Friday, September 8, 2017

A bill to ensure child caregiver stop CMV, # 1 birth defects virus




A law to ensure child caregiver stop CMV, # 1 birth defects virus

Child care providers and teachers of toddlers are at increased risk for contracting cytomegalovirus (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

I am trying to get a CMV prevention education law passed in Connecticut (a CMV testing law passed in 2015). If you would be in support of ensuring childcare givers know their CMV risk and how to prevent it,  please let me know so I can make you aware of opportunities to express your support--either on my TV show, other speaking events, and/or writing a letter of support.  “Increasing risk perception is important because [child care] providers may not be concerned about taking measures to reduce the probability of infection if they feel that they are at low risk” (Thackeray et al., 2016).

I am a former licensed child care provider who was unaware of my increased risk for CMV, the danger it posed to my pregnancy, and my need to diligently practice the proven prevention measures already in place. Like me, less than 20% of child care providers in a recent survey knew about CMV and used diaper wipes to clean hands and surfaces (Thackeray et al., 2016).  As you are probably aware, diaper wipes do not kill CMV (Stowell et.al, 2014). Although CMV did no harm to the toddlers in my care, my daughter Elizabeth was born severely disabled by congenital CMV and passed away at the age of 16 in 2006. 

To learn more about CMV, see the flyer put out by the Connecticut Department of Public Health by clicking here. For specifics of CMV in child care, click on "15 Reasons Why Child Care Providers (and all women of childbearing age) Should Be Informed About Congenital CMV."  If interested, I am available to speak to your group--click for my outline and talking points for a presentation on CMV in Child Care or download the pdf.)

ChildCare Aware of America recently published my article, "The Danger of Spreading CMV: How We Can Protect Our Children," but there needs to be a law to ensure all child care providers learn about CMV and the recommendations by the American Academy of Pediatrics et al., in Caring for Our Children, and NAEYC: National Association for the Education of Young Children in its "Early Childhood Program Standards and Accreditation Criteria and Guidance for Assessment (10.D.01, p.91)which" includes: "a. steps to reduce occupational hazards such as infectious diseases (e.g., exposure of pregnant staff to CMV [cytomegalovirus], chicken pox)..."



(You can download this flyer by clicking here).

15 Reasons Why Child Care Providers (and all women of childbearing age) Should Be Informed About Congenital CMV (includes embedded links)


(for pdf, click here)


1)  Congenital CMV is the #1 Birth Defects Virus (Carlson et al., 2010). "More children will have disabilities due to congenital CMV than other well-known infections and syndromes, including own Syndrome, Fetal Alcohol Syndrome, Spina Bifida, and Pediatric HIV/AIDS" (NationalCMV.org).

2) 1% of live born infants are infected prenatally with CMV (American Academy of Pediatrics [AAP] et al., Caring for Our Children, 2011). 

3)  “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.”(Thackeray et al., 2016).

4)  CMV is an “occupational risk" for daycare educators (Joseph, et al., 2006). Caregivers/teachers should be told about CMV because of increased probability of exposure (AAP et al.. 2011). 

5)  General public: 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).

6)  Caregivers/teachers: 8- 20% of caregivers/teachers contract CMV infection every year (AAP et al.. 2011).

7)  44% to 100% of two-year-olds in group daycare are excreting CMV (Pass et al., 1986).

8)  Only 18.5% of licensed “in-home” daycare providers have heard of CMV according to “Child Care Provider Awareness and Prevention of Cytomegalovirus and Other Infectious Diseases” (Thackeray et al., 2016).

9)  NAEYC: National Association for the Education of Young Children and its "Early Childhood Program Standards and Accreditation Criteria and Guidance for Assessment (10.D.01, p.91)" includes: "a. steps to reduce occupational hazards such as infectious diseases (e.g., exposure of pregnant staff to CMV [cytomegalovirus], chicken pox)..."

10)  It is a worker's right to know occupational hazards according to the Occupational Safety and Health Administration (OSHA). There are more than half a million child care workers (573,430) in the U.S. according to the Child Care in America: 2016 State Fact Sheet report (pdf) published by Child Care Aware of America

11) “Providers do not know how to appropriately sanitize surfaces to reduce spread of disease.” Many providers use diaper wipes to clean a surface. Diaper wipes do not sanitize (Thackeray et al., 2016).

12) “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” (Thackeray et al., 2016).

13)  Mothers of children in daycare are also at increased risk for CMV (Pass et al., 1986). “61 % of children under the age of 5 are cared for in a child care facility...Intervening with child care providers and parents through child care facilities are key opportunities to reduce prevalence of CMV infection and other diseases.” (Thackeray et al., 2016).

