie says:

    Hi there,
    How likely is it to acquire cmv infection from fecal matter if I handled soiled clothing and have a small (bad paper cut) cut in my finger? I have been practicing precautions, but this happened and I’m so nervous! I’m very early in my pregnancy and my toddler daughter has CMV. Thank you for your guidance.

  77. Aafreen says:

    Hello doctor.. I am a 27 year old Indian ..I had a stillbirth in 36th week..all of a sudden the baby’s heart stopped.. A month
    Ago..then I went for torch test it shows my cmv IgG- 5.0
    and HSV1 and 2 igG- 0.42..I am really scared about my future
    Pregnancy… Plzz do reply.

    • Dr. Gail Demmler-Harrison, Infectious Diseases Dr. Gail Demmler-Harrison, Infectious Diseases says:

      I am so sorry for your loss. Please accept my condolences on the loss of you baby.
      A positive IgG titer for CMV does not mean CMV was the cause of your child’s in utero demise due to a fatal heart arrhythmia. CMV IgG antibody is common, and most people will have CMV IgG antibody from a prior old CMV infection. Please consult a maternal fetal high risk doctor who can help explain the causes for your baby’s utero demise from a heart arrhythmia. There are potentially many causes that should be investigated.

      Best wishes for you.

      Dr Gail Demmler Harrison
      CMVDOC

  78. Lauren says:

    Hi Dr. Demmler Harrison,
    Thank you for your blog and for taking the time to respond to comments and questions. I have learned a lot from reading it. I am currently pregnant with my third child and I have two daughters who are age 4 and age 17 months. I was tested for CMV during my last pregnancy and tested negative, and I have not been retested during this pregnancy so I am acting as though I am still negative and taking appropriate precautions. I am being careful to follow the precautions, but I had an unusual incident take place that I am concerned about. As I was rinsing the food out of my daughters’ dishes after they ate and preparing to put them in the dishwasher, water splashed up directly into my eye. I guess it was because I was filling the dish with water to get the stuck-on food out and scraping the food out at the same time. Is this a possible means of CMV exposure? A similar thing has happened to me before when rinsing their dishes, but it wasn’t directly in my eye like it was this time, so I am really concerned. Thank you for any help you can provide!

  79. Cicely says:

    Hi Dr. Gail Demmler-Harrison,
    Could you tell me which type of disinfectant wipes are effective to use around the house to kill CMV on surfaces? I’ve contacted Clorox and Lysol and both say they are not able to claim that they kill CMV, but when I do research on envelope viruses such as CMV, everything I find says it requires low level disinfectant. I found Clorox Healthcare hydrogen peroxide wipes that claim to kill CMV. Just curious to know what you would say should work. I’m pregnant and have a toddler with CMV. Thank you!

    • Dr. Gail Demmler-Harrison, Infectious Diseases Dr. Gail Demmler-Harrison, Infectious Diseases says:

      Hello,

      All of the antiseptic surface wipes available should readily kill CMV on surfaces, since it is an enveloped virus and not able to survive outside of the body very long .The envelope of the virus, which it uses to attach to living cells, is very vulnerable to being dissolved by detergents and disinfectants. So even though they have all not been systematically studied, I would assume all of the wipes available for surface cleaning have the ability to remove by physical action of wiping the surface and to in activate CMV through disinfection on surfaces.

      Dr Gail Demmler Harrison
      CMVDOC

  80. Donna S says:

    Dear Doctor Harrison,

    At 17 weeks gestation my perinatologist found slightly echogenic bowel on ultrasound. He reccomeended that I do a, CF carrier test and torch titer for toxoplasmosis and CMV. I have 3 children and also work in healthcare so I assumed that I had already been exposed to those viruses. At 27 weeks I found out that my torch titer came back positive for CMV IgM and negative for IgG. I was completely shocked! I have been asymptomatic throughout pregnancy. Currently the baby also has a calcification on it’s liver but no other abnormalities and the echogenic bowel seems to be resolving. I talked with the doctor about therapeutic interventions such has CMV hyper immunoglobulins and he stated that although initial studies suggested benefit, followup studies have not shown benefit and the the Society for Maternal-Fetal medicine does not recommend any specific therapy. Right now I am taking valcclovir 2g 4xs daily to hopefully reduce my viral load. Our current plan is to monitor the baby via US for any tissue injury and repeat the titers
    My questions:
    1.) Does my negative IgG mean the infection is very new?
    2.) I was planning on delivering my baby at a free standing birth center. Should I deliver at a hospital?
    3.) My Nurse midwife recommends that I DO NOT breastfeed, this recommendation seems dated unless the baby is early or of low birth weight.
    4.) Should my children be tested for CMV? Am I a danger to be around pregnant women and infants?
    I am terrified right now I appreciate any extra information or advice you could give me.
    Warmly,
    D.S.

