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Nonprimary infections due to recurrence of latent infections or reinfection with new virus strains during pregnancy can result in fetal infection. Because the prevalence of cCMV increases with increasing maternal CMV seroprevalence, the vast majority of the cases of cCMV throughout the world follow nonprimary maternal infections and is more common in individuals of lower socioeconomic background. Horizontal exposures to persons shedding virus in bodily secretions (young children, sexual activity, household crowding, low income) probably increase the risk of acquisition of an exogenous nonprimary CMV infection and fetal transmission. In addition, more frequent acquisition of new antibody reactivities in transmitter mothers suggest that maternal reinfection by new viral strains could be a major source of congenital infection in such populations. However, the exact frequency of CMV nonprimary infection in seroimmune women during pregnancy and the rate of intrauterine transmission in these women are yet to be defined. Usually, the birth prevalence of cCMV is high (\u22657:1000) in highly seropositive populations. There is increasing evidence that the frequency and severity of the clinical and laboratory abnormalities in infants with congenital CMV infection born to mothers with nonprimary CMV infection are similar to infants born after a primary maternal infection. This is particularly true for sensorineural hearing loss, which contributes to one third of all early-onset hearing loss in seropositive populations. This brief overview will discuss the need for more research to better clarify the natural history of cCMV in highly seropositive populations, which, in almost all populations, remains incompletely defined.<\/jats:p>","DOI":"10.1093\/infdis\/jiz443","type":"journal-article","created":{"date-parts":[[2019,8,29]],"date-time":"2019-08-29T19:26:39Z","timestamp":1567106799000},"page":"S15-S22","source":"Crossref","is-referenced-by-count":56,"title":["Natural History of Congenital Cytomegalovirus Infection in Highly Seropositive Populations"],"prefix":"10.1093","volume":"221","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8985-1570","authenticated-orcid":false,"given":"Marisa Marcia","family":"Mussi-Pinhata","sequence":"first","affiliation":[{"name":"Department of Pediatrics, Ribeir\u00e3o Preto Medical School, University of S\u00e3o Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aparecida Yulie","family":"Yamamoto","sequence":"first","affiliation":[{"name":"Department of Pediatrics, Ribeir\u00e3o Preto Medical School, University of S\u00e3o Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2020,3,5]]},"reference":[{"key":"2020030507500028700_CIT0001","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1128\/CMR.00062-12","article-title":"The \u201csilent\u201d global burden of congenital cytomegalovirus","volume":"26","author":"Manicklal","year":"2013","journal-title":"Clin Microbiol Rev"},{"key":"2020030507500028700_CIT0002","doi-asserted-by":"crossref","first-page":"2187","DOI":"10.1017\/S0950268812002695","article-title":"Early high CMV seroprevalence in pregnant women from a population with a high rate of congenital infection","volume":"141","author":"Yamamoto","year":"2013","journal-title":"Epidemiol Infect"},{"key":"2020030507500028700_CIT0003","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1002\/rmv.535","article-title":"Review and meta-analysis of the epidemiology of congenital cytomegalovirus (CMV) infection","volume":"17","author":"Kenneson","year":"2007","journal-title":"Rev Med Virol"},{"key":"2020030507500028700_CIT0004","doi-asserted-by":"crossref","first-page":"202","DOI":"10.1002\/rmv.655","article-title":"Review of cytomegalovirus seroprevalence and demographic characteristics associated with infection","volume":"20","author":"Cannon","year":"2010","journal-title":"Rev Med Virol"},{"key":"2020030507500028700_CIT0005","doi-asserted-by":"crossref","first-page":"e89857","DOI":"10.1371\/journal.pone.0089857","article-title":"Predictive factors of cytomegalovirus seropositivity among pregnant women in Paris, France","volume":"9","author":"N\u2019Diaye","year":"2014","journal-title":"PLoS One"},{"key":"2020030507500028700_CIT0006","doi-asserted-by":"crossref","first-page":"e2034","DOI":"10.1002\/rmv.2034","article-title":"Estimation of the worldwide seroprevalence of cytomegalovirus: a systematic review and meta-analysis","author":"Zuhair","year":"2019","journal-title":"Rev Med Virol"},{"key":"2020030507500028700_CIT0007","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1002\/rmv.1744","article-title":"The apparent paradox of maternal seropositivity as a risk factor for congenital cytomegalovirus infection: a population-based prediction model","volume":"23","author":"de Vries","year":"2013","journal-title":"Rev Med Virol"},{"key":"2020030507500028700_CIT0008","doi-asserted-by":"crossref","first-page":"e11","DOI":"10.1093\/cid\/ciq085","article-title":"Attribution of congenital cytomegalovirus infection to primary versus non-primary maternal infection","volume":"52","author":"Wang","year":"2011","journal-title":"Clin Infect Dis"},{"key":"2020030507500028700_CIT0009","doi-asserted-by":"crossref","first-page":"398","DOI":"10.1093\/cid\/cix337","article-title":"Risk factors for congenital cytomegalovirus infection following primary and nonprimary maternal infection: a prospective neonatal screening study using polymerase chain reaction in saliva","volume":"65","author":"Leruez-Ville","year":"2017","journal-title":"Clin Infect Dis"},{"key":"2020030507500028700_CIT0010","doi-asserted-by":"crossref","first-page":"1200","DOI":"10.1093\/infdis\/jiy321","article-title":"Seroconversion for cytomegalovirus infection during pregnancy and fetal infection in a highly seropositive population: \u201cThe BraCHS Study\u201d","volume":"218","author":"Mussi-Pinhata","year":"2018","journal-title":"J Infect Dis"},{"key":"2020030507500028700_CIT0011","volume-title":"World Population Prospects, 2019","author":"United Nations. 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