Wednesday, July 17, 2019

OSHA, CDC and UCONN: New Resources for Child Care Providers to Protect Their Unborn Children from CMV, #1 Birth Defect Virus

On May 22, 2019, OSHA announced in "QuickTakes," its newsletter on workplace safety and health: "A common virus, Cytomegalovirus (CMV) affects thousands of workers in childcare centers and healthcare facilities. These workers are at the greatest risk of exposure because the virus is often spread through saliva and other body fluids of young children. OSHA's new webpage on CMV [https://www.osha.gov/SLTC/cmv/], explains how to minimize health risks associated with workers' exposure to this virus."

CDC Provides CMV Brochures in English and Spanish

CDC's information for child care providers: https://www.cdc.gov/cmv/congenital-infection.html#childcare-providers
CDC's flyers in English and Spanish , "Congenital CMV Facts for Pregnant Women and Parents":

UCONN Provides CMV Training Video and Quiz

The University of Connecticut recently came out with a CMV training module for child care providers.  The link to the video and quiz:  https://aural.rehab.uconn.edu/cmv-training-module/  

Connecticut Department of Public Health Has CMV Prevention Wall Flyer

Connecticut Department of Public Health
 (CT DPH) website has flyers and information: http://portal.ct.gov/DPH/Family-Health/EHDI/CMV. The National CMV Foundation allowed the CT DPH to embed their logo in their “Are You Pregnant” National CMV Awareness Flyer.

Connecticut and CMV Law Effective in 2016

Letter about CMV in Child Care and Connecticut's 2016 law from Brenda K. Balch, MD, Connecticut's American Academy of Pediatrics (AAP) Early Hearing Detection and Intervention (EHDI) Chapter Champion: https://drive.google.com/file/d/1xjQKI8SE1awlHPdD-k27ZwG62W7dnlv3/view?usp=sharing

Tuesday, June 4, 2019

CMV Risk to Unborn Children of Child Care Providers/Teachers: Know OSHA's action regarding CMV precautions?





Can you help spread OSHA's CMV news to your state to help protect the unborn babies of caregivers/teachers? Click on these links to find your state's OSHA office, Child Care Licensing office and Department of Public Health office. This would be a great topic for the American Industrial Hygiene local and national chapter meetings. The following is what I have been emailing agencies but I could use your help. Please edit to fit your state and circumstances for any agency you have connections with: 

Dear [OSHA, Child Care Licensing, Department of Public Health, Child Care Director, etc]:

Please tell caregivers/teachers who work with young children about CMV and OSHA's new action regarding CMV precautions to protect their unborn children at: https://www.osha.gov/SLTC/cmv. Congenital CMV is the most common infectious cause of birth defects in the U.S. according to the Centers for Disease Control and Prevention (CDC). Approximately 4,000 babies each year in the U.S. are born disabled by congenital CMV.

On May 22, 2019, the Occupational Safety and Health Administration (OSHA) announced in "QuickTakes," its newsletter on workplace safety and health: "A common virus, Cytomegalovirus (CMV) affects thousands of workers in childcare centers and healthcare facilities. These workers are at the greatest risk of exposure because the virus is often spread through saliva and other body fluids of young children. OSHA's new webpage on CMV [https://www.osha.gov/SLTC/cmv/], explains how to minimize health risks associated with workers' exposure to this virus."

Although licensed child care providers learn infection control methods, surveys show that most do not know about their occupational risk for 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). Infection control methods can only reduce the transmission of CMV if workers are motivated to follow them.

CDC Provides Teaching Tools in English and Spanish

June is the perfect time to share CMV prevention tips because the CDC recognizes June as National Cytomegalovirus (CMV) Awareness Month. This year, CDC is featuring CMV as the Disease of the Week on June 24. and rolling out a re-designed, more digital friendly CMV website (https://www.cdc.gov/cmv/). "All of our CMV website content is syndicated, so you can copy the embedded code from CDC’s Public Health Media Library and place CDC’s content on your own website, mobile application, RSS feed, or similar digital channels," states Holly Patrick, MS, MPH, Communication Specialist, National Center for Immunization and Respiratory Diseases, Division of Viral Diseases, Centers for Disease Control and Prevention (CDC, Atlanta, GA, 404.718.5494, mdu8@cdc.gov).

