2023 Early Hearing Detection & Intervention Conference
March 5-7, 2023 • Cincinnati, OH
10/25/2016 | 1:30 PM - 2:30 PM | Fighting Back the 'Silent' Global Burden of Congenital Cytomegalovirus Infection and Hearing Loss Related to Cytomegalovirus | BGPOP Building 4A/B/C
Fighting Back the 'Silent' Global Burden of Congenital Cytomegalovirus Infection and Hearing Loss Related to Cytomegalovirus
Introduction: Congenital infection with the human cytomegalovirus (CMV) is the leading cause of congenital infections worldwide. In developed countries it is the most common non-genetic cause of a sensorineural hearing loss and an important cause of microcephaly, neurodevelopmental delay, seizure disorders, and cerebral palsy, with profound with impact on cognitive and social development of the affected children and their families (Manicklal et al. 2013).
Only 10% of congenital CMV infections lead to symptoms after birth; however, 50% of congenital CMV-related hearing loss emerges later in life. Prevalence numbers of congenital CMV infections given for middle Europe are up to 0.7% per 1,000 newborns, and for developing countries up to 1-5% (Manicklal et al. 2013).
Newborn screening programs for congenital CMV infections are under discussion. Antiviral therapy of symptomatic children has been shown to effectively reduce the risk of long-term impairments. Because an effective pre-conceptual vaccine against CMV could potentially prevent congenital CMV infection, a couple of active and passive immunization strategies are under clinical trials.
Method: In an international project* in Germany and Qatar, 12,000 neonates undergo a CMV screening by real-time PCR-based testing of liquid-saliva specimens. If a congenital CMV infection is confirmed, babies are enrolled in a 6-year follow-up program.
Results: By the end of April, 2016, cytomegalovirus-screenings of about 1200 German neonates and 270 Qatari neonates indicated congenital CMV infections in 3 German and 2 Qatari babies, who were enrolled in treatment and follow-up programs.
Conclusion: The high prevalence of congenital CMV infections and their lifelong sequelae call for action, with respect to the implementation of universal neonatal CMV screening, follow-up, prevention, and intervention programs that seem to be feasible and effective. References: Manicklal S, Emery VC, Lazzarotto T, Boppana SB, Gupta RK. The "Silent" Global Burden of Congenital Cytomegalovirus. Clin Microbiol Rev. 2013 Jan;26(1):86-102.
*Funded by Qatar National Research Fund, NPRP7-1845-3-480.
- To learn about the prevalence of congenital CMV infection and related hearing loss
- To learn about lifelong sequelae of congenital CMV infection, in particular related hearing loss
- To learn about possible prevention, screening, follow-up and intervention programs
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Presenters/Authors
Katrin Neumann
(), University of Bochum, Germany, Katrin.Neumann@rub.de;
Prof. Katrin Neumann is Head of the Dept. of Phoniatrics and Pediatric Audiology and of Cochlear Implant Center (Children) at the University of Bochum, Germany. She chairs the Technical Access Committee of the Coalition on Global Hearing Health. She contributes to the work of the Prevention of Deafness and Hearing Impairment Team of the WHO as a member of the WHO Expert Advisory Board. She is associate editor of several international journals, received national and international awards, and published more than 190 original articles, monographies, and book chapters.
Her research focuses are: implementation of newborn hearing screening, language screening, and CMV screening programs for children, examination of speech, language, and hearing processes with neuroimaging techniques, voice physiology and pathology, nature and treatment of stuttering, singer´s voice, diagnostics, treatment and rehabilitation of children with hearing aids and implants.
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Khalid Shahada
(), Hamad Medical Corporation, khadi@hmc.org.qa;
Dr. Khalid Shahada is the Co-Lead-PI of the project described here and serve as consultant of hearing disorders. He is the Head of Audiology & Balance Unit, HMC since 2004 and works as head of the National Program for Early Detection of Hearing Loss since 2003. He is the national coordinator of Ear and Hearing Care in the state of Qatar. He is the Principal Investigator of the research on “Low Laser Therapy (LLT) in patients with vertigo and tinnitus”. He is also doing research on “Post binaural cochlear implant fluctuating Hearing Loss - A case study” and “Genetics of Hearing Loss in Qatar Population
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Klaus Überla
(), University of Erlangen, klaus.ueberla@fau.de;
Prof. Klaus Überla is Head of the Institute of Virology of the University of Erlangen since 2015 and chaired before the Institute of Molecular and Medical Virology of the Ruhr-University and heading its diagnostic laboratory since 2001. He developed and implemented novel tests for HIV drug resistance testing (Walter et al., 1999, Journal of Clinical Virology 13: 71-80; Schmidt et al., 2000, AIDS 14: 1731-1738), directed a large diagnostic study on CoV-NL63 (van der Hoek et al., 2005, PloS Medicine 2(8):e240) and established a screening procedure for unknown viruses (Stang et al., 2005, J Clin Microbiol 43:716-720; Klempa et al., 2009, J Virol 83: 5749-5759).
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Thomas Lücke
(), University of Bochum, t.luecke@klinikum-bochum.de;
Prof. Thomas Lücke is head of the department of neuropediatrics, metabolics and social pediatrics and commissarial head of the clinic of pediatrics of the University of Bochum. He conducted several outcome studies focusing on psychomotor outcome of children with underlying diseases (Lücke et al. Dev Med Child Neurol 2007; Das et al. Arch Dis Child Fetal Neonatal Ed 2009; Grigull et al. Ped. Transplantation 2011). Standardized procedures and tests to assess psychomotor development are established in his department. In the project decribed here he is responsible for neurologic and psychomotor testing and follow-up of patients and controls.
