Wednesday, May 17, 2017

WHAT TO SAY TO CAREGIVERS ABOUT CMV

by Lisa Saunders

NOT SURE WHAT TO SAY TO CAREGIVERS/TEACHERS?

Contact  your Department of Public Health to learn if they have materials and advice for you.

The following are some ideas for a memo:

“CMV—Another Good Reason to Wash Your Hands!”


What is CMV? 
According to the CDC, "Cytomegalovirus (pronounced sy-toe-MEG-a-low-vy-rus), or CMV, is a common virus that infects people of all ages. Over half of adults by age 40 have been infected with CMV...Most people infected with CMV show no signs or symptoms. However, CMV infection can cause serious health problems for people with weakened immune systems, as well as babies infected with the virus before they are born (congenital CMV)."

Remind your employees of your handwashing and sanitizing procedures (assuming you are following procedures by the American Academy of Pediatrics in "Situations that Require Hand Hygiene" from Caring for Our Children, or
NAEYC: National Association for the Education of Young Children), which provide strong protection against cytomegalovirus (CMV) infection. Remind them that cleaning hands or surfaces with diaper wipes does not sanitize them and they should never kiss children on the mouth or share food and utensils with them.

You could tell them something like, “As with anything, the effectiveness of the hygiene measures is impacted by how well individuals follow appropriate protocol.  Now is a good time to review the handwashing policy and monitor your own handwashing.”

Click here for sample talking points to cover.

Prevention tips include:
  • Wash hands often with soap and water for 15-20 seconds, especially after wiping runny noses, changing diapers, picking up toys, etc. If soap and water are not available, use alcohol-based hand gel.
  • Use soap and water or a disinfectant to clean hard surfaces that have been contaminated by secretions.
  • Don’t kiss young children on the lips or share food, drinks, or eating utensils with them.
  • Pregnant women working in child care facilities should minimize direct exposure to saliva…Hugging is fine and is not a risk factor, (NY Dept. of Health)
  • Staff should be advised not to allow children to put their fingers or hands in another person’s mouth. (AAP, 2011)
RESOURCES :

1."Staff Education and Policies on Cytomegalovirus (CMV)," American Academy of Pediatrics (AAP) et al., Caring for Our Childrenhttp://cfoc.nrckids.org/StandardView/7.7.1.1

2."Situations that Require Hand Hygiene" (AAP et al., Caring for Our Children): http://cfoc.nrckids.org/StandardView/3.2.2

3. National CMV Awareness Flyer with the Connecticut Department of Public Health (DPH) logo found under the "Information for Healthcare Providers” section at: http://www.ct.gov/dph/cwp/view.asp?a=3138&q=527824

4. Fact sheet from MotherToBaby.org on CMV  includes child care providers.

5.Connecticut Department of Public Health posts on its website: CDC Recommendations for People Who Care for Infants and Children

6.National CMV Foundation features several types of CMV flyers for downloading.

7.Congenital CMV Disease Research Clinic and Registry provides resources for women of childbearing age.

8. CMV prevention brochure specifically for child care providers: Utah's brochure for childcare providers).

9.For students and families: Free CMV Teaching Tool Kit: "Once Upon a Placemat: A Table Setting Tale" by Lisa Saunders—Educational coloring book and fairytale emphasizes hand-washing and refraining from sharing cups/utensils.

10, Henry The Hand teaching supplies/programs for schools. Created newsletter campaign on CMV.

11. Congenital CMV Foundations that help women of childbearing age protect their pregnancies.

12. Connecticut CMV Law: "Update on Statewide Neonatal CMV Screening" (December 8, 2015): "New legislation that requires screening for congenital CMV infection in neonates who fail their hearing tests... In this talk we will review the background to the legislation as well as the rationale behind CMV screening and the limitations of the available literature in guiding management. The steps that should occur as part of the CMV screening process will be outlined and discussed." Meeting Materials:

RESOURCES FOR TRAINING CHILD CARE WORKERS

Tuesday, May 16, 2017

Congenital CMV Foundations and how they help women of childbearing age protect their pregnancies.

CMV FOUNDATIONS IN THE U.S.

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. The CMV Registry supports CMV research, disseminates information and provides parent support. Visit: Dr. Demmler-Harrison’s Blog. Contact: 832-824-4330, gjdemmle@texaschildrens.org

“At the National CMV Foundation, we work to inform and educate others on specific prevention measures to protect against the risk of CMV infection.” They have a great CMV Q. and A; simple flyers for downloading, and ways to get involved

Lenore Pereira, Ph.D., Founder of Congenital Cytomegalovirus Foundation, and Professor, Cell and Tissue Biology Department, University of California San Francisco.  The Congenital CMV Foundation raises awareness about maternal testing for first infection during pregnancy, newborn testing and the need to develop a vaccine. Excellent research papers available on the website. Contact: lenore.pereira@ucsf.edu

National CMV Registry for Pregnant Women (part of the CMV Research Foundation)
Stuart Adler, M.D., Professor Emeritus of Pediatrics and Professor of Microbiology and Immunology, Virginia Commonwealth University. He organized the National CMV Registry for Pregnant Women. Contact: sadler@vcu.edu

OTHER COUNTRIES: 

Monday, May 15, 2017

WHY MOST CHILD CARE PROVIDERS HAVE NEVER HEARD OF CMV

According to the study “Child Care Provider Awareness and Prevention of Cytomegalovirus and Other Infectious Diseases,” only 18.5% of licensed “in-home” daycare providers have heard of CMV. The authors also state: “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. Baby wipes may make a surface look clean, but they do not sanitize it. (Thackeray and Magnusson, 2016).