14)  $1.86 billion annually, with a cost per child of more than $300,000, is the estimated cost of congenital CMV to the US health care system (Modlin, Arvin, et al., 2004).

15)  The CDC "suggests that pregnant women reduce their risk of CMV acquisition during pregnancy using simple hygienic precautions but this suggestion is not often followed...the efficacy of hygienic precautions has been [greater than] 75%.” (Adler, 2015).  “Perhaps no single cause of birth defects and developmental disabilities in the United States currently provides greater opportunity for improved outcomes in more children than congenital CMV…women deserve to be informed about how they can reduce their risk of CMV infection during pregnancy…” (Cannon et al., 2005).

...

Here is my One-Page CMV Fact Sheet for Policy Makers, which includes cost estimates. The Connecticut Department of Public Health, http://www.ct.gov/dph/cwp/view.asp?a=3138&q=527824provides the following information and flyers about Congenital CMV:

  1. National CMV Foundation flyer: Are You Pregnant? (2017). Retrieved from Connecticut Department of Public Health: http://www.ct.gov/dph/lib/dph/ehdi/ncmvf_awareness_flyer_ct_dph.pdf
  2. About Cytomegalovirus (CMV) FOR OBSTETRIC HEALTH CARE PROVIDERS. (2017). Retrieved from Connecticut Department of Public Health: http://www.ct.gov/dph/lib/dph/ehdi/about_cmv_obs.pdf
  3. About Cytomegalovirus (CMV): TESTING FOR OBSTETRIC HEALTH CARE PROVIDERS. (2017). Retrieved from Connecticut Department of Public Health: http://www.ct.gov/dph/lib/dph/ehdi/cmv_testing_info_obs.pdf


Prior Connecticut CMV Bills: 


2014: The following CMV education and testing bill passed the House, but was never brought to the Senate floor: H.B. No. 5147. (2014). Retrieved from Connecictut General Assembly : http://www.cga.ct.gov/asp/cgabillstatus/cgabillstatus.asp?selBillType=Bill&bill_num=5147&which_year=2014

2015: The following CMV testing bill passed in 2015: H.B. No. 5525: An Act Concerning Cytomegalovirus. (2015). Retrieved from Connecticut General Assembly: https://www.cga.ct.gov/asp/cgabillstatus/cgabillstatus.asp?selBillType=Bill&which_year=2015&bill_num=5525+


    MORE RESOURCES

                              Tuesday, September 5, 2017

                              2017 Tool Kit: CMV in Child Care Awareness

                              Child care providers should be educated about CMV in child care. If you would like to ask your legislator to pass a law to ensure that they are, the following are some suggested print outs to place in a three ring binder in plastic sheets for your representatives:

