Introduction:
Universal screening for congenital cytomegalovirus (CMV) for newborns has been a topic of considerable debate in medical circles. With the potential to identify congenital CMV infections early, the question arises: does the clinical benefit justify the cost? This article examines the implications of adding universal CMV screening to the Québec newborn screening program, reflecting on clinical outcomes and healthcare expenditure.
Understanding CMV and Its Consequences
CMV, a prevalent virus within the herpesviridae family, can cause congenital infections with variable outcomes. In Canada, the birth prevalence of congenital CMV (cCMV) is around 0.5%. While most infected newborns appear asymptomatic, a minority may suffer from severe neurodevelopmental issues, sensorineural hearing loss, or even mortality.
The Case for Universal Screening
The current method of screening in Québec captures only a fraction of cCMV cases by means of polymerase chain reaction (PCR) test on saliva. A rapid review and narrative synthesis of existing literature, alongside expert consultations, have highlighted the potential of universal screening. PCR tests on saliva have shown promise, albeit with concerns over false positives and false negatives.
Weighing Clinical Benefits Against Costs
The clinical dimension of universal CMV screening is compelling, particularly for early intervention in hearing loss. However, the economic dimension cannot be overlooked. Limited evidence suggests that universal screening may be cost-effective, potentially leading to savings or cost-neutrality in public healthcare spending.
Ethical Considerations and Healthcare Equity
Universal screening could reduce inequities by aiding vulnerable populations. Conversely, it may also inadvertently increase stigma or delay treatment for other conditions. The ethical landscape is complex, necessitating careful consideration.
Operational Challenges and Recommendations
Implementing universal CMV screening would necessitate significant changes in sample collection and processing. Given the current healthcare labour shortages, the anticipated benefits may not be fully realised. Consequently, the Institut national d’excellence en santé et en services sociaux (INESSS) does not recommend adding cCMV screening to Québec’s newborn screening program at this time. Instead, a focus on public education about CMV prevention is advised.
Conclusion:
While universal CMV screening presents clear clinical advantages, its cost-effectiveness and impact on healthcare equity and operations must be scrutinised. As the healthcare landscape evolves, so too may the recommendations on universal CMV screening, pending further evidence.