REASONS WHY THERE IS SUCH LOW CMV AWARENESS

  • No central U.S. daycare licensing division to enforce licensing education and methods of CMV control: According to the Department of Labor, "Education and training requirements vary by setting, state, and employer."
  • Still no national CMV awareness campaign: “Despite being the leading cause of mental retardation and disability in children..."--Clinical Advisor, Educate pregnant women to prevent congenital CMV” (2014).
  • CMV prevention education is not part of a doctor’s “standard of care.”
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 lack of prevention education: 

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,’ explains OB-GYN Laura Riley, M.D., director of infectious disease at Massachusetts General Hospital in Boston. ‘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.” (Article, “Washing our hands of the congenital cytomegalovirus disease epidemic,” by Cannon MJ, Davis KF, published in BMC Public Health 2005, 5:70).
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.”
4.     Concerns about effectiveness of CMV prevention instructions.  “…because of concerns about effectiveness (i.e., Will women consistently follow hygienic practices as the result of interventions?), the medical and public health communities appear reluctant to embrace primary CMV prevention via improved hygienic practices, and educational interventions are rare,” state Drs. Cannon and Davis in “Washing our hands of the congenital cytomegalovirus disease epidemic

Monday, May 8, 2017

CMV BIBLIOGRAPHY WITH SOURCE LINKS

CMV BIBLIOGRAPHY WITH SOURCE LINKS
Compiled by Lisa Saunders

Adler SP, Finney JW, Manganello AM, Best AM. (2004, October). Prevention of child-to-mother transmission of cytomegalovirus among pregnant women. Retrieved from National Center for Biotechnology Information: http://www.ncbi.nlm.nih.gov/pubmed/15480372
Adler SP1, Finney JW, Manganello AM, Best AM. (1996, March). Prevention of child-to-mother transmission of cytomegalovirus by changing behaviors: a randomized controlled trial. Retrieved from PubMed.gov: https://www.ncbi.nlm.nih.gov/pubmed/8852913#
Adler, S. P. (2015, September). Prevention of Maternal–Fetal Transmission of Cytomegalovirus. Volume 2, Issue 9, Pages 1027–1028. BioMedicine. Retrieved November 9, 2016, from http://www.ebiomedicine.com/article/S2352-3964(15)30098-0/fulltext
Adler, Stuart P., M.D. (1989, November 9). Cytomegalovirus and Child Day Care. New England Journal of Medicine. Retrieved 2017, from http://www.nejm.org/doi/full/10.1056/NEJM198911093211903
Adler, Stuart, MD, Emeritus Professor of Pediatrics and Chairman, Division of Infectious Disease. (2014, Feb. 28). Public Hearing Testimony, Raised H.B. No. 5147 . Retrieved from Connecticut General Assembly: http://www.cga.ct.gov/2014/PHdata/Tmy/2014HB-05147-R000228-Stuart%20Adler,%20Emeritus%20Professor%20of%20Pediatrics%20and%20Chairman,%20Division%20of%20Infectious%20Disease-TMY.PDF
Aiken, Brianne M., Digital Content Editor. (2015, June 1). Connecticut passes cytomegalovirus screening law for newborns. Retrieved from Clinical Advisor: http://www.clinicaladvisor.com/web-exclusives/congenital-cytomegalovirus-cmv-connecticut-law/article/418100/
American Academy of Pediatrics . (2012, 2015). Children in Out-of-Home Care. In B. C. Pickering LK, Red Book: Infectious Diseases American Academy of Pediatrics (pp. 145 (2012); 144-145 (2015)). Elk Grove Village, IL. Retrieved December 30, 2016, from https://redbook.solutions.aap.org/DocumentLibrary/RB12_interior.pdf
American Academy of Pediatrics, American Public Health Association, National Resource Center for Health and Safety in Child Care and Early Education. (2011). National Health and Safety Performance Standards: Guidelines for Early Care and Education Programs. Retrieved from Caring for Our Children: http://cfoc.nrckids.org/WebFiles/CFOC3_updated_final.pdf
American Academy of Pediatrics, American Public Health Association, National Resource Center for Health and Safety in Child Care and Early Education. (n.d.). Standard 7.7.1.1: Staff Education and Policies on Cytomegalovirus (CMV). 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
American College of Obstetricians and Gynecologists. (2015, June). Cytomegalovirus, Parvovirus B19, Varicella Zoster, and Toxoplasmosis in Pregnancy. 125(6), 1514. Retrieved from American College of Obstetricians and Gynecologists (ACOG): https://access.acog.org/eweb/ACOGResponsivePage.aspx?WebCode=LoginRequired&Site=congress&urlReq=http://www.acog.org/Resources%20And%20Publications/Practice%20Bulletins/Committee%20on%20Practice%20Bulletins%20Obstetrics/Cytomegalovirus%20Parvovirus%20B19%2
