A LANDMARK 3-year study in Israel has demonstrated the effectiveness of congenital cytomegalovirus (cCMV) universal screening in detecting hidden infections in newborns, potentially transforming public health approaches to cCMV. The research, conducted across two hospitals in Jerusalem from April 2022 to March 2025, screened 48,556 infants, nearly 95% of live births, with a newly developed pooled-saliva real-time PCR (rtPCR) method.
The innovative pooled-saliva technique allowed multiple samples to be tested simultaneously, achieving a pooling efficiency of 5.82 samples per rtPCR test while maintaining high sensitivity, with only a 3.7 Ct loss. This approach not only reduces laboratory workload but also makes large-scale universal screening feasible in diverse healthcare settings.
Universal Cytomegalovirus Screening Uncovers Cases Missed by Targeted Methods
The study identified 176 newborns with cCMV, translating to a birth prevalence of 3.6 per 1,000 infants. Strikingly, 57% of these cases would have been missed using conventional expanded-targeted screening methods, which typically focus on infants with failed hearing tests, clinical suspicion, or a maternal history of CMV infection. Of the infants identified through universal screening, eight were moderately to severely symptomatic, three were asymptomatic with sensorineural hearing loss, and 11 received antiviral treatment with valganciclovir.
Early Detection Supports Timely Treatment and Public Health Policy
The findings revealed that cCMV cases occurred in infants born to mothers with both primary and non-primary infections, with similar rates of moderate-to-severe symptoms and developmental sequelae at one year. This highlights the importance of universal screening in identifying at-risk infants regardless of maternal infection type. Early diagnosis through pooled-saliva testing enables timely intervention, improves clinical outcomes, and provides valuable data to inform public health guidelines and vaccination policies.
The study underscores that universal cCMV screening using pooled saliva is both feasible and clinically impactful. Researchers advocate for further cost–benefit analyses, but the evidence strongly supports broader implementation of this sensitive screening approach, potentially reshaping newborn health strategies worldwide.
Reference
Friedman SE et al. Lessons derived from a 3-year congenital cytomegalovirus screening programme in Israel: a prospective population-based cohort study. Lancet Infect Dis. 2025; DOI:10.1016/S1473-3099(25)00620-6.
