Tuesday, April 11, 2017

Have a toddler or care for one?



According to a recent New York Times article, CMV is a Greater Threat to Infants Than Zika, but Far Less Often Discussed (2016).

by Lisa Saunders

HAVE A TODDLER OR CARE FOR ONE?

Everyone agrees toddlers are cute--and they are! However, toddlers spread infections by putting each other’s toys in their mouths, sharing cups and utensils, and needing adults to wipe their noses, feed them, and change their diapers. If you have a toddler who participates in group activities with other toddlers, are a nursery volunteer, a babysitter, or a child care provider, you need to know about cytomegalovirus (CMV). 

THE PROBLEM

CMV can cause birth defects if a woman contracts the virus when she is pregnant. 
  • 1 out of 100 live babies are born with congenital (present at birth) CMV according to the American Academy of Pediatrics.
  • According to the Centers for Disease Control and Prevention (CDC): "Most babies with congenital CMV will not have signs or symptoms. However, about one in five babies with congenital CMV infection will have symptoms or long-term health problems such as hearing loss, vision loss, intellectual disability, small head size, lack of coordination, weakness or problems using muscles and seizures."  
  • "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.
  • Mothers of children in daycare are 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).

DILIGENCE REQUIRED!

Pregnant child care givers need to be extra diligent about sanitizing surfaces used by toddlers and washing their hands after direct contact with a toddler's bodily fluids. Assume ALL toddlers are excreting CMV because between 44% to 100% of toddlers were shedding the virus in the study,“Group day care and cytomegaloviral infections of mothers and children.” Toddlers can shed CMV for many months in their saliva, urine and other bodily fluids. 

WHAT TO DO?

The American Academy of Pediatrics  co-authored Caring for Our Childrenwhich includes Standard 7.7.1.1Staff Education and Policies on Cytomegalovirus (CMV), states childcare workers of childbearing age should be informed about their increased probability of exposure to CMV and:
  • Hygiene measures (especially handwashing and avoiding contact with urine, saliva, and nasal secretions) aimed at reducing acquisition of CMV;
  • The availability of counseling and testing for serum antibody to CMV to determine the caregiver/teacher’s immune status... 
WHY HAVEN'T YOU HEARD OF CMV BEFORE?

Less than half (44%) of OB/GYNs warn patients about CMV according to a survey done by the American College of Obstetricians and Gynecologists (ACOG) in 2007.  The following reasons have been cited for this: 

1.     Don’t want to frighten their patients: An OB/GYN was quoted in FitPregnancy magazine (June/July '08): "The list of things we're supposed to talk about during women's first visit could easily take two hours and scare them to death...That's just the reality."
2.     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” (Washing our hands of the congenital cytomegalovirus disease epidemicCannon and Davis, 2005).
3.     Feel prevention measures are “impractical or burdensome." According to the New York Times, “Guidelines from ACOG suggest that pregnant women will find CMV prevention ‘impractical and burdensome,’ especially if they are told not to kiss their toddlers on the mouth — a possible route of transmission.”

DOES PREVENTION EDUCATION WORK? 
Yes! In 2016, the New York Times summarized two prevention studies in its article,CMV Is a Greater Threat to Infants Than Zika, but Far Less Often Discussed:  “A study in a French hospital found five to 10 minutes of counseling about CMV prevention resulted in fewer women contracting the virus. In another study, pregnant mothers shown a video and offered hygiene tips were much less likely to get CMV (5.9 percent) than those not given information on prevention (41.7 percent).” 

CMV PREVENTION RESOURCES


FUN, FREE CMV PREVENTION TOOLKIT FOR FAMILIES AND CHILD CARE CENTERS
  • "Grandma" speaks for Miss Cup to teach germ prevention while featuring Mr. Knife's fear of the dish running away with the spoon to teach table-setting in the "color-me-in" fairytale,"Once Upon a Placemat: A Table Setting Tale." FREE Teaching Toolkit includes:
  • Placemats: Side one: Placemat with tableware characters with space for your coloring artist's name (perfect for laminating and using as a table-setting reminder). Side two: Germ prevention tips and hand-washing instructions.
  • Video: Short introduction of  the tableware characters by Lisa Saunders, the parent representative of the Congenital Cytomegalovirus Foundation. 
  • Educational Coloring Book:  Contact LisaSaunders42@gmail.com for a free pdf version of Once Upon a Placemat: A Table Setting Tale or ask your library to carry a copy for you to borrow (copies also available on Amazon). 
###


Author's note: I am the parent representative of the Congenital Cytomegalovirus Foundation, a CMV education consultant, and helped Connecticut become the second state in the U.S. to pass a CMV law. I was a licensed home daycare provider and church nursery volunteer who was not advised that caring for toddlers in a group setting increased my risk of contracting CMV. Although I washed my hands after every diaper change, I should have been much more diligent about washing them after picking up toys and wiping runny noses. My daughter Elizabeth (1989-2006) was born severely disabled from congenital CMV. 

CMV and Daycare Figures to Consider: 


What do other countries do about CMV in daycare?