AN ACT CONCERNING NEWBORN SCREENING FOR CYTOMEGALOVIRUS AND ESTABLISHING A PUBLIC EDUCATION PROGRAM FOR CYTOMEGALOVIRUS: Substitute House Bill No. 5147. (2014). Retrieved 2017, from State of Connecticut: https://www.cga.ct.gov/2014/FC/2014HB-05147-R000494-FC.htm
Armstrong, Farah,President and Founder, Maddie's Mission. (2014, Feb. 28). Public Hearing Testimony, Raised H.B. No. 5147 . Retrieved from Connecticut General Assembly : http://www.cga.ct.gov/2014/PHdata/Tmy/2014HB-05147-R000228-Farah,%20Armstrong-TMY.PDF
Arvin, A. et. al., . (2004). Vaccine Development to Prevent Cytomegalovirus Disease: Report from the National Vaccine Advisory Committee. Retrieved from Oxford Journals: http://cid.oxfordjournals.org/content/39/2/233.long
Babies Born with CMV (Congenital CMV Infection). (n.d.). Retrieved 2017, from Centers for Disease Control and Infection: https://www.cdc.gov/cmv/congenital-infection.html
Bailey, Jenny Meeden, Texas, baby first in Houston to receive ganciclovir treatment. (2014, Feb. 28). Public Hearing Testimony, Raised H.B. No. 5147. Retrieved from Connecticut General Assembly: http://www.cga.ct.gov/2014/PHdata/Tmy/2014HB-05147-R000228-Jenny%20Meeden%20Bailey-TMY.PDF
Balch, Brenda K., MD. (2015, February 20). HB 5525. Retrieved from Connecticut General Assembly: http://www.cga.ct.gov/2015/PHdata/Tmy/2015HB-05525-R000220-Brenda%20Kinsella%20Balch,%20MD.%20AAP%20Connecticut%20Chapter%20Champion%20for%20the%20Early%20Hearing%20Detection%20and%20Intervention-TMY.PDF
Balch, Brenda K; Saunders, Lisa. (2016, September 27). As One Door Closed, Another Door Opened: CT Congenital CMV Initiative. Retrieved from CMVConference.com: http://cmvconference.com/Materials/Austin/Tuesday/11.00AM/Brenda%20Lisa%20CMV%20Texas%202016%20PowerPoint%202%208_AMedits%202%20%202.pdf
Barry, A. J. (2013, December 18). Loss and love: Author raises awareness about preventable birth defect. Grace Body & Soul--The Day. Retrieved from http://www.theday.com/article/20131218/GRACE01/131219832/-1/grace
Blazek, Nicole, Senior Clinical Content Editor. (2014, June 21). Educate pregnant women to prevent congenital CMV. Retrieved from The Clinical Advisor: http://www.clinicaladvisor.com/educate-pregnant-women-to-prevent-congenital-cmv/article/357115/
Bond, A. (2015, September/October). In Memory of Elizabeth: Her daughter's death from a preventable disability spurs Lisa Avazian Saunders '82 into action. Cornell Alumni Magazine. Retrieved from http://cornellalumnimagazine.com/index.php?option=com_content&task=view&id=2235&Itemid=1&ed=49
Botti, D. J. (2009, Jan 21). What every pregnant woman needs to know. Times Herald-Record. Retrieved from http://www.recordonline.com/article/20090121/HEALTH/901210313
Cannon MJ, Westbrook K, Levis D, Schleiss MR, Thackeray R, Pass RF. . (2012, May). Awareness of and behaviors related to child-to-mother transmission of cytomegalovirus. Retrieved January 9, 2015, from National Center for Biotechnology Information, U.S. National Library of Medicine : http://www.ncbi.nlm.nih.gov/pubmed/22465669
Cannon, Michael J.; Davis, Katherine Finn. (2005, June 20). Washing our hands of the congenital cytomegalovirus disease epidemic. Retrieved from BMC Public Health: http://www.biomedcentral.com/1471-2458/5/70
Carlson, A. M., Norwitz, E. R., & Stiller, R. J. (Fall 2010). Cytomegalovirus Infection in Pregnancy: Should All Women Be Screened? Reviews in Obstetrics and Gynecology. Retrieved from National Center for Biotechnology Information: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3046747/
Centers for Disease Control and Prevention. (n.d.). Retrieved from Congenital CMV Infection Trends and Statistics: http://www.cdc.gov/cmv/trends-stats.html
Centers for Disease Control and Prevention (CDC). (n.d.). Cytomegalovirus (CMV) and Congenital CMV Infection. Retrieved from Centers for Disease Control and Prevention (CDC): http://www.cdc.gov/cmv/index.html
Centers for Disease Control and Prevention (CDC). (n.d.). Infant Health. Retrieved from Centers for Disease Control and Prevention (CDC): http://www.cdc.gov/nchs/fastats/infant-health.htm
Centers for Disease Control and Prevention (CDC). (n.d.). State and Territorial Data. Retrieved from Centers for Disease Control and Prevention (CDC): http://www.cdc.gov/nchs/fastats/state-and-territorial-data.htm
