Journal of Infectious Diseases
Volume 203 Issue 11 June 1, 2011
http://www.journals.uchicago.edu/toc/jid/current
Mark R. Schleiss

Editor’s Choice: Could Therapeutic Vaccination of Cytomegalovirus-Seropositive Persons Prevent Reinfection and Congenital Virus Transmission?
J Infect Dis. (2011) 203(11): 1513-1516 doi:10.1093/infdis/jir144

Extract
In the developed world, cytomegalovirus (CMV) is the most common congenital viral infection, with an overall birth prevalence of ∼0.6% [ 1]. Approximately 10% of congenitally infected infants have signs and symptoms of disease at birth, and these symptomatic infants have been reported to have a 40%–90% risk of subsequent neurologic sequelae, including mental retardation, microcephaly, development delay, seizure disorders, and cerebral palsy [ 2– 4]. Seven percent –to 20% of asymptomatically infected newborns will also demonstrate sequelae, particularly sensorineural hearing loss [ 5– 7]. The public health impact of congenital CMV infection is substantial and underrecognized; although more children suffer from long-term neurodevelopmental handicaps as a result of congenital CMV infection than either Down syndrome or fetal alcohol syndrome [ 8], awareness unfortunately remains low, particularly among women of childbearing age [ 9, 10]. An effective vaccine could, by preventing neurological sequelae and other disabilities, provide a newborn with a lifetime of benefit. For that reason, a report from the Institute of Medicine (IOM) of the National Academy of Sciences placed CMV in its highest priority category for vaccine development, concluding that a vaccine would be strongly cost saving [ 11, 12].

Among the various CMV vaccine candidates currently in clinical trials [ 13], the most encouraging results to date have been observed in studies of a vaccine based on the immunodominant envelope glycoprotein B (gB). Several clinical trials have been performed using a recombinant form of this protein expressed in Chinese hamster ovary cells, purified and combined with an oil-in-water adjuvant known as MF59 [ 14– 17]. Pass et al recently reported the results of a seminal phase II efficacy trial of the gB-MF59 …