  81. sarah cameron says:

    Dear Dr
    I have never had CMV before (found out via blood test) and already have 3 young children under 6. My husband and I would love another child and I was about to undergo IVF with a frozen embryo but I have cancelled it due to the returning high anxiety I had in my last pregnancy when I was so worried about catching CMV. It was unbearable anxiety and my family are concerned that the same anxiety in another pregnancy would be too much of a stress on me, the baby and the rest of my family. I am thinking that I could make a real effort to try and contract CMV at the toddler groups/nursery where my children go; by drinking out of all the children’s cups after snack time, for example. Then I would get tested in a few months time and if I was positive then wait a year before trying to get pregnant again. Is this a feasible and sensible plan? I know my and my family’s life would be so much calmer if I didn’t have the stress of potentially catching CMV. THANK YOU

  82. sarah cameron says:

    Dear Dr Gail,
    I just wanted to also say how wonderful I think this site is. So much helpful information and I hope that with your and other people’s hard work, CMV will soon no longer be a concern for pregnant mothers. Thank you, Sarah

  83. sarah cameron says:

    Dear Dr Gail
    Sorry to bother you. Another question. My 2 year old went to the toilet in the swimming pool wearing just her tights. They got wet from the puddle of water by the toilet ( I have no idea whether this was pool water or mixed with urine as lots of children use it for lessons). While I washed my hands after using the toilet I then had to pick up the wet tights and carry them to the car. I then scratched my eye ball with my finger nail while itching my eye. Would the chlorine in the water kill the CMV immediately even if high concentration of urine in the puddle? If my finger nail was dry can it still transmit the virus?
    THANK YOU FOR ALL YOUR ADVISE . Such an anxious time being pregnant with no immunity to CMV and little children around.
    Best wishes, Sarah

    • Dr. Gail Demmler-Harrison, Infectious Diseases Dr. Gail Demmler-Harrison, Infectious Diseases says:

      Dear Sarah,
      The likelihood of CMV transmission occurring from this event is exceedingly low to nil-zero. CMV will not survive being outside the body in the environment to be transmitted. CMV transmission most often occurs with touching or contact directly between two mucous membrane surfaces.

      I hope this is helpful.
      Best wishes.
      Dr Gail Demmler Harrison
      CMVDOC

      • sarah cameron says:

        Dear Dr Gail
        Thank you for your reply. It calms me to know CMV will not survive outside to body enough to be transmitted. I long to get pregnant, but with 3 little children under 6 I am so worried I might catch CMV and therefore wonder whether it is too risky (blood tests show I have never had it before). I know the basic precautions to take, but what if a child sneezes over me, or puts their fingers in my mouth after sucking them, or blows a raspberry in my face? Are one-offs like this ok; i.e. will they not transmit? I hate to be so stand-offish to me children incase of catching it and it seems so unfair on them.
        THANK YOU SO MUCH FOR YOUR ADVISE. It means to much to hear a professional option.
        Best wishes
        Sarah

  84. Michelle says:

    Hi Dr. Gail Demmler Harrison,

    I have a few questions regarding CMV.

    Is it safe for a pregnant woman who is not immune to CMV to go swimming with a toddler in a public baby pool? I recently found out that baby swimming diapers do not contain urine. With a high concentration of babies in a pool and lots of splashing that goes into eyes/mouth pretty easily, is it safe for a pregnant woman who is not immune to CMV to participate? I would rather remain cautious and make all sacrifices necessary, but do not want to be silly.

    if a toddler is IGG positive – no IGM – at two years of age (possibly still shedding the virus), would he/she shed the virus more (or start to shed the virus again) if he/she comes into contact with another strain of CMV? How likely is it that a toddler with IGG will come into contact with another strain in a daycare/camp/preschool type setting and then shed that new strain?

    Thank you for your time and help!

