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 7.7.1.1: Staff 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: 

• 1 out of 150 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.
• 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 a average cost per child of over $300,000” was the expense in the early 1990s to the US health care system associated with congenital CMV. 

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 7.7.1.1: 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 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 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.  

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

•             Occupational Safety and Health Administration (OSHA).

•             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

Congenital Cytomegalovirus Foundation
www.AuthorLisaSaunders.com
LisaSaunders42@gmail.com

PO Box 389

Mystic, CT 06355

RESOURCES FOR TRAINING CHILD CARE WORKER

1. 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
   7. 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
   8. 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.