Neonatal screening for congenital cytomegalovirus infection in Tehran, Iran, using Guthrie cards

  • Samileh Noorbakhsh Pediatric Infectious Diseases Research Center, Institute of Immunology and Infectious Diseases, Iran University of Medical Sciences, Tehran, Iran
  • Mohammad Farhadi Head and Neck Research Center, Iran University of Medical Sciences, Tehran, Iran
  • Faezeh Haghighi Cellular and Molecular Research Center, Sabzevar University of Medical Sciences, Sabzevar, Iran
  • Sara Minaeian Pediatric Infectious Diseases Research Center, Institute of Immunology and Infectious Diseases, Iran University of Medical Sciences, Tehran, Iran
  • Morteza Haghighi Hasanabad Pediatric Infectious Diseases Research Center, Institute of Immunology and Infectious Diseases, Iran University of Medical Sciences, Tehran, Iran
Screening; Congenital cytomegalovirus infection; Guthrie card


Background and Objectives: Cytomegalovirus (CMV) constitutes the most common viral cause of congenital infections in newborns worldwide. There are a significant number of asymptomatic newborns with congenital CMV infection in Iran, which may develop long-term sequelae of infection. Unfortunately, limited data exsists from Iran on the rate of congenital CMV infection among neonates. The current study was aimed to investigate the prevalence of congenital CMV infection among Iranian neonates by testing Guthrie cards.
Materials and Methods: Guthrie cards were collected from infants within 2 weeks of life, and total DNA was extracted from samples by thermal shock and evaluated for CMV DNA using nested-PCR assay. CMV infection in newborns was confirmed through a commercial CMV PCR kit. Infected infants underwent further evaluation at the hospital.
Results: CMV infection was identified in four of 1174 infants (0.34%) which is approximately 3 cases per 1000 live births. Infected infants were asymptomatic at birth and had a normal hearing status similar to other children. There were no factors in relation with CMV infection among newborns.
Conclusion: According to the results of this study, infected infants with congenital CMV infection could identify at early stage by testing Guthrie cards (within 21 days of life). Furthermore, since there is a lack of CMV knowledge in our population, educating and effective counseling by obstetricians/ gynecologists to the pregnant women are recommended.