Chen, D. (2017, January 23). Utah's newborn screening law works to catch infants with hearing loss, study says. Deseret News. Retrieved from http://www.deseretnews.com/article/865671709/Utahs-newborn-screening-law-works-to-catch-infants-with-hearing-loss-study-says.html
CHILD CARE CENTER/GROUP INSPECTION FORM. (2017, January 2). Retrieved from Connecticut Office of Early Childhood: http://www.ct.gov/oec/lib/oec/licensing/childcare/cdcc_gdch_inspection.pdf
Childcare Workers. (n.d.). Retrieved January 1, 2017, from United States Department of Labor: Bureau of Labor Statistics: https://www.bls.gov/ooh/personal-care-and-service/childcare-workers.htm
Childcare Workers: Contacts for More Information. (n.d.). Retrieved 2017, from United States Department of Labor: https://www.bls.gov/ooh/personal-care-and-service/childcare-workers.htm#tab-9
Children's Hearing and Speech Services. (n.d.). Retrieved from Utah Department of Health: http://www.health.utah.gov/cshcn/CHSS/CMV.html
Cody, S. (2014, April 28). Mother on a mission to stop birth defects. Retrieved from Fox CT: http://foxct.com/2014/04/28/mother-on-a-mission-to-stop-birth-defects/
Cody, S. (2014, April 28). Mother Working to Protect Pregnant Moms From Dangerous Virus. The Hartford Courant. Retrieved from http://www.ctnow.com/family/hc-mommy-minute-0428-20140428-story.html
Cody, S. (2015, May 6). CT Now. Retrieved from CT Moms Fight for CMV Legislation: http://www.ctnow.com/family/ctnow-ct-moms-fight-for-cmv-legislation-20150505,0,3850658.column
Cody, S. (2015, May 27). New law in Connecticut to fight number one viral cause of birth defects. Retrieved from Fox CT: http://foxct.com/2015/05/27/new-law-in-connecticut-to-fight-number-one-viral-cause-of-birth-defects/
Connecticut Department of Public Health. (n.d.). Retrieved 2017, from Early Hearing Detection and Intervention Program: Congenital Cytomegalovirus (CMV): http://www.ct.gov/dph/cwp/view.asp?a=3138&q=527824
Cytomegalovirus (CMV) and Pregnancy. (2014, September 20 ). Retrieved from MotherToBaby.org: http://mothertobaby.org/fact-sheets/cytomegalovirus-cmv-pregnancy/
Cytomegalovirus (CMV) education bill on hold for now. (2014, May 8). Retrieved from Fox CT: http://foxct.com/2014/05/08/cytomegalovirus-cmv-education-bill-on-hold-for-now/
Cytomegalovirus. (2017). Retrieved from Daycare.com: https://www.daycare.com/fastfacts/illness/cytomegalovirus.html
Cytomegalovirus Infection. (n.d.). Retrieved 2017, from National Organization for Rare Disorders (NORD): https://rarediseases.org/rare-diseases/cytomegalovirus-infection/
Cytomegalovirus-CMV: H.B. 81 (2013) Public Health Initiative in conjunction with the Utah Department of Health. (n.d.). Retrieved from Utah Department of Health: http://www.health.utah.gov/prl/PDF/Utah_CMV_Public_Flyer_2013.pdf
Demmler-Harrison,Gail, MD,Director, Congenital CMV Disease Registry and Research Program. (2015, Feb. 20). Public Hearing Testimony, Raised H.B. No. 5525. Retrieved from Connectictut General Assembly: http://www.cga.ct.gov/2015/PHdata/Tmy/2015HB-05525-R000220-Gail%20Demmler%20Harrison,%20MD-TMY.PDF
Diener, Marissa L., Zick, Cathleen D., McVicar, Stephanie Browning, Boettger, Jill, Park, Albert H. . (2017, January). Outcomes From a Hearing-Targeted Cytomegalovirus Screening Program. Pediatrics. Retrieved from http://pediatrics.aappublications.org/content/early/2017/01/20/peds.2016-0789
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Doutre, S. M. Barrett, T. S. Greenlee, J. & White, K. R. . (2016). Losing Ground: Awareness of Congenital Cytomegalovirus in the United States. Journal of Early Hearing Detection and Intervention, 1(2), 9-48. Retrieved from http://digitalcommons.usu.edu/cgi/viewcontent.cgi?article=1035&context=jehdi
Doutre, Sara, co-founder, Utah CMV Council; Menlove,Ronda, Utah House of Representatives,. (n.d.). Retrieved from Utah CMV Council: http://www.utahcmvcouncil.org/about-us/
Elizabeth Ann Saunders. (2006, February 11). The Journal News. Retrieved from Jo: http://www.legacy.com/obituaries/lohud/obituary.aspx?n=elizabeth-ann-saunders&pid=149413661
Famigletti, C. (2015, February 20). Public Hearing Testimony--Substitute for H.B. No. 5525: An Act Concerning Cytomegalovirus. Hartford, Connecticut. Retrieved from https://www.cga.ct.gov/2015/PHdata/Tmy/2015HB-05525-R000220-Casey%20Famigletti-TMY.PDF
Fink, J. L. (2014, July 1). Congenital Cytomegalovirus Infection Time To Test Newborns. Retrieved December 6, 2014, from ENT Today: http://www.enttoday.org/article/congenital-cytomegalovirus-infection-time-to-test-newborns/
