The Need for Universal Congenital Cytomegalovirus Screening

Congenital cytomegalovirus (cCMV) is the most common infectious cause of birth defects and brain damage, including sensorineural hearing loss and neurodevelopmental disabilities.1Despite its high prevalence, cCMV is often underdiagnosed in the absence of systematic, wide-scale universal screening.2-5There is growing policy momentum for newborn cCMV screening across the United States and Canada from professional organizations to advocacy groups and in state legislation.6-9Organized groups including the American Academy of Audiology, the American Society of Otolaryngology-Head and Neck Surgery, and the American Cochlear Implant Alliance recommend universal cCMV screening.10Against this background, the article by Wats et al in the current issue of Pediatrics focused on analyzing the impact of Connecticut's hearing-targeted screening mandate as a natural experiment on cCMV diagnosis and long-term outcomes of newborns before and after the screening program was implemented.Specifically, this study used an interrupted time series design to compare cCMV diagnosis rates before and after hearing-targeted cCMV surveillance was implemented by the Connecticut Legislature as House Bill (HB) 5525, "An Act Concerning Cytomegalovirus,"11 in 2016.Data were drawn from a large health care delivery network, the Yale New Haven Health System (YNHHS), that includes approximately 60% of Connecticut's population.All patients who received care at YNHHS and were born within its primary service area were assessed, with the period of 2013-2016 representing the preimplementation period and 2016-2023 representing the postimplementation period.Of the 197 177 births in this postimplementation period, 49 cases of definite or probable cCMV were identified overall.The key take-home message is that there was a clear impact of HB 5525 on identification of cCMV cases.Prior to HB 5525, the mean annual cCMV diagnosis rate was approximately 1.1 cases per 10 000 births, but after the law was implemented, there was an immediate and statistically significant increase in the rate of cCMV diagnosis to more than 4 cases per 10 000 births.How much of the increase in cCMV diagnosis is attributable to the legislation?Of the 43 cases of cCMV identified after the implementation of the legislation, only 17 (