CDC's information for child care providers: https://www.cdc.gov/cmv/congenital-infection.html#childcare-providers
CDC's flyers in English and Spanish , "Congenital CMV Facts for Pregnant Women and Parents":

CMV Facts:
I am a former licensed in-home child care provider who was unaware of my occupational risk for CMV until it was too late to help my daughter, Elizabeth, born severely disabled by congenital CMV.
Mothers of young children in group care are also at greater risk (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).

In the U.S., more than half of mothers with young children work. "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).

In 2015, Connecticut become the second state in U.S. to pass CMV legislation, yet its child care workers are still unaware of their occupational risk for CMV. Although the Connecticut Office of Early Childhood’s Division of Licensing for Child Care Providers/Operators now includes “Congenital Cytomegalovirus” under “Disease and Prevention” on its website, linking to CT Department of Public Health's webpage, information on CMV is not included in the required training for child care licensing. (Learn about other state CMV legislation at: https://www.nationalcmv.org/about-us/advocacy)

For more information on CMV, please feel free to contact me. I am the leader of the Child Care Providers Education Committee with National CMV Foundation and can suggest several free resources to share.

Thank you for your time!

Lisa Saunders
Child Care Providers Education Committee
National CMV Foundation
PO Box 389, Mystic, CT 06355
https://congenitalcmv.blogspot.com/
Share the above info through Facebook at: https://www.facebook.com/1157396207678254/posts/2273483586069505/

PS: Potential Cost of Not Warning Child Care Providers about CMV
In New South Wales, “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). Meridian Lawyers stated: "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..."

Actions to consider:

1) Childcare providers are typically trained in first aid, CPR, and other topics. CMV prevention should be included in training about preventing infectious diseases. NAEYC (National Association for the Education of Young Children) includes "a. steps to reduce occupational hazards such as infectious diseases (e.g., exposure of pregnant staff to CMV…” 

2) Give each childcare employee/volunteer a CMV brochure (see Utah's brochure for childcare providers). 

3) CMV prevention added to a childcare center’s handbook. See Staff Education and Policies on Cytomegalovirus(Caring for Our Children, AAP, et al.): "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.” Print "Staff Education and Policies on CMV" by clicking "Save as PDF" at: nrckids.org/CFOC/Database/7.7.1.1 

4) CMV information added to a New Staff Orientation Form. The form should be signed to show the childcare provider read and understood they should consult their healthcare provider about their risk for CMV. See sample wording in Model Child Care Health Policies, which 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). 

5) The Child Care and Development Block Grant Act of 2014 has created regulatory changes. The Administration for Children and Families published Caring for our Children Basics (based on Caring for Our Children) in 2015 to “align basic health and safety efforts across all early childhood settings." In the section, “Prevention of Exposure to Blood and Body Fluids,” it states: “Caregivers and teachers are required to be educated regarding Standard Precautions [developed by CDC] before beginning to work in the program and annually thereafter. For center-based care, training should comply with requirements of the Occupational Safety and Health Administration (OSHA).”

6) Hang signs about CMV prevention in child care centers so staff and parents can see them (see CMV resources below--for Connecticut DPH logo in the “Are You Pregnant” poster by the National CMV Foundation, click here). Signs in child care centers are important because mothers of young children in group care are also at increased risk for contracting CMV (Pass et al., 1986) and are unaware of this. "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).

7) Consider the protocol posted on the website in Queensland, Australia. They relocate workers who are pregnant, or “expect to become pregnant, to care for children aged over two to reduce contact with urine and saliva.” See their list of safety measures in “Cytomegalovirus (CMV) in early childhood education and care services,” on the Workplace Health and Safety webpage.

8) Examples of CMV Protocols in Other Countries: 
In Queensland, Australia, suggested control measures include: "relocating workers who are pregnant, or who expect to become pregnant, to care for children aged over two to reduce contact with urine and saliva" (Queensland Government). 

In Germany, to protect day care workers from primary CMV infection, their “CMV serostatus must be checked at the beginning of their pregnancy.” If the worker “is seronegative, she is excluded from professional activities with children under the age of three years” (Stranzinger et al., 2016).