1. Harrison G (2014). Cytomegalovirus. Feigin and Cherry’s textbook of pediatric infectious disease 7th ed Elsevier Saunders Philadelphia, PP.1969.
2. Atkinson C, Emery V, Griffiths P. Development of a novel single tube nested PCR for enhanced detection of cytomegalovirus DNA from dried blood spots. J Virol Methods 2014;196:40-44.
3. Demmler-Harrison GJ, Weisman LE (2018). Congenital cytomegalovirus infection: clinical features and diagnosis.In: UpToDate. Ed, Ted. W. Post. UpToDate in Walltham, MA.
4. McMullan BJ, Palasanthiran P, Jones CA, Hall BM, Robertson PW, Howard J, et al. Congenital cytomegalovirus—time to diagnosis, management and clinical sequelae in Australia: opportunities for earlier identification. Med J Aust 2011;194:625-629.
5. Buonsenso D, Serranti D, Gargiullo L, Ceccarelli M, Ranno O, Valentini P. Congenital cytomegalovirus infection: current strategies and future perspectives. Eur Rev Med Pharmacol Sci 2012;16:919-935.
6. Kenneson A, Cannon MJ. Review and meta-analysis of the epidemiology of congenital cytomegalovirus (CMV) infection. Rev Med Virol 2007;17:253-276.
7. Barbi M, Binda S, Primache V, Caroppo S, Didò P, Guidotti P, et al. Cytomegalovirus DNA detection in Guthrie cards: a powerful tool for diagnosing congenital infection. J Clin Virol 2000;17:159-165.
8. Barbi M, Binda S, Caroppo S. Diagnosis of congenital CMV infection via dried blood spots. Rev Med Virol 2006;16:385-392.
9. Scanga L, Chaing S, Powell C, Aylsworth AS, Harrell LJ, Henshaw NG, et al. Diagnosis of human congenital cytomegalovirus infection by amplification of viral DNA from dried blood spots on perinatal cards. J Mol Diagn 2006;8:240-245.
10. de Vries JJ, Barbi M, Binda S, Claas EC (2012). Extraction of DNA from dried blood in the diagnosis of congenital CMV infection. In: Diagnosis of Sexually Transmitted Disease. Eds, MacKenzie CR, Henrich B. Springer. pp. 169-175.
11. Saiki RK, Gelfand DH, Stoffel S, Scharf S, Higuchi R, Horn GT, et al. Primer-directed enzymatic amplification of DNA with a thermostable DNA polymerase. Science 1988;239:487-491.
12. Waters A, Jennings K, Fitzpatrick E, Coughlan S, Molloy EJ, De Gascun CF, et al. Incidence of congenital cytomegalovirus infection in Ireland: implications for screening and diagnosis. J Clin Virol 2014;59:156-160.
13. Fahimzad A, Afgeh SA, Eghbali E, Abdinia B, Shiva F, Rahbar M. Screening of congenital CMV infection in saliva of neonates by PCR: report of a pilot screening study in Iran. Clin Lab 2013;59:1171-1174.
14. Karimian P, Yaghini O, Nasr Azadani H, Mohammadizadeh M, Arabzadeh SAM, Adibi A, et al. Prevalence, characteristics, and one-year follow-up of congenital cytomegalovirus infection in Isfahan City, Iran. Interdiscip Perspect Infect Dis 2016; 2016:1-8.
15. Javid N, Cheraghali F, Moradi A, Kelishadi M, Tabarraei A. Newborn screening for congenital cytomegalovirus infection in Iran. Pediatr Infect Dis J 2016;35:1052.
16. Yamamoto AY, Castellucci R, Aragon DC, Mussi-Pinhata MM. Early high CMV seroprevalence in pregnant women from a population with a high rate of congenital infection. Epidemiol Infect 2013;141:2187-2191.
17. Wang S, Wang T, Zhang W, Liu X, Wang X, Wang H, et al. Cohort study on maternal cytomegalovirus seroprevalence and prevalence and clinical manifestations of congenital infection in China. Medicine 2017;96(5):e6007.
18. Sahiner F, Cekmez F, Cetinkaya M, Kaya G, Kalayci T, Gunes O, et al. Congenital cytomegalovirus infections and glycoprotein B genotypes in live-born infants: a prevalence study in Turkey. Infec Dis 2015;47:465-471.
19. Vauloup-Fellous C, Ducroux A, Couloigner V, Marlin S, Picone O, Galimand J, et al. Evaluation of cytomegalovirus (CMV) DNA quantification in dried blood spots: retrospective study of CMV congenital infection. J Clin Microbiol 2007;45:3804-3806.
20. Li L, Zhao L, Li Y. Prevalence of congenital cytomegalovirus infection in Beijing. Chin J Neonatol 2012;27:5-9.
21. Siadati A, Noorbakhsh S, Ghazi F, Rimaz SH, Monavari MR. Cytomegalovirus infection in primipiparous pregnant women and their neonates. Acta Med Iran 2002;40:136-139.
22. Erfanianahmadpoor M, Nasiri R, Vakili R, Hassannia T. Seroprevalence, transmission, and associated factors of specific antibodies against cytomegalovirus among pregnant women and their infants in a regional study. Saudi Med J 2014;35:360-364.
23. Arabzadeh SA, Mosavat SA, Eftekhari N. Seroepidemiology of human cytomegalovirus in pregnant women and their neonates in kerman city during 2005. J Kerman Univ Med Sci 2005;14:279-288.
24. Monavari Seyed Hamidreza, Keyvani H, Kiasari Bahman Abedi, Mollaei H, Fazlalipour M, Vaziri MS, et al. Detection of Cytomegalovirus (CMV) antibodies or DNA sequences from ostensibly healthy Iranian mothers and their neonates. Int J Med Sci 2012;4:155-159.
25. Ziyaeyan M1, Alborzi A, Abbasian A, Kalani M, Moravej A, Nasiri J, et al. Detection of HCMV DNA in placenta, amniotic fluid and fetuses of seropositive women by nested PCR. Eur J Pediatr 2007;166:723-726.
26. Sepahvand P, Makvandi M, Samarbafzadeh A, Talaei-Zadeh A, Ranjbari N, Nisi N, et al. Human Cytomegalovirus DNA among women with breast cancer. Asian Pac J Cancer Prev 2019;20:2275-2279.
27. Göhring K, Dietz K, Hartleif S, Jahn G, Hamprecht K. Influence of different extraction methods and PCR techniques on the sensitivity of HCMV-DNA detection in dried blood spot (DBS) filter cards. J Clin Virol 2010;48:278-281.
28. Cannon MJ, Davis KF. Washing our hands of the congenital cytomegalovirus disease epidemic. BMC Public Health 2005;5:70.
29. Sotoodeh Jahromi A, Jamshidi Makiani M, Farjam M, Madani A, Amirian M, Eqbal Eftekhri T, et al. Cytomegalovirus immunity in pregnancy in south of Iran. Am J Infect Dis 2010;6:8-12.
How to Cite
Noorbakhsh S, Farhadi M, Haghighi F, Minaeian S, Haghighi Hasanabad M. Neonatal screening for congenital cytomegalovirus infection in Tehran, Iran, using Guthrie cards. Iran J Microbiol. 12(3):198-203.
Original Article(s)