Tuesday, February 26, 2019

Poster: Educating Child Care Providers/Early Childhood Teachers About Their Occupational Risk for Cytomegalovirus (CMV)



Lisa Saunders, Leader of Childcare Providers Education and Outreach, National CMV Foundation

Poster content reviewed by 
Brenda Balch, MD, American Academy of Pediatrics (AAP) Early Hearing Detection and Intervention Connecticut Chapter Champion

INTRODUCTION

8 - 20% of child care providers contract CMV every year (Red Book, AAP, 2015) as compared to 1-4% of women (who have never had CMV) in the general population (CDC, 2018).

On average, 30-40% of preschoolers in day care excrete CMV in their saliva and/or urine (Red Book, AAP, p. 144). "Up to 70% of children ages 1 to 3 years in group care settings excrete the virus (“Staff Education and Policies on Cytomegalovirus” (http://nrckids.org/CFOC/Database/7.7.1.1Caring for Our Children: National Health and Safety Performance Standards; Guidelines for Early Care and Education Programs, AAP et al., modified 2017)

Parents of children in day-care centers are at increased risk for contracting CMV (Pass et al, 1986). “Almost all the babies that I see who have congenital CMV, there is an older toddler at home who is in daycare,” said Dr. Jason Brophy, a pediatric infectious disease specialist, in the Ottawa Citizen (Payne, 2018).

“Small children have habits that facilitate the dissemination of diseases, such as putting their hands and objects in their mouths, very close interpersonal contact” (Nesti and Goldbaum, 2007)."Children enrolled in child care facilities are more likely to acquire CMV than are children cared for at home” (Caring for Our Children, AAP et al., modified 2017).

Child care providers are largely unaware of CMV and many acknowledge using diaper wipes to clean (Thackeray and Magnusson, 2016). Diaper wipes do not effectively remove CMV from hands (Stowell et al., 2014). 

American Academy of Pediatrics, et al., states: “Female employees of childbearing age should be referred to their primary health care provider or to the health department authority for counseling about their risk of CMV infection. This counseling may include testing for serum antibodies to CMV to determine the employee’s immunity against CMV infection...it is also important for the child care center director to inform infant caregivers/teachers of the increased risk of exposure to CMV during pregnancy”  (Caring for Our Children, AAP et al., modified 2017).


“I was a pregnant licensed child care provider, church nursery volunteer and the mother of a toddler, yet I didn’t know about CMV. I always washed my hands after changing diapers, but often too busy chasing toddlers to get to the sink after wiping noses and picking up toys, I used diaper wipes to clean my hands—not realizing they don’t effectively remove CMV”--Lisa Saunders, mother of Elizabeth born with congenital CMV (seen above). Elizabeth had a small, damaged brain, hearing and vision loss, cerebral palsy, developmental delays and epilepsy. Elizabeth died during a seizure at the age of 16 in 2006.

PURPOSE

Increase awareness that CMV is an “occupational hazard” for child care providers/early childhood educators (National Association for the Education of Young Children (NAEYC): Early Childhood ProgramStandards and Accreditation Criteria and Guidance for Assessment, p.90)

Explain why most child care providers have not heard about CMV.

Suggest methods for improving education to ultimately prevent CMV.

LOW CMV AWARENESS AMONG CHILD CARE PROVIDERS

2016: Only 18.5% of licensed “in-home” daycare providers surveyed have heard of CMV and “Providers do not know how to appropriately sanitize surfaces to reduce spread of disease” (Thackeray and Magnusson, 2016).

2018: A nationwide child care survey confirmed: "Consistent with previous research, child care providers do not have knowledge regarding CMV or cCMV" (DeWald et al., 2018)


IF CMV WAS A PROBLEM, WOULDN’T MY DOCTOR TELL ME?
5 Possible Reasons Women Are Unware of CMV

1) CMV prevention education is not part of a doctor’s “standard of care.”

2) Doctors don’t want to frighten, worry or “burden” patients.
New York Times: "The American College of Obstetricians and Gynecologists [ACOG] used to encourage counseling for pregnant women on how to avoid CMV. But last year [2015], the college reversed course, saying, ‘Patient instruction remains unproven as a method to reduce the risk of congenital CMV infection.’ Some experts argue that because there is no vaccine or proven treatment, there is no point in worrying expecting women about the virus...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.” (Saint Louis, 2016). 

3) Low media coverage. In the HealthNewsReview.org article, "Why does CMV get so much less news coverage than Zika — despite causing far more birth defects?"  the author states,  “Researchers we spoke with identified the same factors – fear and the epidemic/endemic nature of the diseases – as driving the media disparity” (Shipman, 2018).

