Cytomegalovirus

At a glance

Cytomegalovirus from the Infection Control in Healthcare Personnel: Epidemiology and Control of Selected Infections Transmitted Among Healthcare Personnel and Patients (2024) guideline.

Recommendations

  1. Work restrictions are not necessary for healthcare personnel who have an exposure to cytomegalovirus.
  2. Work restrictions are not necessary for healthcare personnel with active cytomegalovirus infection.

For recommendations about healthcare personnel (HCP) who are pregnant or intending to become pregnant and who might be exposed to cytomegalovirus, please see the Pregnant HCP (https://www.cdc.gov/infection-control/hcp/healthcare-personnel-epidemiology-control/pregnant-hcp.html) section.

Background

Cytomegalovirus (CMV) is a member of the herpesvirus family, which also includes herpes simplex virus types 1 and 2, varicella-zoster virus, and Epstein-Barr virus. 1CMV infection is common, with over half of adults infected by age 40 years. 2 Transmission of CMV between healthcare personnel (HCP) and patients in healthcare settings is possible, but has not been well documented. 3 Transmission via touch from HCP or other infected persons has been suggested. 45 However, HCP have not been demonstrated to be at greater risk for acquiring CMV than the general population. 67891011

Occupational Exposures

Transmission of CMV occurs through deposition of infectious body fluids (e.g., urine, saliva, blood, tears, semen, breast milk) from an infected source person onto the mucus membranes of a susceptible host. 1 Several case reports suggest that HCP who developed primary CMV infection did not acquire it from the infected children for whom they provided care, based on genomic analyses of isolates. 12131415 Hence, occupational transmission of CMV in healthcare settings may be very rare.

Using infection prevention and control practices as recommended by CDC (https://www.cdc.gov/infection-control/hcp/isolation-precautions/appendix-a-type-duration.html#C) prevents transmission of CMV in healthcare settings. 116

Clinical Features

Although most people with primary CMV infection are asymptomatic or have mild symptoms, 317 some may experience a mononucleosis-like condition with prolonged fever and hepatitis. 1 After initial infection with CMV, the virus establishes lifelong latency and may occasionally reactivate. 117 Disease from reactivation of CMV infection rarely occurs unless the person's immune system is suppressed due to therapeutic drugs or disease. 1

For most people, CMV infection is not a serious health problem. However, certain groups are at high risk for serious complications from CMV infection, including: 1. Infants infected in utero (i.e., congenital CMV); 2. Very low birth weight and premature infants; 3. People with compromised immune systems (e.g., due to organ and bone marrow transplants, advanced HIV infection). 1

For most healthy people who acquire CMV after birth, there are few symptoms and no long-term health consequences. 1

Testing and Diagnosis

Testing HCP for CMV infection is not typically performed by Occupational Health Services (OHS) nor indicated for most HCP, regardless of symptoms or potential exposure. Information on testing and diagnosis for CMV infection can be found on the CDC website (https://www.cdc.gov/cytomegalovirus/php/laboratories/index.html). 18

Additional Considerations

Post-exposure prophylaxis (PEP) is not administered after exposure to CMV. No treatment for CMV infection in healthy adults is indicated. 117 For pregnant or immunocompromised HCP who develop signs and symptoms compatible with CMV infection, referral to their obstetric provider (see Pregnant HCP [https://www.cdc.gov/infection-control/hcp/healthcare-personnel-epidemiology-control/pregnant-hcp.html] section), infectious diseases specialist, or transplant team may be indicated for counseling or to discuss the possible need for further diagnostic testing and management. 17

