arrangements is also relatively low. Then it is to be expected that as there is less transmission of CMV the pool of seronegative individuals will actually increase and many more women will reach their reproductive age without the benefit of immunity to CMV.

If the risk of primary CMV infection during gestation increases, it is logical to anticipate more cases of severe congenital infection, as seems to be occurring in our community.

The sequence of these changes in the various socioeconomic groups will differ within any given geographic region principally in relation to the popularity of breast-feeding and the utilization of day-care centers. Since the data analyzed in this review were obtained from a limited number of studies carried out in only a few urban settings in the United States, we should not extrapolate to other settings without considering the many variables that obviously affect the epidemiology of CMV.

SUMMARY

The increase in the popularity of breast feeding and utilization of child care arrangements are having a major effect on the epidemiology of cytomegalovirus infections. The impact is greater for women of upper socioeconomic background who send their toddlers to day-care centers and for day-care workers. If primary cytomegalovirus infections occur during pregnancy it is logical to anticipate more cases of severe congenital infections.

These studies were supported by General Clinical Research Center Grant RR0032, Program Project Grant HD10699, Children's Hospital Research Center Grant HD28831, and University of Alabama, Birmingham, Comprehensive Cancer Center Grant CA13148.

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