4) Although U.S. workers have the right to “receive information and training about hazards” (Occupational Safety and Health Act of 1970), there are no federal laws governing CMV education policies for child care workers. The Department of Labor states, "Education and training requirements vary by setting, state, and employer."

5)"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” (Cannon and Davis, 2005).

GERMANY AND AUSTRALIA

Germany: “to protect DCWs [daycare 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…“ (Stranzinger et al., 2016).

“In Australia, state governments have differing recommendations for pregnant ECEC [early childhood education and care educators] working with young children. Some states, such as Queensland, suggest relocating educators who are pregnant to care for children aged over two to reduce contact with urine and saliva” (Clark, 2019).
\
CMV LAWSUIT BY CHILD CARE WORKER

In New South Wales, Australia, in a landmark decision, “a childcare worker and her severely disabled son were awarded $4.65 million. A Court of Appeal ruled that the child's disabilities resulted from the woman being infected with cytomegalovirus (CMV) at work (Hughes v SDN Children's services 2002)” (Queensland Government, Australia, 2017). 

Meridian Lawyers of Australia state: “The allegations of negligence were that Sydney Day Nursery breached its duty of care to Linda ...by failing to warn her of the risks of CMV in circumstances where the centre knew or ought to have known of the risks of CMV to pregnant women...” 

 

CONCLUSION

“Approximately 1-4% of all pregnant women will experience a primary CMV infection during their pregnancy. If you work in a child care setting, the risk increases to approximately 10%. If you have a toddler at home who is actively infected with CMV and shedding CMV in their saliva or urine, the risk is even higher, approaching 50% in some studies” (“CMV In Pregnancy: What Should I Know?”, Demmler-Harrison, 2014).

In the U.S., “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 and Magnusson, 2016).

Child care licensing agencies should instruct child care centers and preschools to educate staff about CMV. The book, Model Child Care Health Policies, has a sample document to be signed by staff (paid or volunteer) to show “Acceptance of Occupational Risk by Staff Members,” which includes “exposure to infectious diseases (including infections that can damage a fetus during pregnancy)” (American Academy of Pediatrics, Pennsylvania Chapter, Aronson, SS, ed., 2014, p. 116).


HOW YOU CAN HELP

Contact country/state/county child care licensing programs, public health departments, labor departments and labor unions geared to early childhood educators/child care providers. Ask department commissioners how they protect the unborn children of workers. Offer CMV prevention information:

1. "Staff Education and Policies on Cytomegalovirus (CMV)," American Academy of Pediatrics, American Public Health Association, National Resource Center for Health and Safety in Child Care and Early Education. (Revised 2017). National Health and Safety Performance Standards: Guidelines for Early Care and Education Programs. Retrieved from Caring for Our Children:http://nrckids.org/CFOC/Database/7.7.1.1. You can download that page as a pdf by clicking on the upper right side of the webpage: "Save as PDF"

2.  Centers for Disease Control and Prevention (CDC) CMV info available in English and Spanish:
"Congenital CMV Facts for Pregnant Women and Parents":https://www.cdc.gov/cmv/

3. CMV prevention video, "Why Moms-to-be Should Care About CMV" (3:37-minutes): https://youtu.be/OM7WKS7J2mA(content by research nurse, Anna Bartholomew of central Ohio; video by Joel Copeland, Chief Operating Officer of KMI Learning, pro bono, Youtube,  2015).


5. Model Child Care Health Policies, a book by the American Academy of Pediatrics, has a sample document to be signed by staff (paid or volunteer) to show “Acceptance of Occupational Risk by Staff Members,” which includes “exposure to infectious diseases (including infections that can damage a fetus during pregnancy)” (American Academy of Pediatrics, Pennsylvania Chapter, Aronson, SS, ed., 2014, p. 116).

###
NOTE: Illustration  by Marianne Greiner. Reference citations available on primary author’s CMV blog at: https://congenitalcmv.blogspot.com/. Contact author Lisa Saunders at: PO Box 389, Mystic, CT 06355, lisa.saunders@nationalcmv.org or LisaSaunders42@gmail.com


Monday, February 11, 2019

Why Moms-to-be Should Care About CMV



Here is a 3:37-minute CMV prevention video, "Why Moms-to-be Should Care About CMV." The content was created by a research nurse, Anna Bartholomew from central Ohio, and published on Youtube on Jun 22, 2015.  Her father, Joel Copeland, Chief Operating Officer of KMI Learning, did it through this educational video company as a pro bono effort. He gave me permission to show it on my local access TV show, the Lisa Saunders Show, which is also uploaded to Youtube. 


