Cytomegalovirus

Among agents that cause congenital or perinatal infection, cytomegalovirus (CMV) is the most commonly encountered pathogen and is responsible for substantial sequelae in infants. Globally the burden of congenital CMV (cCMV) is underestimated, since surveillance programs are not present in many parts of the world, but in the developed world it is estimated that the birth prevalence is 0.64%, and somewhere between 10% and 15% of infected infants will have long-term neurodevelopmental sequelae, most commonly sensorineural hearing loss. Given the morbidity associated with cCMV infection, development of a safe and effective preconception vaccine is a major public health priority. However, re-infections, with resultant disabling congenital transmission, occur in women with preconception immunity, greatly complicating vaccine design. This chapter summarizes the current state of CMV vaccine development, with an emphasis both on postulated correlates of protective maternal immunity and candidate vaccines moving forward in clinical trials.