Monday, January 2, 2017

January--National Birth Defects Prevention Month. Daycare and CMV: Know the risks! Protect Your Pregnancy!


Daycare and CMV: Know the risks! Protect Your Pregnancy!

by Lisa Saunders


January is National Birth Defects Prevention MonthCan you please use this month to help spread the news about daycare workers and their increased risk for contracting CMV,  the leading viral cause of birth defects? According to the New York TimesCMV Is a Greater Threat to Infants Than Zika, but Far Less Often Discussed.[ii]

The National Birth Defects Prevention Network posts educational materials to distribute in honor of National Birth Defects Prevention Month, including the CDC's Congenital (present at birth) Cytomegalovirus (CMV) Pamphlet.


I am the parent representative of the Congenital Cytomegalovirus Foundation and in 2015, I helped Connecticut become the second state in the U.S. to pass a CMV testing law for babies who fail their newborn hearing screen. The prevention part of the Connecticut CMV bill didn't pass because of funds (and most states don't have any kind of CMV law), so I am hoping the media and general public will help make women of childbearing age aware of how to prevent contracting CMV. 

In my following blurb about congenital (present at birth) CMV, I refer to and link to scientific research so you can believe me. If you are a reporter, are you willing to reveal the "inconvenient truth" about the risk daycare providers are unknowingly placing on their pregnancies?


If you would like to share this message through Facebook, copy and paste this link: https://www.facebook.com/congenitalcmvnews/posts/1239373516147189:0

IF YOU WOULD LIKE TO DOWNLOAD MY FULL DOCUMENT, CLICK HERE: https://drive.google.com/file/d/0B9Klfxar2CmjdDJVb0dyb2FBM1E/view?usp=sharing

INTRODUCTION
I was unaware that cytomegalovirus (CMV) was an occupational risk for daycare educators[i] when I became a licensed home daycare provider in Maryland in 1987. I didn’t know that CMV was the leading viral cause of birth defects and could devastate my own pregnancy with Elizabeth, who was born severely disabled by congenital (present at birth) CMV in 1989.

Today, most U.S. daycare providers are still not aware of their increased risk for contracting CMV because prevention education is not part of a doctor’s “standard practice of care.” According to the New York Times, CMV Is a Greater Threat to Infants Than Zika, but Far Less Often Discussed.[ii]

At the time of Elizabeth’s birth, I was operating my licensed home daycare center and volunteering in our church nursery, additionally putting my pregnancy at risk. Elizabeth was born with an abnormally small head, known as microcephaly, was profoundly mentally impaired, cortically blind, and had cerebral palsy. After her birth, I was given information from the Centers and Disease Control Prevention (CDC) informing me that "People who care for or work closely with young children may be at greater risk of CMV infection than other people because CMV infection is common among young children..."[iii] This information came too late to spare my daughter the years of suffering that lay ahead of her. Nowhere in my daycare licensing literature or training was CMV mentioned. CMV prevention measures were not discussed in my prenatal doctor visits.

As Elizabeth aged, in addition to her disabilities requiring major surgeries such as spinal fusion, she began losing her hearing and developed epilepsy. She died at 16 during a seizure[iv] in 2006 while we were living in New York. I had a bad dream shortly after Elizabeth’s death about new parents wondering why I hadn’t done more to warn them about the precautions to take against CMV. Although I wrote a book about Elizabeth’s life, “Anything But a Dog: the perfect pet for a girl with congenital CMV” (Unlimited Publishing, 2008, Japan, 2017) to share the joys and struggles of raising a child with disabilities, which includes CMV prevention, congenital CMV still remains largely unknown. Recent HealthStylesTM surveys in the U.S. concluded that only 5% of men and 9% of women have heard of CMV (2015 and 2016).[v]

In 2010, my husband and I moved to Connecticut. In 2012, I received an email from a distressed grandmother about her grandson born with congenital CMV in a Connecticut hospital (I am the parent representative of the Congenital Cytomegalovirus Foundation). The mother of her grandson was a high school student interning in a Connecticut daycare center. The young mother, just like me over 20 years earlier, was unaware she was putting her pregnancy at greater risk by working in daycare with young children.  When I visited the family in the hospital, the attending nurse asked me, "Knowing what you do about CMV, why haven’t you launched an awareness campaign?"