Here is the link to "Why Moms-to-be Should Care About CMV"https://youtu.be/OM7WKS7J2mA

Monday, February 4, 2019

Feb is International Prenatal Infection Prevention Month. CDC Warns CMV, #1 Birth Defects Virus, Can Be in Saliva of Young Children: Moms, Teachers and Child Care Providers Use Precaution


Lisa Saunders (pictured above with daughter Elizabeth in 1994)



Feb: Prenatal Infection Prevention Month. CDC Warns CMV in Tots, says: 
"Women may be able to lessen their risk of getting CMV by reducing contact with saliva and urine from babies and young children."


February is International Prenatal Infection Prevention Month. The Centers for Disease Control and Prevention (CDC) lists cytomegalovirus (CMV) first of four infections on its webpage, Protect Your Unborn Baby or Newborn from Infections:

According to the CDC, "A pregnant woman infected with CMV can pass the virus to her baby during pregnancy. About one out of every 200 babies is born with congenital CMV infection. However, only about one in five babies with congenital CMV infection will be sick from the virus or have long-term health problems. CMV is passed from infected people to others through body fluids, such as saliva, urine, blood, vaginal secretions, and semen. Infants and young children are more likely to shed CMV in their saliva and urine than older children and adults. Women may be able to lessen their risk of getting CMV by reducing contact with saliva and urine from babies and young children. Some ways to do this are by not sharing food and utensils with babies and young children, and washing hands after changing diapers."

"It's been 13 years this February since my daughter Elizabeth died during a seizure at age 16. Epilepsy was one of her many health complications as a result of me contracting CMV when I was pregnant with her," says Lisa Saunders, leader of Child Care Providers Education Committee, National CMV Foundation. "I was a licensed, in-home child care provider, church nursery volunteer and the mother of a toddler, yet I didn't  know about CMV. I always washed my hands after changing diapers, but often too busy chasing toddlers to get to the sink after wiping noses and picking up toys, I used diaper wipes to clean my hands not realizing they didn't kill CMV. I had known about CMV, I would have taken extra precautions, such as always washing my hands with soap and water and never sharing  cups with my own toddler."

Saunders says, "The prevalence of CMV in child care is a very inconvenient truth." Mothers of children in group care are at increased risk for CMV because their child is at greater risk for contracting CMV in daycare. In  the article, "Infectious diseases and daycare and preschool education," the authors state: 
“Children cared for at daycare or in preschool education exhibit a two to three times greater risk of acquiring infections… Small children have habits that facilitate the dissemination of diseases, such as putting their hands and objects in their mouths, very close interpersonal contact” (Nesti and Goldbaum, 2007).

“Almost all the babies that I see who have congenital CMV, there is an older toddler at home who is in daycare,” said Dr. Jason Brophy, a pediatric infectious disease specialist, in the Ottawa Citizen (Payne, 2018). 


On average, 30-40% of preschoolers in day care excrete CMV in their saliva and/or urine (Red Book: 2015 Report of the Committee on Infectious Diseases, AAP, p. 144). 

"Up to 70% of children ages 1 to 3 years in group care settings excrete the virus” (AAP et al., Caring for Our Children: National Health and Safety Performance Standards; Guidelines for Early Care and Education Programs, modified 2017)


Although Saunders has been shouting CMV prevention from the rooftops ever since her daughter died and helped get a CMV testing law passed in Connecticut in 2015, CMV prevention remains little known--even among child care providers and early childhood education teachers who have an occupational risk for the virus. "I've had so many people respond to my CMV warnings that, 'If CMV was really a problem, my doctor would have told me.'"

Saunders believes there are six reasons why most women have never heard of CMV: 

1)      CMV prevention education is not part of a doctor’s “standard of care.” 
2)      "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.” Cannon and Davis, 2005.)
3)      Doctors don’t want to frighten, worry or “burden” patients:
·        FitPregnancy magazine: "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,” said OB-GYN Laura Riley, M.D., director of infectious disease at Massachusetts General Hospital (June/July, 2008). 
·        The New York Times, "The American College of Obstetricians and Gynecologists [ACOG] used to encourage counseling for pregnant women on how to avoid CMV. But last year, the college reversed course, saying, ‘Patient instruction remains unproven as a method to reduce the risk of congenital CMV infection.’ Some experts argue that because there is no vaccine or proven treatment, there is no point in worrying expecting women about the virus...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.” (Saint Louis, 2016).  
4)      No national public awareness campaign in United States: “Despite being the leading cause of mental retardation and disability in children, there are currently no national public awareness campaigns to educate expecting mothers about congenital CMV” (Clinical Advisor,  2014).

