UAB researchers received a record $602 million in grants and contracts in fiscal year 2019, marking a second year of double-digit percentage growth in funding. Despite the global outbreak of COVID-19, that productivity has increased in fiscal year 2020. At a faculty town hall meeting July 8, Chris Brown, Ph.D., vice president for Research, noted that new awards for sponsored activity are up by $38 million through June, a 10% year-over-year increase.
You can keep up with the latest projects every Tuesday, when Brown’s office releases a list of the grants and contracts awarded the previous week (BlazerID required).
In this series, we’re spotlighting new or re-funded projects to offer a window into the groundbreaking, lifesaving work done by our colleagues around campus.
This week, we’re taking a look at a project to study a simple behavioral intervention in pregnant women to lower their risk of being infected with cytomegalovirus, a leading infectious cause of hearing loss in young children.
Project title: Prenatal behavioral intervention to prevent maternal cytomegalovirus in pregnancy
Principal investigator: Professor Karen Fowler DrPH, Division of Pediatric Infectious Diseases, Department of Pediatrics; co-investigators: Professor William Britt, M.D., Professor Suresh Boppana, M.D., and Associate Professor Shannon Ross, M.D., all of the Division of Pediatric Infectious Diseases; Professor Susan Davies, Ph.D., Department of Health Behavior; Professor Alan Tita, M.D., Ph.D., Department of Obstetrics and Gynecology
Funding: Five years, $2,981,588, from the Eunice Kennedy Shriver National Institute of Child Health & Human Development
Even though cytomegalovirus has infected a large portion of the world, it keeps a low profile. Nearly one in three children in the United States are infected by age 5 and more than half of American adults have been infected by age 40, according to the Centers for Disease Control and Prevention. The infection stays with them for life, but for most people this herpes virus — which comes from the same family as chickenpox and most often is referred to as CMV — brings no symptoms. When infection occurs in the womb, however, it can cause a range of complications. CMV is the leading infectious cause of hearing loss in young children, for instance.
One in 200 babies is born with CMV infection, said Karen Fowler, DrPH, professor in the Division of Pediatric Infectious Diseases in the School of Medicine. "Many times the babies can be completely asymptomatic — if you hadn't done a test after delivery you wouldn't have known. But some babies have hearing loss, or small heads or cerebral palsy and some even die. There are a variety of issues." Yet if you mention CMV to the vast majority of women, they are mystified, Fowler said. "They have never heard of it."
Fowler is principal investigator on a new five-year, nearly $3 million grant from the NIH's Eunice Kennedy Shriver National Institute of Child Health & Human Development to study a behavioral intervention in mothers that aims to prevent maternal CMV infection in pregnancy.
| "Many times the babies can be completely asymptomatic — if you hadn't done a test after delivery you wouldn't have known. But some babies have hearing loss or small heads or cerebral palsy, and some even die. There are a variety of issues." |
Antiviral therapies can be given to infants if they are diagnosed with CMV within 21 days of birth, but many babies are asymptomatic for months or even years. By then it is too late to intervene. "Some children come in at 2 years old with sudden hearing loss," Fowler said. "We get calls because we have a great infectious diseases division with an international reputation, but if a child wasn't tested at birth we cannot confirm CMV and there is nothing we can do for antiviral treatment at that time." Several pharmaceutical companies, including Merck and Moderna, are working on CMV vaccines, but these are probably years away from widespread clinical use, Fowler said.
In the meantime, "it's important that pregnant women know about it," Fowler said, "because there are simple things you can do to lower your risk."
Avoiding CMV
Cytomegalovirus is spread through "pretty intimate contact — sharing of bodily fluids such as saliva and breastmilk or through blood or urine," Fowler said. Handwashing and other hygiene measures lower the risk of spread. “But it's also important to not have encounters with the saliva of young children, whether it's your child or someone else's,” she said. “We think saliva is the most important route. A toddler brings you a toy and wants you to put it in your mouth. Or you are sharing the same spoon and cup — the things that parents normally do."
"It's important that pregnant women know about it, because there are simple things you can do to lower your risk." |
In many developing countries, nearly all women of child-bearing age are infected with CMV. It is less common in the United States, but becoming more so. "Women may come into child-bearing age who have been exposed over the course of their lives, but they can also get re-infected with a different strain of the virus," Fowler said. "Just because mom has it doesn't mean the baby is necessarily going to become infected," she noted. "The virus only crosses the placenta about a third of the time. But we hope to stop some of those infections, and also reinfections, during pregnancy."
Effective reminders
The study builds on previous research by Fowler and colleagues, funded by a grant from the Centers for Disease Control and Prevention, that showed women could make behavior changes to reduce their CMV risk during pregnancy in response to an intervention. "We all know behavior change is hard, but we found that in a mixture of urban women in Birmingham, Black and white, that they heard the message and changed their behaviors during pregnancy,” Fowler said. “We heard from pregnant women, 'I can do that — I'm happy to do that if I know it will protect my baby.'"
But convincing national OB/GYN groups to recommend CMV education as part of routine maternal care requires more evidence, Fowler said. "OBs are really busy; they say, ‘If we're going to get involved in educating women, we want to know it is going to make a difference.’"
The new study will include a short video explaining CMV, how it spreads and how to reduce the risk of acquiring an infection, followed by 12 weeks of reminders and encouragement to participants through text messages. "You need to hear something more than once to incorporate it into your daily life," Fowler said. A control group will receive similar messaging and reminders relating to stress-prevention.
"We will need to enroll several hundred women over time," Fowler said. The ongoing COVID-19 pandemic is complicating the trial launch, "but we are getting everything in place to start as soon as we can," she said. "We hope to get started by the fall."
