Wednesday, April 26, 2017

15 Reasons Why Caregivers/Teachers Should Know About CMV

15 Reasons Why Child Care Providers (and all women of childbearing age) Should Be Informed About Congenital CMV

(for pdf, click here)

1)  Congenital CMV is the #1 Birth Defects Virus (Carlson et al., 2010). Disabilities from congenital CMV "exceeds those from the fetal alcohol syndrome, spina bifida, and childhood infections..."(Boppana and Fowler, 2017). 

2) Of the four million infants born each year in the U.S., approximately 1% are infected prenatally with CMV (American Academy of Pediatrics [AAP] et al., Caring for Our Children, 2011).  Ten percent of those infants (about 4,000) may have one or multiple abnormalities.

3)  “Women who are exposed to CMV prior to conception or within the first trimester of pregnancy and seroconvert have increased risk of their infant being infected with CMV.”(Thackeray et al., 2016).

4)  CMV is an “occupational risk" for daycare educators (Joseph, et al., 2006). Caregivers/teachers should be told about CMV because of increased probability of exposure (AAP et al.. 2011). 

5)  General public: 1-4% is the estimated “annual rate of a pregnant woman who is CMV antibody negative catching CMV for the first time in pregnancy” Demmler-Harrison, MD, CMV in Pregnancy: What Should I Know?, 2014).

6)  Caregivers/teachers: 8- 20% of caregivers/teachers contract CMV infection every year (AAP et al.. 2011).

7)  44% to 100% of two-year-olds in group daycare are excreting CMV (Pass et al., 1986).

8)  Only 18.5% of licensed “in-home” daycare providers have heard of CMV according to “Child Care Provider Awareness and Prevention of Cytomegalovirus and Other Infectious Diseases” (Thackeray et al., 2016).

9)  It is a worker's right to know occupational hazards according to the Occupational Safety and Health Administration (OSHA). There are more than half a million child care workers (573,430) in the U.S. according to the Child Care in America: 2016 State Fact Sheet report (pdf) published by Child Care Aware of America

10) “Providers do not know how to appropriately sanitize surfaces to reduce spread of disease.” Many providers use diaper wipes to clean a surface. Diaper wipes do not sanitize (Thackeray et al., 2016).

11) “Increasing risk perception is important because providers may not be concerned about taking measures to reduce the probability of infection if they feel that they are at low risk” (Thackeray et al., 2016).

12)  Mothers of children in daycare are also at increased risk for CMV (Pass et al., 1986). “61 % of children under the age of 5 are cared for in a child care facility...Intervening with child care providers and parents through child care facilities are key opportunities to reduce prevalence of CMV infection and other diseases.” (Thackeray et al., 2016).

13)  $1.86 billion annually, with a cost per child of more than $300,000, is the estimated cost of congenital CMV to the US health care system (Modlin, Arvin, et al., 2004).

14)  The CDC "suggests that pregnant women reduce their risk of CMV acquisition during pregnancy using simple hygienic precautions but this suggestion is not often followed...the efficacy of hygienic precautions has been [greater than] 75%.” (Adler, 2015).  “Perhaps no single cause of birth defects and developmental disabilities in the United States currently provides greater opportunity for improved outcomes in more children than congenital CMV…women deserve to be informed about how they can reduce their risk of CMV infection during pregnancy…” (Cannon et al., 2005).

15)  NAEYC: National Association for the Education of Young Children and its "Early Childhood Program Standards and Accreditation Criteria and Guidance for Assessment (10.D.01, p.91)" includes: "a. steps to reduce occupational hazards such as infectious diseases (e.g., exposure of pregnant staff to CMV [cytomegalovirus], chicken pox)..."


Lisa Saunders compiled "15 Reasons Child Care Providers Should be Informed About  Congenital CMV". She is the author of author of  "The Danger of Spreading CMV: How We Can Protect Our Children" published in ChildCare Aware of America (June 2017). 

Free CMV Teaching Tool Kit: "Once Upon a Placemat: A Table Setting Tale" by Lisa Saunders

Free CMV Teaching Tool kit by Lisa Saunders

 "Once Upon a Placemat: A Table Setting Tale"
Educational "color-me-in" fairytale

Childcare workers and mothers of toddlers are at greater risk for contracting #1 viral cause of birth defects, congenital cytomegalovirus (CMV)

Mystic, Conn.— Lisa Saunders, author of “Once Upon a Placemat: A Table Setting Tale,” created a free downloadable school/child care program kit for parents and teachers to use to instruct children on table setting and germ prevention, particularly against diseases spread through saliva.

In Once Upon a Placemat: A Table Setting Tale"Grandma" reminds children when and why to wash their hands and speaks for Miss Cup to teach germ prevention. She also features 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 Tool kit 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.

"Once Upon a Placement is a clever way to get across an important message about prevention of infectious diseases. As a doctor, I recommend it to my young patients and their families. As a grandmother, I have shared it with my granddaughter." Gail J Demmler Harrison, MD, CMV Registry, CMV Research and CMV Clinic

"The lesson of how to set a table is valuable as this is part of encouraging a family to sit down and eat together—a main intervention in preventing obesity," said Alison Dvorak, MS, RDN, CDN, of Franklin, Connecticut.


Author's note:  “Once Upon a Placemat” is an expanded version of the fairytale Saunders told in her children’s novel, “Ride a Horse, Not an Elevator,” which is featured in the Cornell University 4-H “Horse Book in a Bucket” program.