Note from me, Lisa Saunders:
I am the leader of the Child Care Providers Education Committee, National CMV Foundation. Using the song,"Had I Known (about CMV)," by Debra Lynn Alt, I created a public service announcement (PSA) on Congenital CMV: Music Video--"Had I Known (about CMV)". The video is geared to those who care for young children. YouTube version at https://youtu.be/1WoGjfieRhY. You are welcome to share this on TV, online, in presentations, etc.

CMV RESOURCES

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).

4. National CMV Foundation has flyers for downloadinghttps://www.nationalcmv.org/resources/educational-downloads

5. OSHA: SAFETY AND HEALTH RESOURCES
OSHA's new webpage on CMV (https://www.osha.gov/SLTC/cmv/), explains how to minimize health risks associated with workers' exposure to this virus.

ABOUT LISA SAUNDERS

Lisa Saunders is the mother of a Elizabeth born severely disabled by congenital cytomegalovirus (CMV) in 1989. Until Elizabeth's birth, Lisa was unaware of CMV and although she was a licensed, in-home child care provider, a church nursery volunteer and the mother of a toddler--all activities that put her at high risk for CMV--she was not educated about the disease and how to reduce her chances of contracting it. In 2015, Lisa was instrumental in helping Connecticut become the second state in the U.S. to enact a law requiring the testing of newborns for CMV if they fail their hearing screen. A graduate of Cornell University, Lisa is a public speaker, an award-winning writer and the author of several books--some with a CMV prevention message. She is the leader of the Child Care Providers Education Committee with the National CMV Foundation.  

National Cytomegalovirus (CMV) Awareness Month--What's new from CDC and OSHA



June is National Cytomegalovirus (CMV) Awareness Month. See latest news below from the Centers for Disease Control and Prevention (CDC) and the Occupational Safety and Health Administration (OSHA). I include additional resources at the end of this post. 

June 4, 2019 (email I received from CDC):

Greetings CMV Partners,

In June, CDC recognizes CMV Awareness Month as an opportunity to bring greater attention to congenital CMV, the most common infectious cause of birth defects in the United States. This year, CDC is:

·         Introducing a new banner to increase visibility of all our CMV Awareness Month communication products.

·         Rolling out a re-designed, more digital friendly CMV website (https://www.cdc.gov/cmv/
that includes new pages about National CMV Awareness Month and What CDC Is Doing.

·         Posting key social media messages about congenital CMV with links to information and resources on Twitter, FacebookInstagram, and LinkedIn.

·         Featuring CMV as the Disease of the Week on June 24.

All of our CMV website content is syndicated, so you can copy the embedded code from CDC’s Public Health Media Library and place CDC’s content on your own websitemobile application, RSS feed, or similar digital channels. Whenever CDC updates the content, it will be automatically updated on your website. Technical Help is available if needed.

All of our products are designed to increase public awareness and knowledge about congenital CMV, and to help healthcare professionals recognize the signs and symptoms of the disease early in children to ensure they get the services they need. You can find these products on our CMV website.   

How You Can Help
We hope you will share CDC’s materials about congenital CMV with your colleagues, partners, and patients, and post them on your social media outlets and websites. 

Sincerely,
Holly Patrick

Holly Patrick, MS, MPH
Communication Specialist
National Center for Immunization and Respiratory Diseases
Division of Viral Diseases

Centers for Disease Control and Prevention (CDC)
1600 Clifton Road, Mailstop A-34, Atlanta, GA 30333
404.718.5494  |   mdu8@cdc.gov 

***

May 22, 2019: 

The Occupational Safety and Health Administration (OSHA) now has information on CMV for child care and healthcare workers. In its  recent issue of "QuickTakes," a twice monthly newsletter on workplace safety and health (May 22, 2019 , Volume 18, Issue 9), they made the following announcement: 


SAFETY AND HEALTH RESOURCES
Webpage Provides Information on Protecting Workers from CMV Exposure

A common virus, Cytomegalovirus (CMV) affects thousands of workers in childcare centers and healthcare facilities. These workers are at the greatest risk of exposure because the virus is often spread through saliva and other body fluids of young children. OSHA's new webpage on CMV (https://www.osha.gov/SLTC/cmv/), explains how to minimize health risks associated with workers' exposure to this virus.

