According to the CDC, "Risk of transmission for primary infection is 30 to 40% in the first and second trimesters, and 40 to 70% in the third trimester. The risk of transmission following non-primary infection is much lower (3%). The risk of complications to the fetus is greatest if a primary infection occurs during the first trimester.”
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* From Red Book: 2015 Report of the Committee on Infectious Diseases, AAP, p. 144, 145:
CYTOMEGALOVIRUS INFECTION. Spread of CMV from an asymptomatic infected child in child care to his or her pregnant mother or to a pregnant child care provider, with subsequent transmission to the fetus, is the most important consequence of child carerelated CMV infection (see Cytomegalovirus Infection, p 317). Children enrolled in child care programs are more likely to acquire CMV than are children primarily cared for at home. Excretion rates from urine or saliva in children 1 to 3 years of age who attend child care centers usually range from 30-40% but can be as high as 70%, and intermittent excretion commonly continues for years. Studies of CMV seroconversion among female child care providers have found annualized seroconversion rates of 8% to 20%. Women who are or who may become pregnant and who are CMV naïve are at risk of being infected during pregnancy and transmitting CMV to their fetus.
In view of the risk of CMV infection in child care staff and the potential consequences of gestational CMV infection, female child care staff members should be counseled about these risks. This counseling includes discussion between the woman and her health care provider. In utero fetal infection can occur in women with no preexisting CMV immunity (maternal primary infection) or in women with preexisting antibody to CMV (maternal nonprimary infection) by either acquisition of a different viral strain during pregnancy or from reactivation of an existing maternal infection. CMV excretion is so prevalent that attempts at isolation or segregation of children who excrete CMV are impractical and inappropriate. Similarly, testing of children to detect CMV excretion is inappropriate, because excretion often is intermittent and results of testing can be misleading. Therefore, use of Standard Precautions and hand hygiene are the optimal methods of prevention of transmission of infection.
BLOODBORNE VIRUS INFECTIONS
HBV, HIV, and hepatitis C virus (HCV) are bloodborne pathogens. Although risk of contact with blood containing one of these viruses is low in the child care setting, appropriate infection-control practices will prevent transmission of bloodborne pathogens if exposure occurs. All child care providers should receive regular training on how to prevent transmission of bloodborne infections and how to respond should an exposure occur (www. osha.gov/SLTC/bloodbornepathogens/index.html).
**American Academy of Pediatrics, American Public Health Association, National Resource Center for Health and Safety in Child Care and Early Education. Caring for Our Children: National Health and Safety Performance Standards; Guidelines for Early Care and Education Programs, 4th ed. Itasca, IL: American Academy of Pediatrics; 2019, http://nrckids.org/CFOC, retrieved Jan. 2019.
***See below for the form, "Acceptance of Occupational Risk by Staff Members" with the following suggested citation from p. ii: Pennsylvania Chapter of the American Academy of Pediatrics. Model Child Care Health Policies. Aronson, SS, ed. 5th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2014. www.ecels-healthychildcarepa.org.
Copyright © 2014 Pennsylvania Chapter of the American Academy of Pediatrics. All rights reserved. "Permission is granted to reproduce or adapt content for use within a child care setting. These policies are for reference purposes only and shall not be used as a substitute for medical or legal consultation, nor be used to authorize actions beyond a person’s licensing, training or ability."
|Model Child Care Health Policies, 5th Edition, Aronson, SS, ed., Pennsylvania Chapter of the American Academy of Pediatrics (2014).|
|"Acceptance of Occupational Risk by Staff Members" form. Model Child Care Health Policies, 5th Edition, Aronson, SS, ed., Pennsylvania Chapter of the American Academy of Pediatrics (2014)., p. 116.|
|Copyright page ii from: Model Child Care Health Policies, 5th Edition, Aronson, SS, ed., Pennsylvania Chapter of the American Academy of Pediatrics (2014).|