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Norbert Teig
(), University of Bochum, norbert.teig@rub.de;
Dr. Norbert Teig chairs the Dept. of Neonatology of the Ruhr-University Bochum. He has been involved in many clinical studies in neonatology since years (Simbruner et al. and neo.nEURO.network. Pediatrics 2010;126:e771-8; ETTNO Investigators. Neonatology 2012;101:301-305; Göpel et al. and German Neonatal Network. Lancet 2011;378:1627-34) and is member of the German Neonatal Network (GNN) which organizes a large prospective multicenter descritpive study, encompassing about 40 neonatal intensive care units and about 35% of all very preterm newborns in Germany. Important parts of these studies deal with getting informed consent of parents of newborns, performing oral swabs (for genetic studies in this case) and organizing the transfer of these specimens and data on a large scale basis (Spiegler et al. 2012; Härtel C et al. and German Neonatal Network [GNN](www.vlbwi.de). PLOS one 2012; Härtel et al. and German Neonatal Network. Crit Care Med 2011). He performs similar tasks in the study on congenital CMV infection described here.
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Stefan Dazert
(), University of Bochum Germany, Stefan.Dazert@rub.de;
Prof. Stefan Dazert is head of the Dept. of Otorhinolaryngology, Head & Neck Surgery at the Ruhr-University Bochum. He has a broad expertise in all surgical procedures of the temporal bone and the lateral skull base including infectious diseases and cochlear implantation (Minovi et al., 2013, Eur Arch Otorhinolaryngol; Olszewska et al., 2013, Otol Neurootol). His main research interest is to investigate criteria for auditiory neuron survival and neurite extension to potentially improve cochlear implant efficacy (Brors et al., 2008, Audiol Neurootol; Dazert et al., 2008, Brain Res). In the project described here he is responsible for the surgical collection of intracochlear and intravestibular fluids for further CMV screening and possibly for cell culture experiments of inner ear tissues.
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Stefan Volkenstein
(), University of Bochum, Stefan.Volkenstein@rub.de;
Dr. Stefan Volkenstein is ENT-specialist, senior physician and PI of the Inner Ear Research Lab at the Department of Otolarngology, Head & Neck Surgery of the Ruhr-University in Bochum. He gained parts of his research and clinical expertise during a 2-year-fellowship at Stanford University, CA, USA, funded by the German National Academy of Science Leopoldina. Main focus of his scientific work is the developing auditory system and especially alterations of the neuronal processing and networking (Volkenstein et al., 2013: Transient, afferent input-dependent, postnatal niche for neural progenitor cells in the cochlear nucleus. Proc Natl Acad Sci U S A, 110:14456-61). He will bring in his broad clinical and surgical knowledge regarding the diagnostics and treatment of hearing disorders. In the project described here he is responsible for harvesting specimens during cochlear implant operations, preliminary cell culture experiments, counselling of patients and controls during follow-up.
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Emmanouela Dimitrakopoulou
(), University of Bochum, Emmanouela.Dimitrakopoulou@rub.de;
Emmanouela Dimitrakopoulou is bachelor of science in mathematics and expects her masters degree in cognitive sciences on the topic of functional and structural implications of network size in the hippocampal formation, by using computational methods. She is doctoral student in the Dept. of Phoniatrics and Pediatric Audiology of the University of Bochum. In the decribed project she is the coordinator.
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Hans J Trampisch
(), University of Bochum, Hans.J.Trampisch@rub.de;
Prof. Hans J Trampisch (PhD) is professor of Medical Statistics and head of the Department of Medical Informatics, Biometry and Epidemiology of the University of Bochum. He has a big amount of experience in the design, data management, and analysis of large scale clinical and epidemiological trials and in methodology of diagnostic and screening tests. He is the initiator and coordinator of the “German acupuncture trial (gerac)” with about 2.500.000 patients (Acupuncture Trialists', 2012, Arch Intern Med. 1444-1453) and co-initiator of the “German epidemiological trial (getABI) on ABI” with 6.880 patients (Diehm et al., 2009, Circulation 120:2053-2061). Actually, he is co-investigator in the BMBF(German Ministry of Education and Research)-collaborative project “Individualized assessment and management of osteoporosis on a biomechanical basis” (BioAsset, cohort study with about 7.000 patients), and initiator and coordinator of the multi-centre-projects “Priscus I/II” on chronical illness in older age groups (BMBF: Thiem et al., 2012, Z Gerontol Geriatr, 107: 230-234). In the project described here he is responsible for data management and statistical analysis, the setup of a database for the collection of molecular and clinical data of the participants, and for the cost-effectiveness analysis.
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Peter Kern
(), University of Bochum, Peter.Kern@uk-essen.de;
Dr. Peter Kern, MD is head of the Dept. of Obstetrics & Gynaecology and Perinatology of the St. Elisabeth-Hospital of the Ruhr-University of Bochum. He is specialized in Perinatology, with academic teaching in this field since 2005, and performed his doctorate in fertility medicine (published in Human Reproduction Vol. 18, No.11, pp.2628-2633, 2003). He has been granted a scholarship for throughout his studies by one of the nationally acknowledged foundations supported by the German Government. During his studies he participated in research projects related to infectious diseases in India, Indonesia and Malaysia with grants. Here is well acquainted with the mechanisms of mother-child-disease transmission. In 2013 he was awarded the Klaus-Dieter-Schulz-Quality-Assurance-Award with his working group by the German Society of Senology. In 2014 he received the San Antonio Clinical Scholar Award in Texas, USA, for his scientific work. He has published several international publications. In the current CMV-project, he is responsible as the coordinating gynecological and perinatological department and for CMV screening of the well-babies.
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