I explained to the nurse that CMV parents, scientists and doctors have been trying for years to raise awareness, but the real risk of CMV to pregnancies remains little discussed—a real tragedy, especially in light of recommendations made by the American Academy of Pediatrics (AAP): "In view of the risk of CMV infection in child care staff and the potential consequences of gestational CMV infection, child care staff members should be counseled about risks. This counseling may include testing for serum antibody to CMV to determine the child care provider’s protection against primary CMV infection..."[vi] (pg 145, AAP Red Book, 2012; pgs 144-145, AAP Red Book, 2015).

According to the study, “Child Care Provider Awareness and Prevention of Cytomegalovirus and Other Infectious Diseases” by Rosemary Thackeray and Brianna M. Magnusson, “Women who are exposed to CMV prior to conception or within the first trimester of pregnancy and seroconvert have increased risk of their infant being infected with CMV (Hyde et al. 2010)” Despite a daycare worker’s high risk of contracting CMV, only 18.5% of licensed “in-home” daycare providers in the western U.S. have heard of it. The authors state, “Providers do not know how to appropriately sanitize surfaces to reduce spread of disease.” For example, using baby wipes may clean a surface, but they does not sanitize it. The authors conclude: “Awareness of CMV and how to prevent transmission of infectious disease is low. Intervening with child care providers and parents through child care facilities are key opportunities to reduce prevalence of CMV infection and other diseases” (Thackeray and Magnusson, 2016).


Daycare facts:

·        Each day in the United States, 61 % of children under the age of 5 are cared for in a child care facility (Laughlin 2013)” (Thackeray and Magnusson, 2016)

·        Between “7.9–10% of daycare workers contract CMV infections each year.” (“Losing Ground: Awareness of Congenital Cytomegalovirus in the United States, Doutre et al, 2016) [vii] 

·        “CMV-seronegative women have a 5- to 25-fold increased risk of developing CMV if exposed to children in day care…” state OB/GYNs Carlson, Norwitz and Stiller in their article, Cytomegalovirus Infection in Pregnancy: Should All Women Be Screened? (2010). [viii]

·        9%-20% of CMV-seronegative women who work in day care centers with young children will acquire CMV infection,” according to Dr. Gail Demmler-Harrison, Director, Congenital CMV Disease Research, Clinic & Registry in Cytomegalovirus: The Virus All Pregnant Women Should Know About Now, (2016)[ix]

·        Mothers of children in daycare are also at increased risk for contracting CMV according to the study, "Increased Rate of Cytomegalovirus Infection among Parents of Children Attending Day-Care Centers.” (Pass, et al, 1986)[x]

Between 20-60% of women are “susceptible (seronegative) to CMV at conception. Maternal immunity from a pre-conception infection protects against a second CMV infection and protects the fetuses from severe postnatal neurosensory deafness and neurologic damage. Thus a primary maternal infection with CMV in early pregnancy cause the majority of congenital disease…In the US, 60% of the mothers of children in daycare are CMV seronegative, and at least 25% of all children attending large group child care centers are shedding CVM,” states Dr. Stuart P. Adler in his 2015 article, “Prevention of Maternal–Fetal Transmission of Cytomegalovirus.”[xi]

If I had learned that I didn’t have CMV antibodies (seronegative) when planning to become pregnant,  I would not have cared professionally for several toddlers because it’s difficult to wash your hands every time you pick up toys, wipe noses and change diapers in addition to chasing after several toddlers. I also would have been far more careful when handling the saliva of my own toddler and would never have shared food or drinks with her. (All mothers like me, no matter what their occupation, believe—and justly so—that it is their right to know how to prevent congenital CMV from happening to their newborn). 

My publication research has led me to believe there are four mains reasons for the lack of CMV awareness in the U.S.:

1.     No national law to ensure compliance with the American Academy of Pediatrics recommendation to educate childcare workers about CMV risks. (The U.S. Senate recommends[xii] more CMV counseling, but it’s not a law.)
2.     CMV prevention education is not part of a doctor's "standard of care" (not even OB/GYNs)[xiii]
3.     No national CMV awareness campaign[xiv] targeted to women and men of childbearing age (the virus is also sexually transmitted so men need to be aware of precautions to take when handling toddler saliva/urine).
4.     No standardized national daycare licensing protocol as is the case in Germany and Queensland, Australia. (Queensland relocates workers who are pregnant, or “expect to become pregnant, to care for children aged over two to reduce contact with urine and saliva.”[xv] In Germany, “to protect DCWs [day care workers] from primary infection, their CMV serostatus must be checked at the beginning of their pregnancy. When the DCW is seronegative, she is excluded from professional activities with children under the age of three years in order to prevent feto- or embryopathy in her offspring."[xvi] 
  1. Most CMV infections go undiagnosed—“The virtual absence of a prevention message has been due, in part, to the low profile of congenital CMV. Infection is usually asymptomatic in both mother and infant, and when symptoms do occur, they are non-specific, so most CMV infections go undiagnosed.” (Article, “Washing our hands of the congenital cytomegalovirus disease epidemic,”[xvii] by Cannon MJ, Davis KF, published in BMC Public Health 2005, 5:70).

