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Advisory Committee Chair

Cora Lewis

Advisory Committee Members

Suresh Boppana

Karen Fowler

Document Type

Thesis

Date of Award

2021

Degree Name by School

Master of Science in Public Health (MSPH) School of Public Health

Abstract

Background: Congenital cytomegalovirus (cCMV) infection is a leading non-genetic cause of sensorineural hearing loss (SNHL) in children. Most infants (~90%) with cCMV have no clinical abnormalities at birth (asymptomatic cCMV), but 10-15% of these children develop SNHL. Due to lack of biomarkers, it is currently not possible to identify asymptomatic infants at-risk for hearing loss.Objective: To determine whether newborn viral load (VL) levels are predictive of hearing loss in children with asymptomatic cCMV. Methods: As part of the NIDCD CHIMES study, newborns at seven U.S. medical centers were screened for CMV by saliva PCR and enrolled in a follow-up study for long-term hearing follow up after confirmation with urine and saliva PCR in the neonatal period. We compared viral load levels in saliva and urine between children with and without hearing loss. Results: Hearing loss outcomes and VL data were available in 384 /391 (98%) infants enrolled into the study and confirmed to have cCMV. Saliva VL levels were significantly higher in symptomatic infants at screening compared to asymptomatic infants (1x107 IU/ml and 1.8x106 IU/ml respectively; p = 0.002). There was no significant difference in VL levels of saliva at screening and saliva and urine samples at enrollment between children with and without hearing loss. Although the median VL in screening saliva samples (7.4x106 IU/ml, range: 1.3x103 – 7.7x108) was higher in children with SNHL compared to normal hearing (1.74x106 IU/ml, range: 3.5x102 – 1.7x1010), there was significant overlap between the groups. However, among asymptomatic children, there was no significant difference between viral load levels of children with and without SNHL (4.2x106 IU/ml vs 1.74x106 IU/ml respectively; p = 0.19). Conclusion: Children with asymptomatic and symptomatic cCMV shed large amounts of virus in the newborn period. However, in asymptomatic infants with cCMV, viral load levels are not predictive of hearing loss.

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