    • Dr. Gail Demmler-Harrison, Infectious Diseases Dr. Gail Demmler-Harrison, Infectious Diseases says:

      The risk of acquiring CMV form a public swimming pool has never been studied. It is not likely to be high, especially if the grown woman does not get water in her mouth. Also, the pool chlorination system should inactive most if not all CMVs in the water.
      A toddler who is CMV IgG positive may actively shed CMV at any time, most often for a year after fist acquiring it and then sporadically from his/her own strain and also possibly from a reinfection strain. A pregnant woman who wishes to practice precautions against CMV transmission while she is pregnant should assume ALL toddlers may be actively shedding CMV in their saliva and urine.

      Best wishes.
      Dr Gail Demmler Harrison
      CMVDOC

  85. sarah cameron says:

    Sorry Dr Gail
    One more quick question. If a surface which has had saliva or urine on it, eg a toilet seat, is dry and then touched, will the CMV still be transmissible? I feel your last reply suggests that the surface still has to be wet to be transmissible, is that right?
    Best wishes

    Sarah

    • Dr. Gail Demmler-Harrison, Infectious Diseases Dr. Gail Demmler-Harrison, Infectious Diseases says:

      Yes, in general, it is felt that the secretion must be moist for CMV to be transmitted – there are a few reports of CMV in secretions being recovered in a laboratory research setting, after a few minutes of being on a surface. The degree of wetness/dryness was not specified in the studies. And transmission to another person was not attempted in these studies. We assume CMV viruses are not transmissible if in dry secretions because the outer envelope of the virus, which is necessary for attachment to a new cell, is destroyed by drying. Transmission of CMV via a toilet seat has not been documented in any realm of current knowledge.

  86. Emily T. says:

    Hi Dr. Harrison,

    Thank you for this post and your advocacy for this virus. I am currently 15 weeks pregnant and asked my doctor to get tested for CMV since my pregnant sister was diagnosed with a primary CMV infection in her pregnancy. At 6 weeks my CMV IgG result was 5.1 and IgM was 2.53. Originally, my doctor told me that my numbers indicated that I had be exposed to CMV but that I was immune. However, weeks later she said that may not be the case due to the fact that one can be reinfected.

    All this to say, I am wondering in your experience, with results like mine at this current stage in pregnancy, what have you seen happen and how would you suggest I proceed in my pregnancy? Whether that be an amniothentisis or further testing?

    Thank you so much,
    Emily T.

  87. Jen says:

    I had cmv 5 years ago, we are now trying to get pregnant, should I be concerned about my prior positive results?

    • Dr. Gail Demmler-Harrison, Infectious Diseases Dr. Gail Demmler-Harrison, Infectious Diseases says:

      A positive cmv antibody from a long past infection is not a significant risk to an upcoming pregnancy.
      I hope this is helpful to you.

      Best wishes!
      Dr Gail Demmler Harrison
      CMV DOC

  88. Joseph says:

    Is it ok to continue a baby if IgG and IgM both are positive tested after 7 weeks of pregnancy?
    Or abortion?

    • Dr. Gail Demmler-Harrison, Infectious Diseases Dr. Gail Demmler-Harrison, Infectious Diseases says:

      A positive cmv igg and igm may mean a recent cmv infection in the mother but it does not mean the baby is cmv infected or cmv affected with cmv disease because most of time cmv will not be passed from mother to baby (only 40%) and many most cmv infection are not severe and is not an indication by itself for a pregnancy termination from most experts so please consult your doctor to follow your fetus health carefully for evidence of cmv. Also a pregnancy termination is a private matter between you and your doctor.
      I hope this information is helpful.
      Dr Gail Demmler Harrison

  89. Brian says:

    Hi Dr Gail –

    Thank you for your blog and for all your help. I am a father of an 18 month old boy that goes to daycare. I recently tested positive for an acute CMV infection (IgG and IgM antibodies both positive), which I assume that I contracted from him. My wife and I are planning on trying for a second child in the near future, so she was tested but her results showed no IgG or IgM antibodies.

    My questions are: what is the risk that I could pass the virus on to my wife? And what can I do to minimize that risk, i.e. waiting until my IgM go down before trying to conceive, etc.? Thanks very much.

    • Dr. Gail Demmler-Harrison, Infectious Diseases Dr. Gail Demmler-Harrison, Infectious Diseases says:

      Hello,

      Thank you for your comment on my CMV blog post.

