Saturday, March 11, 2017

Pregnant Child Care Givers: Protect your baby from CMV


by 
Lisa Saunders
Former licensed daycare provider

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). 

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."  

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 Standard 7.7.1.1Staff 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. [1]
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

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. Day 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).

Congenital CMV "By the Numbers: in the U.S.

Fun, Free Teaching Toolkit for Students and Their Families!
Miss Cup teaches germ prevention in educational coloring book, "Once Upon a Placemat: A Table Setting Tale"

"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. If you would like to distribute Once Upon a Placemat: A Table Setting Tale to daycare children and their families, they are available on Amazon or in bulk through www.authorLisaSaunders.com.

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Author's note: I was a licensed home daycare provider 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, "Pregnant Child Care Givers: Protect your pregnancy from CMV." Please see below my signature for resources and agencies 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 WORKERS
  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. 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
  4. 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


ENSURE YOUR STATE IS AWARE OF THE RECOMMENDATIONS MADE BY THE American Academy of Pediatrics.  

Agencies to Contact:
•             Your state’s 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/ See: http://childcareaware.org/providers/training-essentials/health-and-safety-training/
•             National Association for Family Child Care: https://www.nafcc.org/Observer-Requirements
•             National Association for the Education of Young Children: http://naeyc.org/content/about-naeyc
•             Council for Professional Recognition: http://www.cdacouncil.org/about/cda-credential



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. 

Bibliography

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

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

Pass RF, Hutto C. (1986, Jul-Aug 8). Group day care and cytomegaloviral infections of mothers and children. Retrieved from National Center for Biotechnology Information: http://www.ncbi.nlm.nih.gov/pubmed/3018892

Stranzinger J, Kozak A, Schilgen B, et al.9. (2016). Are female daycare workers at greater risk of cytomegalovirus infection? A secondary data analysis of CMV seroprevalence between 2010 and 2013 in Hamburg, Germany. Retrieved from GMS Hygiene and Infection Control: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4844919/

Thackeray, R. & Magnusson, B.M. (2016, April). Child Care Provider Awareness and Prevention of Cytomegalovirus and Other Infectious Diseases. Child & Youth Care Forum, 45(2), 301–314. Retrieved from http://link.springer.com/article/10.1007%2Fs10566-015-9325-y



WRITTEN OR PRODUCED BY LISA SAUNDERS

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. (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. (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

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