Goderis, Julie, MD, et al. (2014, October 27). Hearing Loss and Congenital CMV Infection: A Systematic Review. Retrieved from Pediatrics: http://pediatrics.aappublications.org/content/early/2014/10/21/peds.2014-1173.abstract#aff-1
Green Cleaning, Sanitizing, and Disinfecting: A Toolkit for Early Care and Education: A Checklist for Early Care and Education. (n.d.). Retrieved 2017, from U.S. Environmental Protection Agency: https://www.epa.gov/sites/production/files/2013-08/documents/checklist_8.1.2013.pdf
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: Fact Sheet: Handwashing. (n.d.). Retrieved 2017, from U.S. Environmental Protection Agency: https://www.epa.gov/sites/production/files/2013-08/documents/fact_sheet_hand_washing.pdf
Greenlee, Janelle, President and Founder, Stop CMV. (2014, Feb. 28). Public Hearing Testimony, Raised H.B. No. 5147 . Retrieved from Connecticut General Assembly: http://www.cga.ct.gov/2014/PHdata/Tmy/2014HB-05147-R000228-Janelle%20Greenlee,%20President%20and%20Founder,%20Stop%20CMV-TMY.PDF
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Saunders, L. (2001, September 5). A Tale of Two Dogs and a Shelter. Journal News. Retrieved from https://drive.google.com/file/d/0B9Klfxar2CmjdnVXLW9IT1VYaE0/view?usp=sharing
Saunders, L. (2001, August 3). Elizabeth and Floyd's Excellent Adventure. Rockland Review. Retrieved from https://drive.google.com/file/d/0B9Klfxar2CmjVjhxY0RwVnh1YzA/view?usp=sharing
Saunders, L. (2006, Summer). Epilepsy: Elizabeth, Forever Sweet Sixteen. CURE (Citizens United for Research in Epilepsy) Newsletter, p. 5. Retrieved from http://www.cureepilepsy.org/downloads/CureNewsLetterSum06.pdf
Saunders, L. (2006, October 18). The silent virus that silenced Elizabeth. Times Herald Record, p. 2B. Retrieved from https://drive.google.com/file/d/0B9Klfxar2CmjcXZqYkdNLWdub0E/view?usp=sharing
Saunders, L. (2007, September). Family Health: The Tragic Kiss--Suffern Mom Works to Spread Word About CMV. Rockland Parent Magazine. Retrieved from https://drive.google.com/file/d/0B9Klfxar2CmjakJDbTdsMXBWNmM/view?usp=sharing
Saunders, L. (2007, January 28). Pregnant Women: Learn Risk of CMV. The Journal News, p. 4B. Retrieved from https://drive.google.com/file/d/0B9Klfxar2CmjOXVNZ1c2YkNscEk/view?usp=sharing
Saunders, L. (2009). Anything But a Dog! The perfect pet for a girl with congenital CMV (cytomegalovirus). Retrieved from http://www.amazon.com/Anything-But-Dog-Congenital-Cytomegalovirus/dp/1588329968/ref=sr_1_1?s=books&ie=UTF8&qid=1340644532&sr=1-1&keywords=anything+but+a+dog+lisa+saunders
Saunders, L. (2010, Fall). CMV: The Virus Nobody Talks About. Siemens Healthcare Diagnostics magazine, p. 41. Retrieved from https://drive.google.com/file/d/0B9Klfxar2CmjdTNiXzN5SkRTSUM5Nk4wRGRXVnJ6TzJtdGRv/view
Saunders, L. (2012). Mystic Seafarer's Trail: Secrets behind the 7 Wonders, Titanic's Shoes, Captain Sisson's Gold, and Amelia Earhart's Wedding . CreateSpace Independent Publishing Platform . Retrieved from https://www.amazon.com/Mystic-Seafarers-Trail-Titanics-Earharts/dp/1480085847/ref=tmm_pap_swatch_0?_encoding=UTF8&qid=1484581084&sr=1-5
Saunders, L. (2013). Surviving Loss: The Woodcutter's Tale. CreateSpace Independent Publishing Platform. Retrieved from https://www.amazon.com/Surviving-Loss-Woodcutters-Lisa-Saunders/dp/1482315505/ref=asap_bc?ie=UTF8
Saunders, L. (2014, April ). Author Wears Many Hats. (S. Simcox, Ed.) Inside Mystic Magazine. Retrieved from https://drive.google.com/file/d/0B9Klfxar2CmjSTZZV0xOOTR5bVE/edit
Saunders, L. (2014, September). How a Parent Can Raise a CMV Prevention Message. Presentation: CMV Public Health & Policy Conference, Salt Lake City, UT . Mystic, CT. Retrieved from https://drive.google.com/file/d/0B9Klfxar2CmjcnYwYzhrc0NfR3c/view
Saunders, L. (2015, July 13). Congenital Cytomegalovirus (cCMV) and What Happened in Connecticut. PowerPoint Presentation to Medical Assistance Program Oversight Council's Women’s Health Committee. Hartford, Connecticut. Retrieved from https://www.cga.ct.gov/med/committees/med5/2015/0713/20150713ATTACH_CMV%20CT%20PowerPoint.pdf
Saunders, L. (2015, Februrary 20). Public Hearing Testimony--Substitute for H.B. No. 5525: An Act Concerning Cytomegalovirus. Hartford, Connecticut. Retrieved from https://www.cga.ct.gov/2015/PHdata/Tmy/2015HB-05525-R000220-Lisa%20Saunders,%20Parent%20Representative,%20Congenital%20Cytomegalovirus%20Foundation-TMY.PDF
Saunders, L. (2016). Color-Me-In Placemat with CMV Prevention: Side One. Once Upon a Placemat: A Table Settng Tale. Mystic, Connecticut. Retrieved from https://drive.google.com/file/d/0B9Klfxar2CmjbWlfQlpGS3VDMlBXVklDN0JnM0lxa3lXRVpR/view?usp=sharing