      CMV may be transmitted from husband to wife, so if you have a documented acute CMV infection, you will be shedding CMV in your saliva, urine and semen for a while (hard to predict how long but likely weeks to months). It is therefore recommended you not try to conceive your baby at this time. Waiting until your CMV IgM antibody is negative is a good plan and will reduce your risk of CMV transmission.

      Also your wife should practice CMV precautions with your 18 month old toddler and any other young child, while she is planning pregnancy or pregnant, since she is CMV seronegative and at risk for catching CMV for the first time right now. The risk of catching a CMV infection in the family from a toddler who is actively CMV infected is around 40-50%. So your wife may also want to recheck her CMV antibody status prior to trying to become pregnant, once you two are ready to try again for a pregnancy, just to be sure she is not experiencing an active CMV infection. If she is noted to have an active CMV infection, then delay pregnancy until she is also CMV seronegative and resolved her primary CMV infection before trying for your next baby.

      I hope this is helpful information!
      Dr Gail Demmler Harrison
      CMVDOC

    • Dr. Gail Demmler-Harrison, Infectious Diseases Dr. Gail Demmler-Harrison, Infectious Diseases says:

      Hello,

      Thank you for your comment!

      CMV may be transmitted from husband to wife, so if you have a documented acute CMV infection, you will be shedding CMV in your saliva, urine and semen for a while (hard to predict how long but likely weeks to months). It is therefore recommended you not try to conceive your baby at this time. Waiting until your CMV IgM antibody is negative is a good plan and will reduce your risk of CMV transmission.

      Also your wife should practice CMV precautions with your 18 month old toddler and any other young child, while she is planning pregnancy or pregnant, since she is CMV seronegative and at risk for catching CMV for the first time right now. The risk of catching a CMV infection in the family from a toddler who is actively CMV infected is around 40-50%. So your wife may also want to recheck her CMV antibody status prior to trying to become pregnant, once you two are ready to try again for a pregnancy, just to be sure she is not experiencing an active CMV infection. If she is noted to have an active CMV infection, then delay pregnancy until she is also CMV seronegative and resolved her primary CMV infection before trying for your next baby.

      I hope this is helpful information!
      Dr Gail Demmler Harrison
      CMVDOC

      • Brian says:

        Thank you, Dr Gail! Yes that is very helpful information.

        How often would you recommend that I get my CMV antibodies checked? My IgM was 104 AU/ml in late June and down to 61 AU/ml in early September. So trending in the right direction but not down to zero yet.

        Thanks very much.
        -Brian

  90. Alicia Hawa says:

    How long after being exposed to CMV would your igm be positive if you’ve never been infected before?

    • Dr. Gail Demmler-Harrison, Infectious Diseases Dr. Gail Demmler-Harrison, Infectious Diseases says:

      In general the CMV IgM response will be detectable 2 weeks to 16 weeks after a CMV exposure in a normal healthy individual. The time frame for IgM seroconversion varies on the type of exposure and the intensity of the exposure. For example, a blood product transfusion incubation period may be as short as 2 weeks, but a person to person exposure may take 12 to 14 weeks to seroconvert. It is difficult in person to person exposures to know exactly which exposure was the significant one, however.

      Dr Gail Demmler Harrison

  91. Michelle says:

    Hi Dr. Gail Demmler Harrison,

    Could you tell me if that statistic, “The risk of catching a CMV infection in the family from a toddler who is actively CMV infected is around 40-50%” is still relevant when taking the listed precautions? Does that risk decrease substantially when taking CMV precautions?

    How long does it take for a child/toddler to move from IGM to IGG (in other words, no IGM but IGG positive)?

    Thank you for your time!

  92. Cicely says:

    Thanks for this information on CMV. Could you tell me if regular Purell alcohol-based sanitizer works to inactivate/kill CMV on hands? I am practicing precautions, as is my husband around our toddler, but want to make sure that sanitizer is just as effective as soap and water. Thanks!

  93. M says:

    When planning to try to conceive when should precautions against toddlers be started?

    • Dr. Gail Demmler-Harrison, Infectious Diseases Dr. Gail Demmler-Harrison, Infectious Diseases says:

      It would be wise to practice CMV precautions as soon as you think you are trying to become pregnant. So before conception, during the time you are trying is also important because an early CMV infection around the time of conception can be very serious to the early pregnancy and developing fetus.