In Queensland, Australia, they relocate “workers who are pregnant, or who expect to become pregnant, to care for children aged over two to reduce contact with urine and saliva.” In Germany: "Based on the German Maternity Protection Law (Mutterschutzgesetz)… 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..."

I wrote this blog post about the problem in case you would like to share some version of it: 

Have a toddler or care for one?



Gail J Demmler-Harrison, MD, Professor, Pediatrics, Section Infectious Diseases, Baylor College of Medicine, Attending Physician, Infectious Diseases Service, Texas Children's Hospital, CMV Registry, CMV Research and CMV Clinic.

Caroline Bailey, congenital CMV survivor and Master's college student. 


Brenda K. Balch, MD, Connecticut’s American Academy of Pediatrics Early Hearing Detection & Intervention Chapter Champion.



Sincerely,

Lisa Saunders, parent representative
PO Box 389
Mystic, CT 06355

Thursday, March 16, 2017

Dear Nursery or Child care Center: Please protect your child care givers from CMV

Flyer created by the National CMV Foundation. Click for more downloadable CMV flyers

CMV (cytomegalovirus) can cause birth defects if a woman contracts the virus when she is pregnant. Toddlers in child care are often shedding the virus, putting their caregivers at higher risk for contracting CMV. Congenital (present at birth), is the leading viral cause of birth defects, causing more disabilities than Down Syndrome, Fetal Alcohol Syndrome, Spina Bifida, and Pediatric HIV/AIDS.

The American Academy of Pediatrics states: "Spread of CMV from an asymptomatic infected child in child care to his or her mother or to child care providers is the most important consequence of child care-related CMV infection."  

To protect future babies, please ask child care centers to adhere to the following guidelines set forth and co-authored by the American Academy of Pediatrics in the book, "Caring for Our Children." Excerpt: 
Standard 7.7.1.1Staff Education and Policies on Cytomegalovirus (CMV) states childcare workers of childbearing age should be informed about their increased probability of exposure to CMV and:
  • Hygiene measures (especially handwashing and avoiding contact with urine, saliva, and nasal secretions) aimed at reducing acquisition of CMV;
  • The availability of counseling and testing for serum antibody to CMV to determine the caregiver/teacher’s immune status. 
The following is congenital CMV in numbers with embedded links for more information: 


What do other countries do about CMV in daycare?
In Queensland, Australia, they relocate “workers who are pregnant, or who expect to become pregnant, to care for children aged over two to reduce contact with urine and saliva.” In Germany: "Based on the German Maternity Protection Law (Mutterschutzgesetz)… 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..."


Learn more:

"CMV in Child Care: Protect Your Pregnancy"

Caring for a Toddler?
Everyone agrees toddlers are cute--and they are! But if you are a daycare worker, a nursery volunteer, or have a toddler in daycare, you need to know about cytomegalovirus (CMV). 
The Problem
CMV can cause birth defects if a woman contracts the virus when she is pregnant. The Centers for Disease Control and Prevention (CDC) states, "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," Toddlers spread infections by putting each other’s toys in their mouths, sharing cups and utensils, and needing adults to wipe their noses, feed them, and change their diapers. Between 8- 20% of female child care providers contract CMV infection every year.    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)


Diligence Required!
Pregnant child care givers need to be extra diligent about sanitizing surfaces used by toddlers and washing their hands after direct contact with a toddler's bodily fluids. Assume ALL toddlers are shedding CMV because between 44% to 100% of toddlers were shedding the virus in the study,“Group day care and cytomegaloviral infections of mothers and children.” Toddlers can shed CMV for many months in their saliva, urine and other bodily fluids. 

What to do?
The American Academy of Pediatrics  co-authored Caring for Our Children, which includes Standard 7.7.1.1Staff Education and Policies on Cytomegalovirus (CMV), which states childcare workers of childbearing age should be informed about their increased probability of exposure to CMV and:
  • Hygiene measures (especially handwashing and avoiding contact with urine, saliva, and nasal secretions) aimed at reducing acquisition of CMV;
  • The availability of counseling and testing for serum antibody to CMV to determine the caregiver/teacher’s immune status... 
CMV Prevention Resources
The Congenital CMV Disease Research Clinic and Registry provides resources to share with women of childbearing age. In addition, the National CMV Foundation features CMV prevention flyers for downloadingYou can also print the CDC’s congenital CMV pamphlet in English or Spanish, found on the National Birth Defects Prevention Network website. Utah, the first state to pass a law requiring daycare providers are informed about CMV (2013), provides this brochure for childcare providers. Cooperative Extension has several articles on sanitizing hands and surfaces in child care centers.  

Conclusion--Child Care Centers Should Provide CMV Prevention Education: 
Only 18.5% of licensed “in-home” daycare providers have heard of CMV according to a 2016 study. In addition, Providers do not know how to appropriately sanitize surfaces to reduce spread of disease.” For example, many providers use baby wipes to clean a surface. Although the surface may look clean, baby wipes do not sanitize it. "Intervening with child care providers and parents through child care facilities are key opportunities to reduce prevalence of CMV infection and other diseases."(Child Care Provider Awareness and Prevention of Cytomegalovirus and Other Infectious Diseases,”Thackeray and Magnusson, 2016).