                              1. Flyer for healthcare providers and those who care for toddlers--either their own or professionally: Two-sided flyer includes poster for hanging and content from CT Public Health webpage. CT Dept Public Health CMV flyer/web content.
                              2. Pamphlet for policy makers/daycare directors: six panel, two page flyer, front and back, for those who want to ensure child care providers learn how to protect their pregnancies: CT Child Care Providers Against CMV
                              3. Assorted Flyers: National CMV Foundation: Click the following for simple flyers for downloading. The National CMV Foundation allowed the Connecticut Department of Public Health to include its logo in this flyer. 
                              4. One-Page CMV Fact Sheet for Policy Makers includes cost estimates
                              5. Recommendations made by the American Academy of Pediatrics or: "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
                              6. ChildCare Aware of America:  "The Danger of Spreading CMV: How We Can Protect Our Children."
                              7. Recent survey of child care providers (most have never heard of CMV).  
                              8. Study showing that diaper wipes do not kill CMV. 
                              9. Study: "In the past, the hazards facing child care workers have largely been ignored by health and safety professionals, due in part to a lack of awareness of hazards and inconsistencies in state health and safety requirements" (Bright et al., 1999).
                              10. Rights of child care providers:  Occupational Safety and Health Administration (OSHA) states it is a worker's right to know occupational hazards
                              11. State child care licencing departments: click here
                              12. States with a CMV law: click here
                              13. Study:  "Children cared for at daycare or in preschool education exhibit a two to three times greater risk of acquiring infections...control measures are indispensable to the prevention and control of infectious diseases." (Nesti et al,, 2007)
                              14. Child with Congenital CMV in Your Childcare Center? What to tell your staff
                              15. 15 Reasons to Tell Child Care Providers About CMV (for pdf, click here)
                              16. Fact sheet from MotherToBaby.org on CMV  includes child care providers. 
                              17. CMV prevention brochure specifically for child care providers: Utah's brochure for childcare providers.
                              18. NAEYC: National Association for the Education of Young Children and its "Early Childhood Program Standards and Accreditation Criteria and Guidance for Assessment (10.D.01, p.91)" includes: "a. steps to reduce occupational hazards such as infectious diseases (e.g., exposure of pregnant staff to CMV [cytomegalovirus], chicken pox)..."
                              19. LOUIS, C. S. (2016, Oct. 24). CMV Is a Greater Threat to Infants Than Zika, but Far Less Often Discussed. The New York Times. Retrieved from http://www.nytimes.com/2016/10/25/health/cmv-cytomegalovirus-pregnancy.html?_r=0
                              20. H.B. 81 Second Substitute Cytomegalovirus Public Health Initiative. (2013 General Session). Retrieved from Utah State Legislature: http://le.utah.gov/~2013/bills/static/hb0081.html
                              Connecticut: 
                              1. Flyers from the Connecticut Department of Public Health website,  Congenital Cytomegalovirus (CMV): http://www.ct.gov/dph/cwp/view.asp?a=3138&q=527824
                              2. National CMV Foundation flyer: Are You Pregnant? (2017). Retrieved from Connecticut Department of Public Health: http://www.ct.gov/dph/lib/dph/ehdi/ncmvf_awareness_flyer_ct_dph.pdf
                              3. About Cytomegalovirus (CMV) FOR OBSTETRIC HEALTH CARE PROVIDERS. (2017). Retrieved from Connecticut Department of Public Health: http://www.ct.gov/dph/lib/dph/ehdi/about_cmv_obs.pdf
                              4. About Cytomegalovirus (CMV): TESTING FOR OBSTETRIC HEALTH CARE PROVIDERS. (2017). Retrieved from Connecticut Department of Public Health: http://www.ct.gov/dph/lib/dph/ehdi/cmv_testing_info_obs.pdf
                              5. H.B. No. 5147. (2014). Retrieved from Connecictut General Assembly : http://www.cga.ct.gov/asp/cgabillstatus/cgabillstatus.asp?selBillType=Bill&bill_num=5147&which_year=2014
                              6. H.B. No. 5525: An Act Concerning Cytomegalovirus. (2015). Retrieved from Connecticut General Assembly: https://www.cga.ct.gov/asp/cgabillstatus/cgabillstatus.asp?selBillType=Bill&which_year=2015&bill_num=5525+

                              Thursday, August 3, 2017

                              Child with Congenital CMV in Your Childcare Center? What to tell your staff

                              Are you a childcare provider being asked to care for a child born with congenital CMV? 
                              Not sure what to tell your staff? 

                              Click on the following National CMV Foundation  flyer,  "Should you exclude a child born with CMV?" for an answer to this question and read below for more information. According to the flyer (which also includes prevention tips): "Most children born with congenital CMV (cytomegalovirus) will shed, or release, the virus in their body fluids throughout their toddler and preschool years. However, CMV is a very common childhood virus, affecting 70 percent of healthy children between 1 and 3 years of age... According to the Centers for Disease Control and Prevention (CDC), screening of children for CMV infection is not recommended, and infected children should not be excluded from school or other settings. Children born with congenital CMV pose no threat to their peers and no more of a threat to those at risk for CMV infection (ie. pregnant women) than would any other child." 

                              If a child is  KNOWN to be excreting the virus, this is what was posted in a newsletter by the Congenital CMV Disease Research Clinic & Registry:


                              Q. "There are pregnant teachers and other care givers at our school who work closely with children known to have CMV infection. For their safety, should these employees be relieved from their duties in caring for these children?"

                              A: “Changing the duties of a teacher or care giver from children known to have CMV infection to other children may not reduce their risk of acquiring CMV. It is a common virus in all children. In fact, studies reveal that between 30 and 80% of children between the ages of 1-3 years of age who attend some form of group care are excreting CMV. In this setting transmission of CMV is usually transmitted from child-to-child by direct contact with bodily fluids such as saliva or urine. It also may be transmitted to care givers. Therefore it is wise for care givers in this type of setting to be aware of CMV and consider knowing their CMV antibody status. If results are negative, they are susceptible to catching CMV for the first time and it is a potential risk to the fetus if they are pregnant. On the other hand, if results of a CMV antibody titer (IgG) is positive, they have already acquired CMV at some time in their life and their risk is greatly reduced. Additionally, it is important for all care givers to practice good hygienic measures. This is achieved by hand washing with soap and water, especially after diaper changes and any contact with a child's bodily fluids. Kissing and sharing food or drink also should be avoided.” 




                              Childcare staff: 
                              You need to assume ALL young children 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. 

                              Pregnant child care givers need to be diligent about sanitizing surfaces used by toddlers and washing their hands after direct contact with bodily fluids. Licensed childcare facilities have hygiene protocols in place. 

