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.Congenital CMV by the Numbers:
- 1 out of 100 babies are born with congenital CMV.
- 1 out of 5 babies born with congenital CMV will be permanently disabled according to the Centers for Disease Control and Prevention (CDC).
- 1 baby every hour is disabled by congenital CMV (cerebral palsy, mental impairment, hearing and vision loss, epilepsy).
- 8- 20% of female child care providers contract CMV infection every year.
- 1,260,600 work in child care according to the Department of Labor.
- 44% to 100% of two-year-olds in group daycare are excreting CMV.
- #1 Birth Defects Virus--Congenital CMV causes more disabilities than Down Syndrome, Fetal Alcohol Syndrome, Spina Bifida, and Pediatric HIV/AIDS
- 91% of women surveyed in 2015-2016 have never heard of CMV.
- $1.9 billion annually, with an average cost per child of over $300,000 is the estimated expense to the US health care system in caring for babies born disabled by congenital CMV.
- 10-25 % of babies born with asymptomatic congenital CMV will develop sensorineural hearing loss by age 18.
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." (Red Book: Infectious Diseases American Academy of Pediatrics, pp. 145, 2012)
Despite the above numbers, CMV prevention education is not part of a doctor's "standard of care," and in many states, CMV prevention education is not included on the Department of Health websites or in the required training for licensed daycare providers. This is because many people working for these agencies have never heard of congenital CMV (please tell them by directing them to the CDC website at: https://www.cdc.gov/cmv/clinical/features.html).
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).
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)
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 126.96.36.199: Staff 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 ResourcesThe 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 downloading. You 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 and Henry the Hand provides infection control tool kits for schools, etc.
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..."
Conclusion--U.S. 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).
RESOURCES FOR TRAINING CHILD CARE WORKERS
Agencies to Contact:
• Your state’s daycare licensing department found at: http://www.healthychildcare.org/Contacts.html
• Occupational Safety and Health Administration (OSHA) to see what they can do to help.
• Your local universities may have occupational medicine programs.
• Child Care Aware: http://childcareaware.org/
"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 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 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.
RESOURCES FOR TRAINING CHILD CARE WORKERS
- Standard 188.8.131.52: 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/184.108.40.206
- 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
- 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
- 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
- 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:
- CMV prevention music video about my daughter’s life: Girl with congenital cytomegalovirus (CMV)
- Memoir: Anything But a Dog! The perfect pet for a girl with congenital CMV (Unlimited Publishing, 2008, Thousand Books, Japan, 2017)
- Booklet: Surviving Loss: The Woodcutter’s Tale: Fairytale about losing a child.
- 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).
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/