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To the Editor: Dr Fowler and colleagues¹ found that naturally acquired immunity to cytomegalovirus (CMV) among pregnant women resulted in a 69% reduction in the risk of congenital CMV to their offspring. They inferred that vaccine-induced infection would be of the same magnitude. However, this may be an underestimate because intrauterine infection of infants transmitted from seropositive mothers may result either from reinfection or reactivation of latent virus.

As seronegative vaccinees will not have endogenous CMV, and thus will not be subject to reactivation, their protection against primary infection could be higher than the rate reported by Fowler et al.

Financial Disclosure: Dr Plotkin is the former medical and scientific director of Aventis Pasteur and now serves as a consultant to the same company, which is developing a vaccine against CMV.

Stanley A. Plotkin, MD
Doylestown, Pa

1. Fowler KB, Stagno S, Pass RF. Maternal immunity and prevention of congenital cytomegalovirus infection. JAMA. 2003;289:1008-1011. FREE FULL TEXT

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2003;290:1709.

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