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Is targeted cytomegalovirus testing of infants feasible in Western Australia? An observational study
Allison Reid1,2, Asha C Bowen2,3,4,5, Christopher G Brennan-Jones6,7,8
1Department of Otolaryngology, Perth Children's Hospital, Perth, Western Australia, Australia.
Insights
A Western Australian study found a targeted congenital cytomegalovirus (cCMV) testing program is feasible. Implementing this program ensures high-risk infants receive timely diagnosis and intervention for cCMV, preventing potential hearing loss.
Area of Science:
- Pediatrics
- Infectious Diseases
- Public Health
Background:
- Congenital cytomegalovirus (cCMV) is a leading cause of non-genetic hearing loss in infants.
- Current Australian guidelines recommend targeted cCMV testing for high-risk infants, but a formal program is lacking.
- Early diagnosis and intervention are crucial for managing cCMV-related morbidities.
Purpose of the Study:
- To evaluate the feasibility of a targeted cCMV testing program in Western Australia (WA).
- To assess the effectiveness of using the universal infant hearing-screening program to identify infants at high risk for cCMV.
- To analyze the timeliness of testing, results, and follow-up care for infants identified as high-risk.
Main Methods:
- A 2-year statewide observational study (2020-2022) in WA.
- Recruitment of infants who failed newborn hearing screening for saliva PCR testing.
- Exploration of barriers to testing eligibility and assessment of timely reviews for cCMV-positive infants.
Main Results:
- 212 high-risk infants identified; 134 (63%) met inclusion criteria, and 103 (77%) consented.
- Achieved complete and timely cCMV testing and follow-up for positive cases.
- Identified barriers to testing eligibility in 78 high-risk infants.
Conclusions:
- Western Australia lacks a structured targeted cCMV testing program, leading to missed opportunities.
- A structured, targeted cCMV testing program is feasible in WA.
- Implementation would align care with national/international standards and improve outcomes for affected children.
Introduction:
Congenital cytomegalovirus (cCMV) is a common infection at birth with the potential to cause significant and permanent morbidity, most commonly hearing loss. Targeted cCMV testing programmes use hearing loss as an indicator of an infant being at high risk of the infection and thereby can 'target' or focus testing on those at greatest risk. Australian and International guidelines recommend that high-risk infants be offered cCMV testing, yet across Australia, a formal testing system does not exist. This paper presents the results of a Western Australian (WA) targeted testing study, detailing its methodology, strengths and challenges to evaluate the feasibility of a targeted cCMV testing programme in WA.
Methods:
A 2-year statewide observational study was conducted in WA from 2020 to 2022. The study used the established universal infant hearing-screening programme to identify infants at high risk of cCMV. Infants who failed their newborn hearing test were recruited to the study and underwent saliva PCR testing. Confirmatory testing was via urine PCR for CMV. This study examines the first 12 months of data.Data collected included the timeliness of testing and results, both integral to effective cCMV diagnosis and treatment. The reasons for high-risk infants being ineligible for testing were explored, and for cCMV-positive infants, the timeliness of reviews and investigations was evaluated.
Results:
During the study period, 212 infants at high risk of cCMV were identified. Of these, 134 (63%) met inclusion criteria and 103 (77%) consented to participate. The study achieved complete and timely cCMV testing, along with timely review and investigation of cCMV-positive infants. Barriers to testing eligibility among high-risk infants (n=78) were assessed to inform strategies to improve testing access.
Conclusions:
WA currently lacks a structured, targeted cCMV testing programme, resulting in missed diagnosis and early intervention opportunities for high-risk infants. The study findings indicate that a structured, targeted cCMV testing programme is feasible and would ensure affected children receive care that aligns with national and international standards.
