Cytomegalovirus shedding and delayed sensorineural hearing loss: results from longitudinal follow-up of children with congenital infection.
BACKGROUND
The pathogenesis of cytomegalovirus (CMV)-related hearing loss is not well understood.


OBJECTIVE
To evaluate the relationship between persistent CMV shedding and delayed sensorineural hearing loss in children born with congenital CMV.


METHODS
Serial audiologic assessments and CMV cultures of urine and saliva were performed on 580 children who had been diagnosed with congenital CMV infection.


RESULTS
Prevalence of CMV culture-positivity in any specimen decreased to approximately 50% by the third birthday and approximately 5% after the seventh birthday. Intermittent shedding occurred in 28% of children. Seventy-seven children had hearing loss at birth and 38 children developed delayed hearing loss by the end of follow-up. In multivariate analyses, delayed hearing loss was strongly associated with symptomatic infection at birth (OR = 5.9, 95% CI: 1.8-18.9) and modestly associated with older age at last culture-positive visit (OR = 1.6, 95% CI: 1.1-2.0, comparing 1-year age differences) Observed rates of delayed hearing loss were 0.79 per 100 person-years for children asymptomatic at birth and 4.29 per 100 person-years for children symptomatic at birth. Between the ages of 6 months and 8 years, we would expect delayed hearing loss to occur in 6.9% of asymptomatic children and in 33.7% of symptomatic children.


CONCLUSIONS
The strongest risk factor for delayed hearing loss was CMV-related symptoms at birth, but many asymptomatic children also developed delayed hearing loss. Longer duration of CMV shedding may also be a predictor of delayed hearing loss.
Rosenthal
Lauren Stancik
LS
Centers for Disease Control and Prevention, Atlanta, GA, USA.
Fowler
Karen B
KB
Boppana
Suresh B
SB
Britt
William J
WJ
Pass
Robert F
RF
Schmid
Scott D
SD
Stagno
Sergio
S
Cannon
Michael J
MJ
D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D003587:Cytomegalovirus / Q000302:isolation & purification*; D003586:Cytomegalovirus Infections / Q000150:complications / Q000151:congenital* / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006319:Hearing Loss, Sensorineural / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D015995:Prevalence; D012189:Retrospective Studies; D017201:Virus Shedding