About the author:
.Lisa Saunders is an award-winning writer living in Mystic, Connecticut, with her husband and hound. A graduate of Cornell University, she is the parent representative of the Congenital Cytomegalovirus (CMV) Foundation, and in 2015, was instrumental in helping Connecticut become one of the few states in the country to enact a law combating the leading viral cause of birth defects, congenital CMV.  Saunders said, “CMV is carried by a high percentage of apparently healthy toddlers. It is found in bodily fluids such as saliva and is of concern to women of childbearing age because the virus can lead to complications in their baby's development if they are pregnant while infected.”

Co-author of "Once Upon a Placemat," Jackie Tortora, is a digital strategist living with her husband and their young son in Vienna, Virginia. It was illustrated by Marianne Greiner of Bloomfield, New York.  

For more information, visit or write to


Friday, April 21, 2017


Another good reason to wash your hands! Every year, 8- 20% of caregivers/teachers contract cytomegalovirus (CMV), the leading viral cause of birth defects. The American Academy of Pediatrics recommends advising caregivers/teachers of increased exposure to CMV and importance of hand hygiene and avoiding contact with urine, saliva, and nasal secretions.

In this segment, "Child Care and Cytomegalovirus (CMV): Protect Your Pregnancy." women of childbearing age will learn about how to prevent the leading viral cause of birth defects, cytomegalovirus (CMV), a much bigger threat to newborns than Zika. 

Talk show participants in order of appearance:

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. Contact: 832-824-4330, The CMV Registry supports CMV research, disseminates information and provides parent support. Visit:

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 Lisa SaundersInterviewer/Producer, PO Box 389, Mystic, CT 06355,

  • Lisa might be able to mail you a copy of the DVD if your station can't access it another way. 

The interviews of Gail J Demmler-Harrison, MD and Caroline Bailey occurred at the 2016 Congenital Cytomegalovirus Public Health & Policy Conference in Austin, Texas:

If you would like your local access TV station to air this 28-minute segment,  "CHILD CARE AND CMV: PROTECT YOUR PREGNANCY," which includes two pediatricians and one CMV survivor, contact your station, letting them know you live or work in their area. To find your local access TV station, visit:

The show can be seen through: 
The show was filmed at Southeastern Connecticut Television (SEC-TV) Studios.
SEC-TV: Community Television for Groton, Ledyard, Mystic, Stonington, North Stonington, and Voluntown, Connecticut. CHANNELS 12 & 96 on Comcast; ​CHANNELS 12 & 670 on Thames Valley; and ​CHANNEL 99 on Frontier.
Address: SEC-TV, 80 Plaza Court, Groton, CT 06340
Studio Phone: 860-449-1477

Tuesday, April 11, 2017

Have a toddler or care for one? Includes Resources

Image from Surviving Loss: The Woodcutter's Tale, co-authored by Lisa Saunders

"CMV: Protect Your Pregnancy"

by Lisa Saunders

(Lisa is a former licensed daycare provider, church nursery volunteer, and parent representative of the Congenital Cytomegalovirus Foundation.)

Everyone agrees toddlers are cute--and they are! But if you are the mother of a toddler, a nursery volunteer, a child care worker, or have a toddler in group care, you need to know about cytomegalovirus (CMV). 

What is CMV? 
According to the Centers for Disease Control and Prevention (CDC), "Cytomegalovirus (pronounced sy-toe-MEG-a-low-vy-rus), or CMV, is a common virus that infects people of all ages. Over half of adults by age 40 have been infected with CMV...Most people infected with CMV show no signs or symptoms. However, CMV infection can cause serious health problems for people with weakened immune systems, as well as babies infected with the virus before they are born (congenital CMV)."

The Problem
CMV can cause birth defects if a woman contracts the virus when she is pregnant according to the CDC. The CDC states that 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 quickly 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. 

“Women who are exposed to CMV prior to conception or within the first trimester of pregnancy and seroconvert have increased risk of their infant being infected with CMV”(Thackeray et al., 2016).

What Should You Do?
The American Academy of Pediatrics (AAP) co-authored “Caring for Our Children,” which includes Staff Education and Policies on Cytomegalovirus (CMV), stating that caregivers/teachers 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..."

Reduce Transmission of CMV
  1. Wash hands often with soap and water for 15-20 seconds, especially after wiping runny noses, changing diapers, picking up toys, etc. If soap and water are not available, use alcohol-based hand gel.
  2. Use soap and water or a disinfectant to clean hard surfaces that have been contaminated by secretions.
  3. Don’t kiss young children on the lips or share food, drinks, or eating utensils with them.
  4. Pregnant women working in child care facilities should minimize direct exposure to saliva…Hugging is fine and is not a risk factor, (NY Dept. of Health)

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. The book, “Caring for Our Children,” has several articles on sanitizing hands and surfaces in child care centers.  

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 epidemic, Cannon and Davis, 2005).
3.     Feel prevention measures are “impractical or burdensome." According to the New York Times article, CMV Is a Greater Threat to Infants Than Zika, but Far Less Often Discussed (2016), “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! The above mentioned New York Times article 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).” 

Free Teaching Tool Kit for Homes and Group 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:

Television Interview Teaches CMV Prevention
You will find a lot of advice on this segment of the Lisa Saunders ShowChild Care and CMV: Protect Your Pregnancy. Hear tips from:

  • 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.
  • Lisa Saunders, former child care provider, nursery volunteer, and mother of a toddler.

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. When I was of childbearing age, I was a licensed home daycare provider, church nursery volunteer, and the mother of a toddler. I was never advised that caring for toddlers increased my risk of contracting CMV. Although I washed my hands after every diaper change, I should have been much more diligent about hand-hygiene after picking up toys and wiping runny noses. My daughter Elizabeth (1989-2006) was born severely disabled from congenital CMV.  I am the author of  a memoir about my daughter's life, Anything But a Dog! The perfect pet for a girl with congenital CMV,  and the germ prevention coloring book, Once Upon a Placemat: A Table Setting Tale


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