Cytomegalovirus in International Adoptees

Cytomegalovirus (CMV) is a common virus world-wide. In many underdeveloped countries, virtually 100% of the population has had CMV. Infection rates are higher, and exposure to the virus occurs at an earlier age in:

• developing countries
• lower socioeconomic groups in industrialized nations
• Asian populations

We are not presently culturing the urine of internationally adopted children for cytomegalovirus (CMV), because approximately 30-50% of adoptees are excreting the virus, the same percentage that we would expect to find in infants or toddlers in daycare in the U.S. Ordinarily, CMV acquired after birth is benign. However, special problems may arise for women who acquire their first CMV infection during a pregnancy, or for any person whose immune system is compromised after steroid use, chemotherapy or transplantation.

Infants born to women who acquired a primary infection with CMV during pregnancy may have severe sequelae, such as blindness, deafness or mental retardation. Immunocompromised hosts may have severe infections themselves, including pneumonia. In these populations, we recommend checking antibodies to CMV. If the antibody test is positive, then the patient has acquired CMV in the past and the risk of severe complications is low. If the antibody test is negative, then the patient should understand that CMV may be acquired from any of several sources: blood products, sexual partners, or infants or toddlers of any country of origin, including the U.S. Since there is no vaccine to prevent the transmission of CMV from an excreting infant to a caregiver, we recommend good handwashing and excellent personal hygiene when handling urine, diapers, or toys or other objects that may have come in contact with the child's oral secretions. Children present virtually no risk of transmitting the virus after they have been toilet-trained.