In Australia, “In a landmark decision in NSW [New South Wales], a childcare worker and her severely disabled son were awarded $4.65 million. A Court of Appeal ruled that the child's disabilities resulted from the woman being infected with cytomegalovirus (CMV) at work (Hughes v SDN Children's Services 2002).” [xviii] (See: https://www.worksafe.qld.gov.au/injury-prevention-safety/workplace-hazards/hazardous-exposures/biological-hazards/cytomegalovirus-cmv-in-early-childhood-education-and-care-services)



[i] (Joseph, MSc, Serene A, et al, 2006)
[ii] (LOUIS, 2016)
[iii] (Centers for Disease Control and Prevention (CDC), n.d.)
[iv] (Elizabeth Ann Saunders, 2006)
[v] (Doutre, S. M. Barrett, T. S. Greenlee, J. & White, K. R. , 2016)
[vi] (Infectious Diseases American Academy of Pediatrics, 2012, 2015)
[vii] (Doutre, S. M. Barrett, T. S. Greenlee, J. & White, K. R. , 2016)
[viii] (Carlson, Norwitz, & Stiller, Fall 2010)
[ix] (Harrison, Gail Demmler MD, 2016)
[x] (Robert F. Pass, M.D., Cecelia Hutto, M.D., Rebecca Ricks, M.S.N., R.N., and Gretchen A. Cloud, M.S., 1986)
[xi] (Adler, 2015)
[xii] (S.Res.215 - A resolution designating the month of June 2011 as "National Cytomegalovirus Awareness Month": 112th Congress (2011-2012), 2011)
[xiii] (LOUIS, 2016)
[xiv] (Blazek, Nicole, Senior Clinical Content Editor., 2014)
[xv] (Queensland Government (Australia), n.d.)
[xvi] (Stranzinger J, Kozak A, Schilgen B, et al.9, 2016)
[xvii] (Cannon, Michael J.; Davis, Katherine Finn, 2005)
[xviii] (Queensland Government (Australia), n.d.)

If you have a serious interest to learn more, contact me at LisaSaunders42@gmail.com for topics I cover that include:

1.         Daycare Workers, CMV, and Recommendations by the American Academy of Pediatrics
2.         American College of Obstetricians and Gynecologists (ACOG), Lack of Awareness Campaigns, and Daycare Licensing
3.         What is CMV Versus Congenital CMV?
4.         Studies Proving Prevention Education Works
5.         So Will it Make a Difference if Women Are Educated on CMV Prevention?
6.         Lack of CMV Knowledge Can Negatively Impact Unplanned Pregnancies
7.         Public Policy Needed to Protect Daycare Workers
8.         Additional Information For Policy Makers Including Costs
9.         Possible Protocols For Licensed Daycare Centers
10.       Help From Organizations
11.       Congenital Cytomegalovirus Contacts
12.       Summary Of My CMV Prevention Work—Care To Join Me?
13.       Appendix: Diseases Transmitted Through Saliva
14.       Fairy tale and coloring book, Once Upon a Placemat: A Table Setting Tale, which teaches CMV prevention from “Miss Cup” 

OR CLICK HERE TO GET THE REST OF MY REPORT: https://drive.google.com/file/d/0B9Klfxar2CmjdDJVb0dyb2FBM1E/view?usp=sharing




Author's note: I have a lot more research I can share with you. If interested, contact me at LisaSaunders42@gmail.com. The following photograph is me with Connecticut Governor Dan Malloy at the 2015 CMV bill signing requiring testing newborns for CMV if they fail their newborn hearing screen. 


Lisa Saunders
CMV Awareness and Policy AdvocateParent Rep., Congenital Cytomegalovirus Foundation
| LisaSaunders42@gmail.com | www.authorlisasaunders.com | http://congenitalcmv.org/ | PO Box 389, Mystic, CT 06355 | Photo: Lisa with CT Gov. Malloy at CMV bill signing
       


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