Wednesday, March 15, 2017

8- 20% of female child care providers contract CMV infection every year


Want a healthy baby? Want your friends to have one? Then know the numbers of congenital (present at birth) Cytomegalovirus (CMV), the #1 viral cause of birth defects. 

The New York Times states,"CMV is a Greater Threat to Infants Than Zika, but Far Less Often Discussed."

Mothers of toddlers in daycare and child care workers are at increased risk for contracting CMV.

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
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 150 babies are born with congenital (present at birth) CMV according to the Centers for Disease Control and Prevention (CDC).
  • According to the 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 most women heard of CMV?

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.”
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” (Washing our hands of the congenital cytomegalovirus disease epidemicCannon and Davis, 2005).

Does CMV prevention education reduce a women's chances of contracting CMV?
The New York Times summarized two prevention studies:  “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 Is a Greater Threat to Infants Than Zika, but Far Less Often Discussed, 2016)

CMV Prevention Resources

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).


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. 
  • Educational Coloring Book: 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 (the coloring books are also available on Amazon). 

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/ 


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, 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. 

Note: Above image from Surviving Loss: The Woodcutter's Tale--inspired by a girl with congenital cytomegalovirus (CMV).

BIBLIOGRAPHY




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 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); Elk Grove Village, IL. Retrieved December 30, 2016, from https://redbook.solutions.aap.org/DocumentLibrary/RB12_interior.pdf
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
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
Joseph, MSc, Serene A, et al. (2006, Sept). Cytomegalovirus as an occupational risk in daycare educators. Retrieved from PMC: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2528629/
Harrison, Gail Demmler MD. (2016, December 2). Cytomegalovirus: The Virus All Pregnant Women Should Know About Now. Retrieved from Medscape.com: http://www.medscape.com/viewarticle/872452

Lanzieri,Tatiana M., Chung, Winnie, Flores,Marily, Blum, Peggy, Caviness, A. Chantal, Bialek, Stephanie R., Grosse,Scott D., Miller, Jerry A., Demmler-Harrison, Gail. (2017, February ). Congenital Cytomegalovirus Longitudinal Study Group. Pediatrics. Retrieved from http://pediatrics.aappublications.org/content/early/2017/02/14/peds.2016-2610

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

Pass, Robert F. M.D.; Hutto, Cecelia M.D.; Ricks, Rebecca M.S.N., R.N.; and Cloud, Gretchen A. M.S. (1986, May 29). Increased Rate of Cytomegalovirus Infection among Parents of Children Attending Day-Care Centers. New England Journal of Medicine. Retrieved 2017, from New England Journal of Medicine: http://www.nejm.org/doi/full/10.1056/NEJM198605293142204

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

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/

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