                              The following article by me was written for caregivers and published by ChildCare Aware: 



                              If you have any more questions, please let me know.


                              Lisa Saunders, former licensed daycare provider
                              Parent Rep., Congenital Cytomegalovirus Foundation

                              Monday, July 24, 2017

                              Back to School: Share a Meal--Not the Germs! Free Table-Setting Tool Kit Teaches How


                              Back to School: Share a Meal--Not the Germs! 

                              Free Table-Setting Tool Kit Teaches How

                              Teachers/caregivers of young children are at greater risk for contracting diseases as are the children in their care: "Children cared for at daycare or in preschool education exhibit a two to three times greater risk of acquiring infections...control measures are indispensable to the prevention and control of infectious diseases.(Nesti et al,, 2007)

                              Did you know there are many diseases spread through saliva? These include: 

                              1. Cytomegalovirus (CMV). Pregnant teachers can contract CMV from their students and pass it to their unborn babies. Congenital (present at birth) CMV is the leading viral cause of birth defects. Staff of childbearing age need to know the "importance of hand hygiene measures (especially handwashing and avoiding contact with urine, saliva, and nasal secretions) to lower the risk of CMV " (American Academy of Pediatrics [AAP] et al., Caring for Our Children, 2011). 
                              2. Cavity-causing germs.
                              3. Respiratory infections including influenza and croup.
                              4. Strep throat, tonsillitis, and scarlet fever.
                              5. Mononucleosis, commonly known as the “kissing disease,” caused by the Epstein-Barr virus.
                              6. Cold sores, caused by herpes simplex virus-1.
                              7. Hand, foot, and mouth disease, caused by a strain of Coxsackie virus.

                              Teach Infection Control! 

                              Teachers/caregivers can share a meal with their students without sharing the germs! Teach children the importance of handwashing and refraining from sharing cups and utensils with each other by downloading the free program kit created by Lisa Saunders, author of "The Danger of Spreading CMV: How We Can Protect Our Children" published by ChildCare Aware and the "color-me-in" fairytale, Once Upon a Placemat: A Table Setting Tale.  

                              FREE Teaching Tool Kit includes:

                              1. Placemat, Side OnePlacemat with tableware characters with space for your coloring artist's name (perfect for laminating and using as a table-setting reminder). 
                              2. Placemat, Side TwoGerm prevention tips and hand-washing instructions.
                              3. Video: Short introduction of  the tableware characters by Lisa Saunders, the parent representative of the Congenital Cytomegalovirus Foundation. 
                              4. Educational Coloring Book:  "Grandma" reminds children when and why to wash their hands and speaks for Miss Cup to teach germ prevention. She stresses Mr. Knife's fear of the dish running away with the spoon to teach table-setting. For a free pdf version of Once Upon a Placemat: A Table Setting Tale, contact LisaSaunders42@gmail.com or ask your library to carry a copy for you to borrow (copies also available on Amazon). 




                                  Professional reviews:

                                  "Once Upon a Placement is a clever way to get across an important message about prevention of infectious diseases. As a doctor, I recommend it to my young patients and their families. As a grandmother, I have shared it with my granddaughter." Gail J Demmler Harrison, MD, CMV Registry, CMV Research and CMV Clinic

                                  "The lesson of how to set a table is valuable as this is part of encouraging a family to sit down and eat together—a main inte
                                  rvention in preventing obesity," said Alison Dvorak, MS, RDN, CDN, of Franklin, Connecticut.









                                  ###

                                  Author's note:  “Once Upon a Placemat” is an expanded version of the fairytale Saunders told in her children’s novel, “Ride a Horse, Not an Elevator,” which is available on Amazon and was featured in the Cornell University 4-H “Horse Book in a Bucket” program.

                                  About the author:
                                  .Lisa Saunders is an award-winning writer living in Mystic, Connecticut, with her husband and hound. A graduate of Cornell University, she is the parent representative of the Congenital Cytomegalovirus (CMV) Foundation, and in 2015, was instrumental in helping Connecticut become one of the few states in the country to enact a law combating the leading viral cause of birth defects, congenital CMV.  Saunders said, “CMV is carried by a high percentage of apparently healthy toddlers. It is found in bodily fluids such as saliva and is of concern to women of childbearing age because the virus can lead to complications in their baby's development if they are pregnant while infected.”

                                  Co-author of "Once Upon a Placemat," Jackie Tortora, is a digital strategist living with her husband and their young son in Vienna, Virginia. 

                                  The story was illustrated by Marianne Greiner of Bloomfield, New York.  



                                  For more information, visit www.authorlisasaunders.com or write to LisaSaunders42@gmail.com