Making the Case for Hearing Targeted Cytomegalovirus (CMV) Screenings

Prior to the early 1990s, only 50% of children born in the United States were screened for hearing loss before leaving the hospital (NIH, 2018). Newborns were typically only screened if they had risk factors, such as low birth weight or jaundice, which  are indicative of hearing loss. According to the National Institutes of Health (NIH). This led to approximately 6,000 infants discharged from the hospital with an unknown hearing loss annually (2018). In the late 1990s and early 2000s, there was a push for the early identification and intervention of hearing loss (NIH Fact Sheet, 2018). In 2016, the Center for Disease Control (CDC) reported that 94.8% of babies born in the United States were screened for hearing loss prior to reaching one month of age. Of these children, 1.7% were diagnosed with a permanent hearing loss (2016 CDC EHDI Hearing Screening & Follow-up Survey, n.d.).

Cytomegalovirus (CMV) at the time of birth is a known risk factor for hearing loss among neonates. CMV is a common disease related to the herpes simplex virus, affecting approximately 50% to 80% of adults (CDC, 2018); however, the virus often lays dormant and symptoms are absent. If symptoms are present, they are typically mild in a healthy adult and are not a cause for concern (CDC, 2018). Congenital CMV (cCMV) is a form of the virus that is passed from the mother to the newborn in utero. According to the CDC (2018), cCMV is the “most common infectious cause of birth defects in the US,” with approximately 1 out of every 200 infants born with the virus annually. cCMV is responsible for approximately 20% to 25% of congenital hearing losses (Liming, et al., 2016), and can also lead to seizures, vision loss, low birth weight, developmental and motor delays, other health issues, and even death among neonates. Often, newborns do not present with symptoms of cCMV at birth but develop complications later in life (CDC, 2018; Akpan & Pillarisetty, 2019).

Despite the high prevalence of cCMV and its serious implications, there are no universal screening protocols in place. In light of this, several states have implemented hearing targeted  CMV screenings, including Utah, Iowa, Connecticut, New York, Illinois, and Virginia (Connecticut Public Act 15-10, 2016; Illinois Public Act 099-0424, 2016; Iowa Senate File 51; New York Senate Bill S2816, 2017; Utah H.B. 81, 2013; National CMV Foundation, 2020). In a hearing targeted CMV screening, a child will automatically be screened for CMV if he or she fails the newborn hearing screening. If the infant tests positive for CMV, the parents will be educated about the virus and potential intervention options. Other states have based legislation aimed at education and prevention; however these lack a screening component (National CMV Foundation, 2020).

It is important that other states, as well as the nation as a whole, begin to consider implementing hearing targeted CMV screenings to allow providers to identify and intervene at an early age. As future audiologists it is imperative that we are knowledgeable about the impact that common illnesses have on our patients. Additionally, we can be a driving force furthering legislative efforts around the country aimed at CMV. The National CMV Foundation is a great resource to find out more about CMV, current legislative efforts, and how you can become more involved in advocating for patients with CMV in your state. 

Sarah Jones is a third-year AuD student at the University of South Florida (USF). She is the SAA Florida State Ambassador and the  Vice President of the USF chapter of SAA. She is interested in working with patients of all ages with a special emphasis on cochlear implants and legislative efforts to expand CMV screenings for newborns. 

References 

Akpan, S. U. and Pillarisetty, L. S. (2019). Congenital Cytomegalovirus Infection (Congenital CMV Infection). National Center for Biotechnology Information. Retrieved from: https://www.nchi.nlm.nih.gov/books/NBK541003/

 Babies Born with CMV (2018). Center for Disease Control and Prevention (CDC). U.S. Health and Human Services. Retrieved from: www.cdc.gov/cmv.

 Center for Disease Control and Prevention (2018). CMV Factsheet for HealthcareProviders. Retrieved from: https://www.cdc.gov/cmv/downloads/identifying-cmv.pdf

 Center for Disease Control and Prevention (2016). CDC Hearing Screening and Follow-up Survey (HSFS). Retrieved from: https://www.cdc.gov/ncbddd/hearingloss/2016-data/01-data          summary.html

Connecticut Public Act 15-10. (2016). Retrieved from: https://www.cga.ct.gov/2015/ACT/PA/2015PA-00010-R00HB-05525-PA.htm.

llinois Public Act 099-0424. (2016). Illinois General AssemblyRetrieved from: http://www.ilga.gov/legislation/publicacts/fulltext.asp?Name=099-0424

Iowa Senate File 51. (2016). Retrieved from: https://idph.iowa.gov/Portals/1/userfiles/190/Senate%20File%2051.pdf

National CMV Foundation. (2020). Advocacy. Retrieved from: https://www.nationalcmv.org/about-us/advocacy. 

New York Senate Bill S2816. (2017). Retrieved from: https://www.nysenate.gov/legislation/bills/2017/s2816/amendment/original. 

Liming, et. al. (2016). International Pediatric Otolaryngology Group (IPOG) consensus recommendations: Hearing loss in the pediatric patient. International Journal of Pediatric Otorhinolaryngology, 90 (2016) 251-258.

National Institutes of Health (NIH) Research Portfolio Online Reporting Tools. (2018). Newborn Hearing Screening. Retrieved from: https://report.nih.gov/nIHfactsheets/ViewFactSheet.aspx?csid=104

Utah H.B. 81, Cytomegalovirus Public Health Initiative (2013). Utah State Legislature. Retrieved from: https://le.utah.gov/~2013/bills/static/hb0081.html