Saunders, L. (2016). Color-Me-In Placemat with CMV Prevention: Side Two. Mystic, CT. Retrieved from https://drive.google.com/file/d/0B9Klfxar2CmjcnZkNzlEOGRzX2NuTTg1T2ZZNWh3M3Zka184/view?usp=sharing
Saunders, L. (2016, Feb 26). Color-Me-In Video Introducing Book: Once Upon a Placemat: A Table Setting Tale. Includes germ/CMV prevention. Retrieved from Youtube: https://www.youtube.com/watch?v=_0jDOKPFg4M&feature=youtu.be
Saunders, L. (2016). Girl with congenital cytomegalovirus (CMV) set to song, "Voice for Sam" by Debra Lynn Alt. (L. Saunders, Producer) Retrieved from https://www.youtube.com/watch?v=vTbvsMyCftc
Saunders, L. (2016, December). Newsletter: Advocating for CMV awareness and policy. Mystic, Connecticut. Retrieved from Congenital CMV Newsletter: http://us4.campaign-archive2.com/?u=0dd2dc5fa327d215c27770e46&id=cb12b3d880&e=[UNIQID]
Saunders, L. (2016, December). What Pregnant Women and Child Care Givers Need to Know about CMV. Mystic, Connecticut. Retrieved from https://drive.google.com/file/d/0B9Klfxar2CmjWUFWY3M5TTBwQTQ/view?usp=sharing
Saunders, L. (2017). DAYCARE AND CMV: PROTECT YOUR PREGNANCY! Mystic, Connecticut: Unpublished. Retrieved from https://drive.google.com/file/d/0B9Klfxar2CmjdDJVb0dyb2FBM1E/view?usp=sharing
Saunders, L. (2017). Elizabeth and Riley the Miracle Dog (Japanese translation of Anything But a Dog! The perfect pet for a girl with congenital CMV). (S. Nakai, Trans.) Tokoyo: Thousands of Books Japan. Retrieved from http://shop.thousandsofbooks.jp/items/5173204
Saunders, L. (2017). Lisa Saunders, CMV Awareness and Policy Advocate. Retrieved from CongenitalCMV.blogspot.com: http://congenitalcmv.blogspot.com/2016/11/mother-of-congenital-cmv-girl-speaks.html
Saunders, L. (circa 1994). Elizabeth: A Christmas Blessing. Challenge Magazine, 2(4), pp. 14, 16. Retrieved from https://drive.google.com/file/d/0B9Klfxar2CmjN19kelJ0RGVYNEU/view?usp=sharing
Saunders, L. (Jan. 26, 2017). My Story with Congenital CMV Plus Research. Presentation , Society of Maternal Fetal Medicine, Las Vegas, Nevada. Retrieved from https://drive.google.com/file/d/0B9Klfxar2CmjVnZuWW5xa0NaSmc/view?usp=sharing
Saunders, Lisa, Parent Representative, Congenital CMV Foundation. (2014, Feb. 28). Public Hearing Testimony, Raised H.B. No. 5147. Retrieved from Connecictut General Assembly: http://www.cga.ct.gov/2014/PHdata/Tmy/2014HB-05147-R000228-Lisa%20Saunders,%20Parent%20Representative,%20Congenital%20CMV%20Foundation-TMY.PDF
Saunders, Lisa; Demmler-Harrison, Gail J, MD. (2016). Pregnant Women: Most common virus you never heard of; CMV (cytomegalovirus). (L. Saunders, Producer) Retrieved from Youtube: https://www.youtube.com/watch?v=8BEZzr0FCKQ
Saunders, Lisa; Tortora, Jackie. (2016). Once Upon a Placemat: A Table Setting Tale. CreateSpace Independent Publishing Platform. Retrieved from https://www.amazon.com/gp/product/1523750790?keywords=once%20upon%20a%20placemat&qid=1454858533&ref_=sr_1_1&sr=8-1
Schleiss, M. R. (2008). Cytomegalovirus Vaccine Development. Retrieved Januarary 14, 2015, from US National Library of Medicine: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2831992/
Shapiro, Eugene, M.D., Professor of Pediatrics, Epidemiology and Investigative Medicine, Yale University. (2014, Feb. 28). Public Hearing Testimony, H.B. No. 5147. Retrieved from Connecticut General Assembly: http://www.cga.ct.gov/2014/PHdata/Tmy/2014HB-05147-R000228-Eugene%20Shapiro,%20M.D.,%20Professor%20of%20Pediatrics,%20Epidermiology%20and%20Investigative%20Medicine,%20Yale%20University-TMY.PDF
Soren Gantt, MD, PhD, MPH1,2,3; Francois Dionne, PhD4; Fred K. Kozak, MD3,5; et al. (2016, October 10). Cost-effectiveness of Universal and Targeted Newborn Screening for Congenital Cytomegalovirus Infection. Retrieved from http://jamanetwork.com/journals/jamapediatrics/article-abstract/2557388
Souza, M. (2014, April 15). Saunders seeks help with CMV ‘silent virus’ prevention bill. Mystic River Press. Retrieved from https://drive.google.com/file/d/0B9Klfxar2CmjQmtkRUZuQzdBd1k/view?usp=sharing
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Substitute for H.B. No. 5525: An Act Concerning Cytomeglovirus. (2015). Retrieved from Connecticut General Assembly: https://www.cga.ct.gov/asp/cgabillstatus/cgabillstatus.asp?selBillType=Bill&which_year=2015&bill_num=5525+
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Abstract/Outline: Childcare and CMV: Protect Your Pregnancy

