Background
Methods
Scope and general process
Definition of compared interventions
Search strategy and selection criteria
Construction and analysis of decision model
Parameter | Sources | Best estimate | Min-Max | Comments |
---|---|---|---|---|
Sero-prevalence in 15–49 years-old women | [97] | 45.6% | 25.2–61.0% | Robust French representative survey |
Incidence of MPI | 1.0% | 0.2–1.4% | Mean incidence and mean of CI lower and higher limits (expert consensus) | |
Transmission rate from mother to foetus | 40.0% | 5.0–72.2% | Mean transmission rates and CI lower and higher limits from studies reporting rates by trimester of pregnancy | |
Transmission rate from mother to foetus (1st trimester) | 19% | NA | Mean incidence (expert consensus); screening scenario only | |
Transmission rate from mother to foetus (2nd trimester) | 36% | NA | Mean incidence (expert consensus); screening scenario only | |
Transmission rate after reinfectionb | Unknown; assumed equal to transmission after MPI | |||
Proportion of infected newborns who are symptom free | 87.3% | Min: 75.0% | Stable across studies | |
Proportion of medical TOP among MPI or infected foetus | 9.2% | NA | Data from National Reference Laboratory and literature | |
Proportion of medical TOP after screening | 95.0% | NA | Foetal infections confirmed by amniocentesis, positive or not at echography | |
Prevalence of infection at birth | 0.43% | 0.20–0.61% | Min-max from European studies, vary with selection and tests | |
Proportion of infected newborns who are symptomatic | 12.7% | NA | Do not include TOP, part of whom would have diedc | |
Proportion of infected newborns who are symptomatic born from mothers with immunity prior to pregnancy | 12.7% | NA | Stable across studies | |
Incidence of hearing impairment between birth and 5 years among asymptomatic newborns with sequelae | [9] | 53.0% | NA | |
Frequency of any sequelae in asymptomatic newborns | 13.3% | NA | ||
Frequency of any severe sequelae in severe symptomatic newborns | [4, 9, 10, 19, 42, 43, 162, 163, 173] | 47.0% | NA | Middle of value range |
Frequency of any moderate sequela in severe symptomatic newborns | 25.0% | NA | Middle of value range | |
Frequency of any moderate sequela in moderately symptomatic newborns | 16.0% | NA | Middle of value range | |
Proportion of any severe symptomatic newborns without sequela | [105] | 28.0% | NA | Middle of value range |
Proportion of any moderately symptomatic newborns without sequela | [105] | 51.0% | NA | Middle of value range |
Frequency of any severe sequelae in moderately symptomatic newborns | [105] | 33.0% | NA | Middle of value range |
Proportion of any late sequelae among symptomatic newborns with sequelae | 43.0% | NA | ||
Sensitivity IgG | 99.7% | Diasorin test; false negative women considered negatives, but MPI and consequences considered in truly infected women | ||
Specificity IgG | 99.4% | Abbott test; false positive women considered positives, but MPI and consequences considered in truly infected women | ||
Sensitivity IgM | 94.0% | 79.4–95.9%a | Vidas, Beckman-Coulter, Diasorin, Roche, Siemen HC tests | |
Specificity IgM | 99.3% | 96.4–100%a | ||