ORGANIZATIONS THAT MAY HELP TRAIN CHILD CARE WORKERS
Agencies to Contact:
•             Your state’s daycare licensing department found at: http://www.healthychildcare.org/Contacts.html
•             Your local universities may have occupational medicine programs.
•             Child Care Aware: http://childcareaware.org/ 



Fun, Free Teaching Toolkit for Students and Their Families!
"Grandma" uses Miss Cup to enforce germ prevention and uses Mr. Knife's fear that the dish will run away with the spoon to teach table-setting in the educational coloring book,"Once Upon a Placemat: A Table Setting Tale." FREE Teaching Toolkit includes:

Placemats: Side one: Placemat with tableware characters with space for your coloring artist's name (perfect for laminating and using as a table-setting reminder) plus there is space available for your organization's information if so desired before copying. Side two: Germ prevention tips and hand-washing instructions.

Video: Short introduction of  the tableware characters found in the educational coloring booklet, Once Upon a Placemat: A Table Setting Tale, co-authored by Lisa Saunders, the parent representative of the Congenital Cytomegalovirus Foundation. (Ask your library to carry a copy of Once Upon a Placemat: A Table Setting Tale, or contact LisaSaunders42@gmail.com for a free pdf version. 


Author's note: I am the parent representative of the Congenital Cytomegalovirus Foundation and a CMV education consultant. I was a licensed home daycare provider and church nursery volunteer who was not advised that caring for toddlers in a group setting increased my risk of contracting CMV while pregnant. Although I washed my hands after every diaper change, I should have been much more diligent about washing them after picking up toys and wiping runny noses. My daughter Elizabeth (1989-2006) was born severely disabled from congenital (present at birth) CMV. My mission is to try to prevent this from happening to other child care providers (mothers of toddlers and professional daycare providers) and their future babies. You have my permission to republish my above post, "Dear Nursery or Daycare Center: Please protect your child care givers from CMV." Please see below my signature for resources  you may find helpful in your own quest to protect future children from suffering as my daughter did from congenital CMV. 


Sincerely,

Lisa Saunders, parent representative
PO Box 389
Mystic, CT 06355



RESOURCES FOR TRAINING CHILD CARE WORKER
    1. Standard 7.7.1.1: Staff Education and Policies on Cytomegalovirus (CMV). American Academy of Pediatrics (AAP), American Public Health Association, National Resource Center for Health and Safety in Child Care and Early Education.  Retrieved from National Health and Safety Performance Standards: Guidelines for Early Care and Education Programs: Caring for Our Children: http://cfoc.nrckids.org/StandardView/7.7.1.1
    2. National Health and Safety Performance Standards: Guidelines for Early Care and Education Programs. American Academy of Pediatrics, American Public Health Association, National Resource Center for Health and Safety in Child Care and Early Education. (2011). Retrieved from Caring for Our Children: http://cfoc.nrckids.org/WebFiles/CFOC3_updated_final.pdf
    3.     Cytomegalovirus Survival and Transferability and the Effectiveness of Common Hand-Washing Agents against Cytomegalovirus on Live Human Hands. American Society for Microbiology, 80(2 455-461): http://aem.asm.org/content/80/2/455.full (Stowella, J. D. (2014, January 2014 )
    4.     CMV prevention brochures (see Utah's brochure for childcare providers).
    5.     You can print the CDC’s congenital Cytomegalovirus (CMV) Pamphlet, English or Spanish, found at the National Birth Defects Prevention Network).
    6.     A Toolkit for Early Care and Education: A Checklist for Early Care and Education. Green Cleaning, Sanitizing, and Disinfecting: Retrieved 2017, from U.S. Environmental Protection Agency: https://www.epa.gov/sites/production/files/2013-08/documents/checklist_8.1.2013.pdf
    1. Handwashing: Green Cleaning, Sanitizing, and Disinfecting: A Toolkit for Early Care and Education: Toolkit for early child care and education discussing green cleaning, sanitizing, and disinfecting: Handwashing Fact Sheet. Retrieved from U.S. Environmental Protection Agency: https://www.epa.gov/sites/production/files/2013-08/documents/fact_sheet_hand_washing.pdf
    2. Henry the Hand provides infection control tool kits for schools and other groups. 


MY PERSONAL CMV MATERIALS: 

In addition to Once Upon a Placemat: A Table Setting Tale, I have authored or produced:  
  1. CMV prevention music video about my daughter’s life: Girl with congenital cytomegalovirus (CMV)
  2. Memoir: Anything But a Dog! The perfect pet for a girl with congenital CMV (Unlimited Publishing, 2008, Thousand Books, Japan, 2017)
  3. Booklet: Surviving Loss: The Woodcutter’s Tale: Fairytale about losing a child.
  4. Travel memoir: Mystic Seafarer's Trail: My misadventures trying to get thin and famous like Amelia Earhart (married near my home), so people will listen to my CMV prevention message.