Immunoprophylaxis against cytomegalovirus disease.

Abstract

Patients with either deficient or immature immune systems need protection against cytomegalovirus (CMV) disease. That maternal immunization prior to pregnancy will protect newborns from congenital disease is suggested by the fact that newborns who acquire CMV either via transfusion or transplacentally are relatively protected if their mothers had antibodies to CMV prior to pregnancy. For patients becoming partially immunocompromised following solid organ transplantation, protection against severe CMV disease is afforded by immunity acquired either by wild-type infection prior to transplantation or passive or active immunization. In three randomized placebo-controlled studies, live attenuated CMV vaccine has successfully protected seronegative recipients of kidneys from seropositive donors from severe CMV disease by efficiently inducing humoral and cellular immunity. Subunit vaccines comprised of glycoprotein gB, the viral component containing the majority of viral neutralizing epitopes, are in the early phases of study, as are strategies to provide patients with CD8+ deficiency immunoprophylaxis via adoptive transfer of cytotoxic T-cells expanded in vitro against CMV structural proteins. Given all of these facts, safe and effective CMV immunoprophylaxis against CMV disease is possible.