by Lisa Saunders

Abstract: Another good read to wash your hands! Annually, 8 - 20% of caregivers/teachers contract cytomegalovirus (CMV), the #1 birth defects virus. The American Academy of Pediatrics recommends counseling caregivers of their increased exposure to CMV, importance of hand-washing, and avoiding contact with urine, saliva, and nasal secretions. 

Presentation reviewed by 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.


OUTLINE:
1.      Congenital Cytomegalovirus:
According to the CDC, “Cytomegalovirus (pronounced sy-toe-MEG-a-low-vy-rus), or CMV, is a common virus that infects people of all ages. Over half of adults by age 40 have been infected with CMV...Most people infected with CMV show no signs or symptoms. However, CMV infection can cause serious health problems for people with weakened immune systems, as well as babies infected with the virus before they are born (congenital CMV).” Congenital CMV causes more disabilities than Down syndrome, fetal alcohol syndrome, spina bifida, and pediatric HIV/AIDS (NationalCMV.org).

2.      Connecticut Became 2nd State in U.S. to Pass a CMV Testing Law (not from CT? Learn about your state at http://www.healthychildcare.org/Contacts.html):
On January 1, 2016, Public Act Number 15-10 amended existing newborn screening requirements by mandating that infants who fail a newborn hearing screening also be screened for cytomegalovirus (CMV).  The Connecticut Department of Public Health provides resources for CMV prevention at: http://www.ct.gov/dph/cwp/view.asp?a=3138&q=527824

3.      Recommendations from the American Academy of Pediatrics (AAP)--Caring for Our Children, (2011): Caregivers/teachers should be informed about their increased exposure to CMV and: “The importance of hand hygiene measures (especially handwashing and avoiding contact with urine, saliva, and nasal secretions) to lower the risk of CMV… Female employees of childbearing age should be referred to their primary health care provider …for counseling about their risk of CMV infection.”

4.      Caregivers/teachers are at increased risk for CMV:
·        General population: 1-4% is the estimated “annual rate of a pregnant woman who is CMV antibody negative catching CMV for the first time in pregnancy” Demmler-Harrison, MD, CMV In Pregnancy: What Should I Know?, 2014).
·        Caregivers/teachers: 8- 20% of contract CMV infection every year (AAP et al.. 2011)
·        44% to 100% of two-year-olds in a group daycare study were excreting CMV for two years or more (Pass et al., 1986).

5.      Toddlers in group care spread infections such as CMV:
Toddlers put each other’s toys in their mouths, mouth each other’s cups, utensils, and toothbrushes, and need adults to wipe their noses, feed them, and change their diapers.