      Dr Gail Demmler Harrison
      CMVDOC

  94. Carie says:

    Hi Dr. Demmler Harrison,

    I am an American currently living in France. The CMV test was given as a part of my 1st trimester blood work along with toxoplasmosis and other screenings (toxoplasmosis is prevalent in the soil here and the doctors here are always concerned about it) I tested positive for the IgG and IgM CMV antibodies and am awaiting the avidity test results. It is my understanding this will determine if I have antibodies from an old infection or if I acquired a primary infection during pregnancy (since I am only 12 weeks into the pregnancy).

    My questions are
    1. Do you think CMV testing is indicated for all pregnant women within the first trimester? Why do they test for this in some countries in Europe, but not commonly in the U.S.?

    2. I am moving back to the US just before I am due for my 20 week ultrasound. (the 12 week ultrasound showed everything was normal by the way) If the avidity test shows I acquired CMV during the pregnancy, what steps should be taken before the ultrasound and/or what do I need to do to make the new OB aware of the situation? Can any OB or ultrasound tech look for signs of CMV on a 20 week scan or is a specialist indicated?

    Thank you for your time and for providing information on CMV. Like others here I had not heard of the virus until I saw my lab results this week. However, I do feel fortunate to have received a screening early on as opposed to many who do not find out until they have a baby who is impacted by the virus.

    • Dr. Gail Demmler-Harrison, Infectious Diseases Dr. Gail Demmler-Harrison, Infectious Diseases says:

      Hello Carie,

      Thank you for your comment. You have posed very good questions. Your experience illustrates important points about CMV awareness and education in the pregnant woman and monitoring for CMV infection in the mother and her fetus.

      1. Do you think CMV testing is indicated for all pregnant women within the first trimester? Why do they test for this in some countries in Europe, but not commonly in the U.S.?
      Yes, I personally and professionally feel CMV testing is indicated for all pregnant women within the first trimester, if possible. CMV serologic testing allows early diagnosis and careful monitoring of the fetus. It also presents the opportunity for CMV education of the pregnant woman and opens the door for discussion and presentation of CMV prevention measures. If a pregnant woman has a recent or current CMV infection diagnosed during pregnancy, the fetus can be carefully monitored, and in some cases where indicated, tested for congenital CMV by amniocentesis before birth. There are clinical trials in France and the USA for prevention of transmission or treatment of the fetus with congenital in utero CMV disease, through administration of CMV hyper immune globulin and/or antivirals to the mother, also, but these are research protocols at this time, not standard of care treatments recommended to all women. Many but not all CMV experts agree with me.
      The opinion from obstetricians about this recommendation also varies. Some countries especially in Europe are more pro active in supporting CMV awareness, CMV education, and CMV prevention measures in pregnant women. And France is especially forward thinking in this regard. The American College of Obstetrics and Gynecology (ACOG) 2015 Practice Guidelines report does not endorse routine serologic screening of pregnant women for CMV because available CMV serologies can not accurately time the CMV infection and there is no proven intervention such as a medication or vaccine to warrant testing. The ACOG 2015 Guidelines also stated they do not endorse CMV prevention precautions because “Such guidelines may be difficult to implement because they often are considered impractical or burdensome.” However, most if not all CMV experts do support CMV education and prevention strategies, since at this time, we do not have a traditional injectable CMV vaccine for prevention of CMV infection in pregnancy and prevention of congenital CMV infection and disease , only a “CMV Knowledge vaccine” to reduce CMV transmission to pregnant women. And evidence published in the medical literature from the USA and Europe has shown the precautions to be effective in reducing CMV transmission to pregnant women and that pregnant women are very willling and able to practice precautions, during pregnancy, to protect their fetus, when given the information [http://www.sciencedirect.com/…/article/pii/S2211335516301140 ]. And all women value the option of choice to practice CMV precatuions or not during pregnancy.

      2. I am moving back to the US just before I am due for my 20 week ultrasound. (the 12 week ultrasound showed everything was normal by the way) If the avidity test shows I acquired CMV during the pregnancy, what steps should be taken before the ultrasound and/or what do I need to do to make the new OB aware of the situation? Can any OB or ultrasound tech look for signs of CMV on a 20 week scan or is a specialist indicated?
      Notify your obstetrician of your CMV serology results and have your baby carefully evaluated by fetal US. The signs and symptoms by fetal US are usually detectable by routine anatomy scans. If your CMV infection is recent, then more frequent fetal US exams may be recommended by your obstetrician also. In addition, some obstetricians will refer women with a recent CMV infection in pregnancy to a maternal fetal medicine specialist and fetal center for more in depth testing if the routine anatomy scan appears abnormal. Also, if routine anatomy scans are abnormal, further testing of the mother and fetus may be recommended.