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Content Source:
National Center for Emerging and Zoonotic Infectious Diseases (NCEZID)
  1. Centers for Disease Control and Prevention; National Center for Immunization and Respiratory Diseases; Division of Viral Diseases. Cytomegalovirus (CMV) and Congenital CMV Infection: For Healthcare Providers, Clinical Overview. Updated April 5, 2024. Accessed September 17, 2024. https://www.cdc.gov/cytomegalovirus/hcp/clinical-overview/index.html
  2. Centers for Disease Control and Prevention; National Center for Immunization and Respiratory Diseases; Division of Viral Diseases. Cytomegalovirus (CMV) and Congenital CMV Infection. Updated May 30, 2024. Accessed September 17, 2024. https://www.cdc.gov/cytomegalovirus/about/index.html
  3. Committee on Infectious Diseases, American Academy of Pediatrics, Kimberlin DW, Barnett ED, Lynfield R, Sawyer MH. Cytomegalovirus Infection. Red Book: 2021–2024 Report of the Committee on Infectious Diseases. 32nd ed. American Academy of Pediatrics,; 2021:294-300:chap Section 3.
  4. Demmler GJ, Yow MD, Spector SA, et al. Nosocomial cytomegalovirus infections within two hospitals caring for infants and children. The Journal of infectious diseases. Jul 1987;156(1):9-16.
  5. Hutto C, Little EA, Ricks R, Lee JD, Pass RF. Isolation of cytomegalovirus from toys and hands in a day care center. The Journal of infectious diseases. Sep 1986;154(3):527-30. doi:10.1093/infdis/154.3.527
  6. Ahlfors K, Ivarsson SA, Johnsson T, Renmarker K. Risk of cytomegalovirus infection in nurses and congenital infection in their offspring. Acta paediatrica Scandinavica. Nov 1981;70(6):819-23.
  7. Balegamire SJ, McClymont E, Croteau A, et al. Prevalence, incidence, and risk factors associated with cytomegalovirus infection in healthcare and childcare worker: a systematic review and meta-analysis. Syst Rev. Jun 27 2022;11(1):131. doi:10.1186/s13643-022-02004-4
  8. Duvall CP, Casazza AR, Grimley PM, Carbone PP, Rowe WP. Recovery of cytomegalovirus from adults with neoplastic disease. Annals of internal medicine. 1966;64 3:531-41.
  9. Dworsky ME, Welch K, Cassady G, Stagno S. Occupational risk for primary cytomegalovirus infection among pediatric health-care workers. The New England journal of medicine. Oct 20 1983;309(16):950-3. doi:10.1056/nejm198310203091604
  10. Takao M, Yoshioka N, Hagiya H, et al. Risk for the occupational infection by cytomegalovirus among health-care workers. J Infect Chemother. Jul 2020;26(7):681-684. doi:10.1016/j.jiac.2020.02.011
  11. Tolkoff-Rubin NE, Rubin RH, Keller EE, Baker GP, Stewart JA, Hirsch MS. Cytomegalovirus infection in dialysis patients and personnel. Annals of Internal Medicine. 1978;89(5_Part_1):625-628. doi:10.7326/0003-4819-89-5-625
  12. Adler SP, Baggett J, Wilson M, Lawrence L, McVoy M. Molecular epidemiology of cytomegalovirus in a nursery: lack of evidence for nosocomial transmission. J Pediatr. Jan 1986;108(1):117-23. doi:10.1016/s0022-3476(86)80785-5
  13. Hokeberg I, Olding-Stenkvist E, Grillner L, Reisenfeld T, Diderholm H. No evidence of hospital-acquired cytomegalovirus infection in a pregnant pediatric nurse using restriction endonuclease analysis. The Pediatric infectious disease journal. Nov 1988;7(11):812-4. doi:10.1097/00006454-198811000-00017
  14. Wilfert CM, Huang ES, Stagno S. Restriction endonuclease analysis of cytomegalovirus deoxyribonucleic acid as an epidemiologic tool. Pediatrics. Nov 1982;70(5):717-21.
  15. Yow MD, Lakeman AD, Stagno S, Reynolds RB, Plavidal FJ. Use of restriction enzymes to investigate the source of a primary cytomegalovirus infection in a pediatric nurse. Pediatrics. Nov 1982;70(5):713-6.
  16. Siegel JD, Rhinehart E, Jackson M, Chiarello L, the Healthcare Infection Control Practices Advisory Committee. 2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings. Centers for Disease Control and Prevention; National Center for Emerging and Zoonotic Infectious Diseases; Division of Healthcare Quality Promotion. Updated November 27, 2023. Accessed September 17, 2024. https://www.cdc.gov/infection-control/hcp/isolation-precautions/index.html
  17. Committee on Practice Bulletins - Obstetrics; The American College of Obstetricians and Gynecologists. Practice bulletin no. 151: Cytomegalovirus, parvovirus B19, varicella zoster, and toxoplasmosis in pregnancy. Obstetrics and gynecology. Jun 2015;125(6):1510-25. doi:10.1097/01.Aog.0000466430.19823.53
  18. Centers for Disease Control and Prevention; National Center for Immunization and Respiratory Diseases; Division of Viral Diseases. Cytomegalovirus (CMV) and Congenital CMV Infection: For Healthcare Providers, Laboratory Testing. Updated April 15, 2024. Accessed September 17, 2024. https://www.cdc.gov/cytomegalovirus/php/laboratories/index.html