6.      Hand hygiene protocols reduce transmission of CMV: Study, “Cytomegalovirus Survival and Transferability and the Effectiveness of Common Hand-Washing Agents against Cytomegalovirus on Live Human Hands” (Stowella et al., 2014).
·        “After cleansing, no viable virus was recovered using water, plain soap, antibacterial soap, or sanitizer…Our data support the use of alcohol-based sanitizer or almost any hand-cleansing method that involves washing with water as a way to significantly reduce levels of viable CMV on hands and, presumably, reduce transmission risk.”
·        Diaper wipes are NOT EFFECTIVE for sanitizing hands and surfaces! “Viable CMV was recovered from 4/20 hands 10 min after diaper wipe cleansing. CMV remains viable on hands for sufficient times to allow transmission…”

7.      Data from five studies on the effectiveness of CMV prevention through hand hygiene and avoiding bodily fluids:  
“In each report, the efficacy of hygienic precautions has been > 75%...For seronegative pregnant women who are at high risk because of exposure to a young child in the home or in large group childcare, hygienic precautions are simple, inexpensive, and highly effective.” (Prevention of Maternal–Fetal Transmission of Cytomegalovirus, Adler, 2015)

8.      Why it is so important child care providers understand their increased risk for CMV:
Survey of In-Home Child Care Providers: Child Care Provider Awareness and Prevention of Cytomegalovirus and Other Infectious Diseases (Thackeray et al., 2016):
·        Only 18.5% of licensed “in-home” daycare providers have heard of CMV.
·        “Providers do not know how to appropriately sanitize surfaces to reduce spread of disease.” For example, many providers use diaper wipes to clean a surface. Using diaper wipes will not sanitize hands or surfaces.
·        “Increasing risk perception is important because providers may not be concerned about taking measures to reduce the probability of infection if they feel that they are at low risk.”
According to the Connecticut Department of Public Health, unlike childcare providers, “The risk of CMV infection among healthcare workers appears to be no greater than that among the general public. This may be due in part to adherence to standard precautions by healthcare providers when handling body fluids and the lower amount of personal contact in the healthcare setting.”

9.      Sample memo to educate child care workers:
“CMV—Another Good Reason to Wash Your Hands!” Remind your employees of your handwashing and sanitizing procedures, which provide strong protection against CMV. Staff should also be reminded not to share cups or eating utensils, kiss children on the lips, or allow children to put their fingers in another person’s mouth. Employees of childbearing age should be referred to their primary health care provider to discuss CMV.

10.   Resources to educate women of childbearing age about CMV prevention:
Mothers of children in daycare are also at increased risk for CMV (Pass et al., 1986). Provide caregivers and parents with flyers and information from Connecticut Department of Public Health, the  CDCCongenital CMV Disease Research Clinic and RegistryCongenital Cytomegalovirus Foundation, or National CMV Foundation, which has flyers for downloading and CMV Q & A at: https://www.nationalcmv.org/resources/faqs.aspx

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PREVIOUS CMV PRESENTATIONS BY LISA SAUNDERS

·        Society of Maternal Fetal Medicine, Las Vegas, NV (January 26, 2017).
"Congenital CMV and Research" – Caesars Palace. www.smfm.org/meetings/2-37th-annual-pregnancy-meeting. 
·        Maternal and Child Health (MCH) Coalition, Hamden, CT (December 13, 2016).
·        Congenital CMV Public Health & Policy Conference, Austin, TX (September 27, 2016).
Connecticut Congenital CMV Initiative”, co-presented with Brenda K. Balch, MD, Chapter Champion for the American Academy of Pediatrics Early Hearing Detection and Intervention Program, CMVconference.org  
·        Medical Assistance Program Oversight Council's Women’s Health Committee, Hartford, CT (July 13, 2015). “Connecticut and Congenital CMV”. www.cga.ct.gov/med/default.asp.
·        Connecticut Public Health Committee, Hartford, CT (February 20, 2015). Public Testimony for H.B. 5525:
“AN ACT CONCERNING CYTOMEGALOVIRUS”
·        CMV Public Health & Policy Conference, Salt Lake City, UT (September 26, 2014).
Parents Can Raise CMV Awareness (includes getting a bill passed).” Cmvconference.org/archive/cmv2014/index.html
·        Infection Control Nurses of Connecticut Annual Spring Seminar, Plantsville, CT (April 2013).
“CMV: Threat to immunocompromised persons.” http://infectioncontrolct.org/.
·        CMV 2012 Conference, San Francisco, CA (October 29-November 2, 2012).
“Raising CMV Awareness by Writing” - www.congenitalcmv.org.
·        Siemens Healthcare Diagnostics, Tarrytown, NY (2010).
“Living With Congenital CMV” (webinar). https://usa.healthcare.siemens.com.  
·        Maternal-Infant Services Network, Orange, Sullivan and Ulster Counties, NY (March 20, 2009).
“Pregnant Women Need to Know about CMV” - Perinatal Update 2009. misn-ny.org.
·        Centers for Disease Control and Prevention (CDC), Atlanta, GA (November 5-7, 2008).

“Congenital CMV: My Daughter’s Life and Death” - International Congenital CMV Conference. See: http://congenitalcmv.blogspot.com/2008/11/cdc-congenital-cmv-cytomegalovirus-and.html.