      I hope this information is helpful to you.
      Best wishes for a healthy pregnancy and healthy baby!

      Dr Gail Demmler Harrison
      CMVDOC

  95. Tamara says:

    Hello Dr. Gail
    I am currently 12 weeks pregnant with our second child. Our first son goes to day care. My OBGYN tested me for CMV at the beginning of my pregnancy and it turns out that I have had cmv before. He however also told me to take cmv prevention measures as an infection with a different strain is possible. I have been very vigilant and wash my hands all the time. The other day however while I was applying soothing cream on my teething toddler he bit me on my finger and although the cut is tiny it still broke the skin and bled. What should I do? Should I get retested for cmv at my next appointment. What is the risk of a Transmission through a bite for a toddler? Thank you for your advice!

    • Dr. Gail Demmler-Harrison, Infectious Diseases Dr. Gail Demmler-Harrison, Infectious Diseases says:

      I am glad you are CMV aware and that your obstetrician is also CMV aware and embraces the CMV precautions recommended to reduce CMV transmission. Yes it is possible, but not very common, for a “new strain” of CMV to be transmitted in to an already CMV antibody positive “immune” individual. I agree though it is best to practice precautions even if you are CMV seropositive during pregnancy to reduce this slight risk. The risk of CMV transmission from the incident you described is low, especially since you are CMV seropositive.
      Also repeat testing for CMV antibody will not provide any meaningful information about possible tan mission of a “new strain”.
      Therefore, continue your CMV precautions, best you can, and have your pregnancy and fetus followed clinically by your obstetrician.

      I hope this is helpful information.
      Dr Gail Demmler Harrison
      CMVDOC

  96. Kate says:

    Hi Dr,
    Thank you for your incredible work in this area. You have been so generous with your time and the information and advice you have been providing on this blog has no doubt helped a lot of families get through a very tough time.

    I am currently 10 weeks pregnant (confirmed with dating scan) with my second child (number 1 is 20 months & in day care). My friend was recently diagnosed with primary CMV during pregnancy, hence I asked for a test at a 6 week appointment with my GP. I do recall the whole household being sick with an incredibly sore throat approximately 1 week post conception. No fever or fatigue. Unfortunately my tests came back as follows:

    4 weeks gestation = IgG positive , IgM positive – low avidity
    9 weeks gestation = IgG positive, IgM positive- high avidity

    I have an appointment booked with a fetal medicine and also infectious disease specialist in the next two weeks but the wait for answers is driving me crazy! Hoping you might be able to help answer the following questions in the interim:
    1. With my bloods in mind, Is there any chance I got the virus pre-conception? If so , is the risk of transmission <40%?
    2. How early can you see signs of symptomatic cCMV on ultrasound and/or MRI?
    3. Following the published RCT (Revello ) , do you still believe hyper immune globulin has a role in preventing transmission? I am in Australia and not sure if we can even access it here..

    Many thanks in advance,
    Kate

    • Dr. Gail Demmler-Harrison, Infectious Diseases Dr. Gail Demmler-Harrison, Infectious Diseases says:

      Hi Kate,

      Thank you for your post. I am glad you are seeking consultation with a fetal medicine specialist and an infectious diseases specialist. Your baby should be very closely monitored.
      The CMV IgG response is life long, and not helpful really in timing the primary infection.
      The CMV IgM response is variable, and lasts usually 3-4 months in most healthy pregnant women, but can last as short as 2 -3 weeks or as long as a year.
      The CMV IgG avidity response is helpful in timing a CMV infection – primary- within 16 weeks/4 months. Avidity index usually is low if the primary CMV infection occurred 4 months after the primary CMV infection occurrence. These are general findings, and the kinetics of individual avidity responses may vary.