5) Low media coverage about congenital CMV: In article, "Why does CMV get so much less news coverage than Zika — despite causing far more birth defects?"Matt Shipman  writes,  “Researchers we spoke with identified the same factors – fear and the epidemic/endemic nature of the diseases – as driving the media disparity” (HealthNewsReview.org, 2018).

6) Unlike Germany, there is no U.S. law regulating methods of CMV control in the child care setting. According to the Department of Labor, "Education and training requirements vary by setting, state, and employer." In most states, except Utah and Idaho, child care centers are not instructed to tell workers about CMV despite U.S. workers having the right to “receive information and training about hazards” (Occupational Safety and Health Act of 1970).

GERMANY AND AUSTRALIA

·        In Germany, “to protect [day care workers] from primary infection, their CMV serostatus must be checked at the beginning of their pregnancy. When the [day care worker] is seronegative, she is excluded from professional activities with children under the age of three years in order to prevent feto- or embryopathy in her offspring“ (Stranzinger et al., 2016).

·        “In Australia, state governments have differing recommendations for pregnant ECEC [early childhood education and care educators] working with young children. Some states, such as Queensland, suggest relocating educators who are pregnant to care for children aged over two to reduce contact with urine and saliva” (Clark, 2019).

CMV LAWSUIT BY CHILD CARE WORKER

In New South Wales, Australia, in a landmark decision, “a childcare worker and her severely disabled son were awarded $4.65 million. A Court of Appeal ruled that the child's disabilities resulted from the woman being infected with cytomegalovirus (CMV) at work (Hughes v SDN Children's services 2002)” (Queensland Government,Australia, 2017). Meridian Lawyers of Australia state: “The allegations of negligence were that Sydney Day Nursery breached its duty of care to Linda ...by failing to warn her of the risks of CMV in circumstances where the centre knew or ought to have known of the risks of CMV to pregnant women...” See Meridian Lawyers' recommendations for educating child care providers about CMV at: 

CONCLUSION

 “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 and Magnusson, 2016). 

To learn more about CMV and other prenatal infections, all are welcome to "attend" an online, free of charge, Prenatal Infection Prevention SymposiumFebruary 25 - 28, 2019. CME credit will be available for physicians and midwives. 

Lisa Saunders will present, “Help Child Care Providers Fight Cytomegalovirus (CMV): Protect Newborns From #1 Birth Defects Virus,” on Tuesday, February 26 and respond to comments/questions about her presentation that day. Dr. Stuart P. Adler will present, "Prevention of CMV Infections During Pregnancy by Behavior Modification." 

To register for the Prenatal Infection Prevention Symposium, visit: gbsi.me/PIPS (registration is complimentary).The Prenatal Infection Prevention Symposium is a collaborative partnership between Group B Strep International and Star Legacy Foundation, both nonprofit 501(c)(3) organizations working towards more babies being born healthy and staying healthy.

Saturday, February 2, 2019

Music video of a girl growing up with CMV includes prevention message and song, "A Voice for Sam," by Debra Lynn Alt



"Voice for Sam" written by Debra Lynn Alt © 2007 DebraSong Publishing, LLC, through http://www.debrasong.com/

Images of Elizabeth Saunders and slides by Elizabeth's mother, Lisa Saunders: http://www.authorlisasaunders.com/
Words for VOICE FOR SAM
Written by Debra Alt ©2007 Servethrusong, LLC (ASCAP) How can I tell you that I want to go now when I cannot find the words The other kids are playing around me, I’m alone & something hurts I’m a boy who’s feeling scared of all the noises in my head I can hear you but I know you don’t hear me Mom is always so creative finding new things we can try Dad comes home each nite with hope, and fearful eyes he tries to hide And my brother’s on the run, I know it can’t be too much fun It’s not easy living with a boy like me There’s a voice for Sam, and all the others like him We need to understand It’s just who he is, he needs us to find a way in I know you’re trying and I feel all the love, but I still need to ask for more When you see me spinning, and I’m jumping, to a rhythm all my own Please be patient as you can, and accept me as I am I’m still changing, so don’t give up on me Here’s a voice for Sam, and so many others like him We’ve gotta do all that we can He needs us to know, somehow let it show, we’re there for him BRIDGE – The ways of those like Sam, are full of mystery Let’s unlock the gates of silence, Find a way to set these children free Be a voice for Sam, and too many more just like him Try to understand It’s just where he is, he needs us to find a way in Be a voice for Sam (and all the others like me) Be a voice for Sam (it’s just who I am) Be a voice for Sam (keep looking to find a way in) Be a voice for Sam (don’t give up on me) Be a voice for Sam