Evaluation of a prescreening blood donor program for prevention of perinatal transfusion-acquired cytomegalovirus (CMV) infection.

The purpose of this study was to evaluate the efficacy of a prescreened CMV seronegative blood donor group in preventing transfusion-acquired CMV infection in premature infants in the perinatal period. Group 0 donors with known CMV seronegative status were recruited to supply blood to the neonatal intensive care nurseries. One hundred and twenty-seven low birth weight infants born of CMV seronegative mothers remained seronegative when blood for transfusion was screened for CMV antibody. Twenty two infants shared six units of CMV seropositive blood due to technical errors or poor sensitivity of the test kit in the initial phase of the study. Fifteen of these patients were in the study group. One infant died of immaturity at four weeks of age and two of the remaining 14 showed asymptomatic CMV infection. Another infant who received granulocyte concentrates from CMV seropositive donors had symptomatic CMV infection. Throughout the 24 month study period, blood supply to the ICN was adequate and timely. The donor seroconversion rate was 0.7% per annum. Only one infant was exposed to the risk of CMV infection due to donor seroconversion. We conclude that the prescreening donor program is a sensible and efficient approach for providing CMV seronegative blood in neonatal transfusion therapy.

Evaluation of cytomegalovirus (CMV) antibody screening tests for blood donors.

Four technics were compared to find the most suitable screening test for the cytomegalovirus (CMV) antibody status in blood donors. One hundred thirty-five donor samples were tested by two enzyme immunoassays, EIA(Litton) and EIA(Abbott), and by latex agglutination (LA) and complement fixation (CF). The seroreactivity of the tests were judged by concordance of three or more methods. The authors found that the test performance of the EIA(Litton) could be improved with adjustment of sample color variation, which increased the test sensitivity and specificity from 48.8% and 87.2% to 83.8% and 96.4%, respectively. Both the EIA(Abbott) and LA technics proved to be ideal screening tests with 100% sensitivity and negative predictive values. However, the rapid turnaround time and the simplicity in technics and equipment used with the LA test make it the test of choice for blood donor screening.

Cytomegalovirus infections of the neonate and infant.

Cytomegalovirus is ubiquitous. While most infections are asymptomatic, infants and children acquiring CMV may excrete the virus for years in spite of significant antibody responses. CMV may be transmitted vertically or horizontally. Transplacental passage of CMV leads to congenital infection of the neonate. The most severely affected infants are born to mothers who develop a primary infection early in pregnancy and have a suboptimal cell-mediated response. During the perinatal period, the virus may be acquired by the infant from infected breast milk, passage through an infected birth canal, or by blood transfusion. Full-term infants infected during the perinatal period, though usually asymptomatic, may present with rash, hepatomegaly, lymphadenopathy, and/or pneumonia. Perinatally acquired infections in sick preterm infants may cause significant morbidity and mortality. Although specific therapy for infected individuals is currently unavailable, the outlook for an effective vaccine is promising.

Cytomegalovirus infection. Overview and new developments.

Cytomegalovirus (CMV) is a ubiquitous agent that causes infection in all age-groups. Fortunately, the infection is usually asymptomatic, and thus it goes unnoticed. It can, however, have serious sequelae in affected neonates. One of the most significant new developments in our understanding of CMV is its possible role in acquired immune deficiency syndrome, a syndrome that has an extremely high mortality rate. CMV is also closely related to Epstein-Barr and herpes simplex viruses, both of which have known oncogenic potential. Drs Bhumbra and Nankervis discuss the disease potential of CMV and research being done on prevention of CMV infection.