Sensitivity avidity of IgG | 83,0% | During first 12 weeks of pregnancy; applied when IgM positive | ||
Specificity avidity of IgG | 82,0% | During first 12 weeks of pregnancy; applied when IgM positive | ||
Absolute reduction with hygiene | [63] | −50% | Group consensus on most plausible result |
Results
Decision model
Data source
Course of cytomegalovirus infection during pregnancy
Potential impact of systematic serological screening and hygiene promotion
State | Current situation | Screening | Promotion of hygiene | ||||||
---|---|---|---|---|---|---|---|---|---|
Best (%) | Minimum (%) | Maximum (%) | Best (%) | Minimum (% | Maximum (%) | Best (%) | Minimum (% | Maximum (%) | |
CMV seronegative | 435,200 (54.4) | 598,400 (74.8) | 312,000 (39.0) | 433,683 (54.2) | 595,414 (74,4) | 310,128 (38,8) | 435,200 (54.4) | 598,400 (74.8) | 312,000 (39.0) |
MPI | 4352 (0.54) | 1197 (0.15) | 4368 (0.55) | 3018 (0.38) | 1270 (0.16) | 3069 (0.38) | 2176 (0.27) | 598 (0.07) | 2184 (0.27) |
Foetal infection in CMV- | 1741 (0.22) | 60 (0.0008) | 3154 (0.39) | 1741 (0.22) | 60 (0.008) | 3154 (0.39) | 870 (0.11) | 30 (0.004) | 1577 (0.20) |
CMV seropositive | 364,800 (49.6) | 201,600 (25.2) | 488,000 (61.0) | 366,317 (45.8) | 204,586 (25.6) | 488,408 (61,1) | 364,800 (45.6) | 201,600 (25.2) | 488,000 (61.0) |
Foetal infection after RI | 1699 (0.21) | 1540 (0.19) | 1726 (0.22) | 1699 (0.21) | 1540 (0.19) | 1726 (0.22) | 1699 (0.21) | 1540 (0.19) | 1726 (0.22) |
Total foetal infections | 3440 (0.43) | 1600 (0.20) | 4880 (0.61) | 3440 (0.43) | 1600 (0.20) | 4880 (0.61) | 2569 (0.32) | 1570 (0.20) | 3303 (0.41) |
Deaths & TOP | 316 0.040) | 147 (0.018) | 449 (0.056) | 919 (0.12) | 183 (0.023) | 1968 (0.25) | 236 (0.030) | 144 (0.018) | 304 (0.038) |
Total congenital infections | 3123 (0.39) | 1453 (0.18) | 4431 (0.55) | 2522 (0.32) | 1417 (0.18) | 2913 (0.36) | 2333 (0.29) | 1425 (0.18) | 2999 (0.37) |
Symptomatic in RI | 60 (0.008) | 54 (0.007) | 60 (0.008) | 60 (0.008) | 54 (0.007) | 60 (0.008) | 60 (0.008) | 54 (0.007) | 60 (0.008) |
Symptomatic in MPI | 60 (0.008) | 2 (< 0.001) | 110 (0.014) | 41 (0.005) | 1 (< 0.001) | 61 (0.008) | 30 (0.004) | 1 (< 0.001) | 55 (0.007) |
Severe symptomatic | 60 (0.008) | 28 (0.004) | 85 (0.011) | 50 (0.006) | 27 (0,003) | 60 (0.008) | 45 (0.006) | 27 (0,003) | 58 (0.007) |
Moderate symptomatic | 60 (0.008) | 28 (0.004) | 85 (0.011) | 50 (0.006) | 27 (0,003) | 60 (0.008) | 45 (0.006) | 27 (0,003) | 58 (0.007) |
Sequelae asymptom. RI | 197 (0.025) | 179 (0.022) | 200 (0.025) | 197 (0.025) | 179 (0.022) | 200 (0.025) | 197 (0.025) | 179 (0.022) | 200 (0.025) |
Sequelae asymptom. MPI | 202 (0.025) | 7 (< 0.001) | 366 (0.05) | 125 (0.016) | 2 (< 0.001) | 171 (0,022) | 101 (0.013) | 3 (< 0.001) | 183 (0.023) |
Severe sequela (symptom) | 48 (0.006) | 22 (0.003) | 68 (0.009) | 40 (0.005) | 22 (0.003) | 48 (0.006) | 36 (0.005) | 22 (0.003) | 46 (0.006) |
Mod. sequelae (symptom) | 35 (0.004) | 11 (0.001) | 35 (0.004) | 21 (0.003) | 11 (0.001) | 25 (0.003) | 18 (0.002) | 11 (0.001) | 24 (0.003) |
Total poor outcomes | 788 (0.099) | 367 (0.046) | 1119 (0.14) | 1301 (0.16) | 397 (0.050) | 2413 (0.30) | 588 (0.074) | 356 (0.045) | 757 (0.095) |