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Cytomegalovirus Shedding and Delayed Sensorineural Hearing Loss: Results From Longitudinal Follow-up of Children With Congenital Infection

Rosenthal, Lauren Stancik MPH*; Fowler, Karen B. DrPH†; Boppana, Suresh B. MD†; Britt, William J. MD†; Pass, Robert F. MD†; Schmid, Scott D. PhD*; Stagno, Sergio MD†; Cannon, Michael J. PhD*

Pediatric Infectious Disease Journal: June 2009 - Volume 28 - Issue 6 - pp 515-520
doi: 10.1097/INF.0b013e318198c724
Original Studies

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.

From the *Centers for Disease Control and Prevention, Atlanta, GA; and †Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL.

Accepted for publication December 15, 2008.

Supported by National Institute of Child Health and Human Development (P01 HD10699), the National Institute on Deafness and Other Communication Disorders (R01 DC02139), and the UAB General Clinical Research Center (M01 RR00032).

The findings and conclusions in this article have not been formally disseminated by the Centers for Disease Control and Prevention and should not be construed to represent any agency determination or policy.

Address for correspondence: Michael J. Cannon, PhD, Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop A-47, Atlanta, GA 30329. E-mail: mcannon@cdc.gov.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (www.pidj.com).

© 2009 Lippincott Williams & Wilkins, Inc.