Tuesday, April 11, 2017

Have a toddler or care for one?



According to a recent New York Times article, CMV is a Greater Threat to Infants Than Zika, but Far Less Often Discussed (2016).

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 100 live babies are born with congenital (present at birth) CMV according to the American Academy of Pediatrics.
  • According to the Centers for Disease Control and Prevention (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 YOU HEARD OF CMV BEFORE?

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.”

DOES PREVENTION EDUCATION WORK? 
Yes! In 2016, the New York Times summarized two prevention studies in its article,CMV Is a Greater Threat to Infants Than Zika, but Far Less Often Discussed:  “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 PREVENTION RESOURCES


FUN, FREE CMV PREVENTION TOOLKIT FOR FAMILIES AND CHILD CARE CENTERS
  • "Grandma" speaks for Miss Cup to teach germ prevention while featuring Mr. Knife's fear of the dish running away with the spoon to teach table-setting in the "color-me-in" fairytale,"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). Side two: Germ prevention tips and hand-washing instructions.
  • Video: Short introduction of  the tableware characters by Lisa Saunders, the parent representative of the Congenital Cytomegalovirus Foundation. 
  • Educational Coloring Book:  Contact LisaSaunders42@gmail.com for a free pdf version of Once Upon a Placemat: A Table Setting Tale or ask your library to carry a copy for you to borrow (copies also available on Amazon). 
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Author's note: I am the parent representative of the Congenital Cytomegalovirus Foundation, a CMV education consultant, and helped Connecticut become the second state in the U.S. to pass a CMV law. 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. 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 CMV. 

CMV and Daycare Figures to Consider: 


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..."

I wrote this blog post about the problem in case you would like to share some version of it: 

Have a toddler or care for one?



Gail J Demmler-Harrison, MD, Professor, Pediatrics, Section Infectious Diseases, Baylor College of Medicine, Attending Physician, Infectious Diseases Service, Texas Children's Hospital, CMV Registry, CMV Research and CMV Clinic.

Caroline Bailey, congenital CMV survivor and Master's college student. 


Brenda K. Balch, MD, Connecticut’s American Academy of Pediatrics Early Hearing Detection & Intervention Chapter Champion.



Sincerely,

Lisa Saunders, parent representative
PO Box 389
Mystic, CT 06355