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In Reply: We agree with Dr Plotkin that it is likely that our study results underestimated the protection that an effective vaccine would provide against congenital CMV infection. By the selection of only multiparous women, using their previous pregnancy as a starting point for determining CMV status, we excluded younger primiparous women who were more likely to have primary maternal infections. An effective vaccine that could achieve protection similar to or greater than naturally acquired immunity could significantly reduce the central nervous system damage caused by congenital CMV infection.

Karen B. Fowler, DrPH
Department of Pediatrics
University of Alabama at Birmingham

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

JAMA. 2003;290:1709.

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