***

June 4, 2019

Note from me, Lisa Saunders, a former child care provider and leader of the Child Care Providers Education Committee, National CMV Foundation:

Using the song by Debra Lynn Alt, "Had I Known (about CMV)," I created a public service announcement (PSA) on Congenital CMV:  Music Video--"Had I Known (about CMV)". The video is geared to parents who have a young child in group care and those who care for young children. YouTube version at https://youtu.be/1WoGjfieRhY. Please share this on TV, online, in presentations, etc. 

***

HOW YOU CAN HELP

Ask the following groups/departments to pass along to their organizations and networks OSHA's (Occupational Safety and Health Administration) action regarding CMV precautions listed at: https://www.osha.gov/SLTC/cmv

Contact:

Country/state/county child care licensing programs, public health departments, OSHA, labor departments and labor unions geared to early childhood educators/child care providers. 

Also, reach out the staff of National Association for the Education of Young Children (NAEYC), the largest child care accrediting organization; the corporate leaders of Bright Horizons; the American Academy of Pediatrics staff of the Council on Early Childhood and Exchange Press, Inc., the
ChildCare Exchange Magazine.

Offer CMV prevention information:

1. OSHA Webpage Provides Information on Protecting Workers from CMV Exposure
A common virus, Cytomegalovirus (CMV) affects thousands of workers in childcare centers and healthcare facilities. These workers are at the greatest risk of exposure because the virus is often spread through saliva and other body fluids of young children. OSHA's new webpage on CMV (https://www.osha.gov/SLTC/cmv/), explains how to minimize health risks associated with workers' exposure to this virus.

2."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"



3.  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/

4. 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).


6. 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).

For more information on CMV, please feel free to contact me. 

Thank you for your time!

Lisa Saunders
Child Care Providers Education Committee
PO Box 389, Mystic, CT 06355

*S.Res.215 - A resolution designating the month of June 2011 as "National Cytomegalovirus Awareness Month": 112th Congress (2011-2012). (2011). Retrieved from Congress.gov: https://www.congress.gov/bill/112th-congress/senate-resolution/215  

Additional ways to raise CMV awareness among child care workers:

Exchange Press, Inc.
ChildCare Exchange Magazine
https://www.childcareexchange.com/
Bimonthly publication features news and information for center owner and managers and other early childhood professionals, with special features including the "Annual Trend Report on For Profit Child Care" and "The Exchange Top 50" list (January issue) which ranks North America's largest for-profit and national franchising organizations by number of centers in operation and total licensed capacity. Write for Exhange to reach child care providers/directors: https://www.childcareexchange.com/opportunities-for-you/write-for-exchange/



Friday, April 5, 2019

Congenital CMV Public Service Announcement (PSA): Music Video--"Had I Kn...



Please Share This Public Service Announcement (PSA) Video to Prevent Birth Defects from #congenitalCMV The song "Had I Known" © 2018 DebraSong Publishing is used with expressed permission by the songwriter, Debra Lynn Alt. Debra has written and performed for a variety of venues from a Rolling Stone Magazine party, to events for causes she feels passionate about including Habitat for Humanity, Mothers Against Humanity, cancer survivors, child abuse, autism, "MeToo," and Mothers Against Drunk Driving. She can be reached at debrasong@gmail.com, and also on her website, https://www.debrasong.com. Video produced in 2019 by Lisa Saunders (https://congenitalcmv.blogspot.com/). Photos of Elizabeth Saunders (1989-2006) and Natalie Rachels (b. 2006—still going strong) by family, some of Natalie by Jackie Charlebois of Jax Creations Photography. Illustrations by Marianne Greiner, some coloring work by Suzanne Doukas Niermeyer. Natalie’s mother, Jessica Rachels: https://idahocmv.com/ Find live links to cited references at: https://congenitalcmv.blogspot.com/20... 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/ In English En Español 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). 4. National CMV Foundation: https://www.nationalcmv.org/resources... 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). You may contact Lisa Saunders at LisaSaunders42@gmail.com

Watch and share from either link below:

YouTube: https://youtu.be/1WoGjfieRhY

Google Drive: https://drive.google.com/open?id=1kiSfQ4h92w6rgRcqNvM94V5hOHDBSW5u
  

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).

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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