      Therefore if your avidity was low at 4 weeks, then rose to high at 9 weeks, about a month later, it is possible your CMV infection occurred up to 3 months prior to your pregnancy conception. What are the values? Do they help? The avidity tests vary in their ability to accurately predict the timing.
      2) Signs of in utero CMV may be seen very early or later in pregnancy, but usually signs in fetus and placenta manifest by 20-22 weeks after an early first trimester primary infection in the severely affected fetus. This is also quite variable., but your fetal medicine doctor may be able to help with this question also
      3) Yes CMV hyperimmune globulin may reduce the risk of fetal transmission, especially if given early – the Revello study was “under powered” for a clear result for many CMV experts, and the Nigro studies were not randomized, and there is an ongoing randomized clinical trial in USA. I am not sure it is available in Australia. The treatment is not an international standard at this time, but a hopeful intervention that may help some pregnancies.

      Possible resources to reach out to in Australia regarding CMV include Dr Rawlinson, a CMV expert, and his colleagues at NSW – he may be able to help w/ a referral or access to CMV hyperimmune globulin in Australia if your personal physicians and specialists need assistance.
      Professor William Rawlinson AM FAHMS
      Senior Medical Virologist, Director of Virology, Serology and OTDS Laboratories, SEALS Microbiology |
      Serology & Virology Division, Level 4, Campus Centre, Prince of Wales Hospital, Randwick, NSW, 2031Dr
      and
      The Congenital CMV Association of Australia a congenital CMV parent support network
      http://cmv.org.au

      I hope this is helpful information for you.
      Best wishes.
      Dr Gail Demmler Harrison
      CMVDCO

      • Kate says:

        Thank you very much for taking the time to reply.

        My avidity results are as follows:

        4 weeks (9th December, 2016) = 0.11 “Low” (I do not have reference range)

        8 weeks (7th January, 2017) = 0.16 “High” (0.15- 0.25)

        * Then a set of bloods from a different lab at 6 weeks (23rd December, 2016) = 0.186 ” Intermediate” (no reference range provided)

        From my reading and your response I understand that it is likely that I had a peri-conception primary infection. I have read different things in regards to the rates of vertical transmission in this stage – what do you usually quote?

        I do understand that should transmission to the baby occur, the symptoms are usually severe. I will be sure to ask about hyperimmune globulin when I see the specialists next week.

        Many thanks,
        Kate

        • Dr. Gail Demmler-Harrison, Infectious Diseases Dr. Gail Demmler-Harrison, Infectious Diseases says:

          The usually transmission rate for CMV from mother to fetus is 40%, with a range of 30-55%.

          Most CMV infections in the fetus are actually silent or without symptoms in the fetus and newborn. Only 10-15% will have symptoms in utero or at birth, and the range of symptoms is broad and variable.

          I hope this is helpful
          Dr Gail Demmler Harrison
          CMVDOC

  97. Marama says:

    Dr. Gail,
    I am currently freaking out about potential CMV infection. At approximately 12 weeks I was tested for IgG and my result was negative. I was not tested for IgM as his wasn’t a concern, I was just finding out my status. Having realized I am not immune I had been taking all precautions at work and home. I’m a Peds RN and currently not around children in home setting.
    I am now 28 weeks and last week at a family party found out that a 3 year old friends child was sharing my milkshake. Out of the same straw. She attends daycare, and although has never been very ill in her life, I am unsure her CMV status. She is currently happy and healthy. I however have been a helpless wreck this past week in trying to figure out the potential ha done to my baby
    We conceived through ART which make me ten times more nervous.

    1 – when should I be rescreened given babies due in 12 weeks and there’s a chance of having false negatives if we check too early.
    2 – all labs and growth scans have been normal.
    3- should I recheck my labs after babies born just for peace of mind ?

  98. Shellie says:

    Dr Gail
    I recently had uveitis for the 2 ND time and my Dr suggested this test, which I never heard of. I’m 42, my IGG +, IGM+. I have worked in the medical field for over 20 years and I haven’t heard of this.
    Can you tell me if there are any specialists in Michigan that deal with this. My family tested negative. I’m concerned how I got it and no one seems to know much about it. My Dr has no information on this. I’m at a loss.

    • Dr. Gail Demmler-Harrison, Infectious Diseases Dr. Gail Demmler-Harrison, Infectious Diseases says:

      Thank you for your comment.

      You may wish to consult a specialist in ophthalmology and/or infectious diseases or both together to assist you in your medical issues. The University of Michigan Health Care System should have an expert or experts that can help you with a full evaluation. CMV is usually not a cause for anterior chamber uveitis. The CMV IgM antibody levels may be cross reactions with another antibody or autoimmunity antibody.

      Best wishes.
      Dr Gail Demmler Harrison

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