Lisa Saunders, a licensed child care provider, never heard of her occupational risk for CMV, until after her daughter Elizabeth was born with a small, damaged brain from congenital CMV. Elizabeth is seen here as a newborn in 1989 with her mother and big sister. Elizabeth died at 16 during a seizure in 2006.
RE: CMV (#1 birth defects virus) is Occupational Risk for Caregivers/Teachers
Dear Child Care/Teacher Unions:
In your effort to protect caregivers/teachers and their unborn children, please ensure workers know their occupational risk for cytomegalovirus (CMV), the leading viral cause of birth defects. “CMV Is a Greater Threat to Infants Than Zika, but Far Less Often Discussed” (New York Times, 2016).
Each year, one in 200 babies is born with congenital (present at birth) CMV infection in the U.S. According to the Centers for Disease Control and Prevention (CDC), "one in five babies with congenital CMV infection will be sick from the virus or have long-term health problems." Congenital CMV can cause hearing loss, developmental and motor delay, vision loss, microcephaly (small head) and seizures. Congenital CMV is estimated to disable 4,000 babies annually.
As you know, workers have the right to “receive information and training about hazards” (Occupational Safety and Health Act of 1970). Yet, recent surveys show that most women have never heard of CMV—including child care providers (Thackeray, Magnusson, 2016). Many child care providers surveyed acknowledge using diaper wipes to clean, but diaper wipes do not effectively remove CMV from hands (Stowell et al., 2014). Although soap and water is best, hand sanitizer will reduce levels of CMV when a sink is not readily available. Licensed caregivers/teachers are trained in effective disinfecting procedures, but these protocols can only help reduce CMV transmission if workers are motivated to follow them. CMV is also a blood-borne pathogen.
Staff Education and Policies on Cytomegalovirus (CMV): According to Caring for Our Children (American Academy of Pediatrics (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…Up to 70% of children ages 1 to 3 years in group care settings excrete the virus...With regard to child-to-staff transmission, studies have shown increased rates of infection with CMV in caregivers/teachers ranging from 8% to 20%...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” (content in STANDARD modified 3/31/17). Print Staff Education and Policies on CMV by clicking "Save as PDF" at: nrckids.org/CFOC/Database/184.108.40.206
From CDC: You May Be Able to Reduce Your Risk--“The saliva and urine of children with CMV have high amounts of the virus. You can avoid getting a child’s saliva in your mouth by, for example, not sharing food, utensils, or cups with a child. Also, you should wash your hands after changing diapers. These cannot eliminate your risk of getting CMV, but may lessen the chances of getting it” ("Congenital CMV Facts for Pregnant Women and Parents" flyer at: cdc.gov/cmv).
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).
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 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...”
U.S. Child Care Health Policies: The book, Model Child Care Health Policies (AAP, 2014), includes 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)” (p. 116). The book states that programs should describe their commitment “to best practice, as indicated in CFOC3 [Caring For Our Children 3rd Edition, which includes CMV education]...A policy might specify intended compliance with accreditation standards, such as those of the National Association for the Education of Young Children (NAEYC) (www.naeyc.org) [which mentions CMV as an “occupational hazard”] for center-based care or the National Association for Family Child Care (www.nafcc.org)..." (page xviii).
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).”
RESOURCES FOR EDUCATING CHILD CARE PROVIDERS/TEACHERS ABOUT CMV
· CDC flyers: "Congenital CMV Facts for Pregnant Women and Parents" In English and En Español at: cdc.gov/cmv
· Utah Department of Health, required by law to educate child care providers about CMV, has brochures in English and Spanish, “CMV What Childcare Providers Need to Know (English)” | “Lo qué los proveedores de cuidado infantil necesitan saber sobre CMV (Spanish)” at: health.utah.gov/cshcn/programs/cmv.html
· National CMV Foundation: Wall posters: www.nationalcmv.org/resources/educational-downloads
Women have the right to know how to protect their pregnancies. Thank you in advance for your help!
Leader, Child Care Providers Education Committee
National CMV Foundation, Inc.
Lisa Saunders was a licensed child care provider unaware of her increased risk for CMV until after her daughter Elizabeth was born severally disabled by congenital CMV in 1989. Lisa is the author of "The Danger of Spreading CMV: How We Can Protect Our Children" (ChildCare Aware of America, June 2017). Referenced citations on her blog at: congenitalcmv.blogspot.com.
|Lisa Saunders holding a photograph of her daughter Elizabeth (1989-2006), born disabled by congenital CMV. Lisa is at the 2015 ceremonial signing of a law aimed at battling CMV with Connecticut Governor Malloy.|
In 2015, Connecticut passed a law aimed at battling CMV (by testing newborns who fail their hearing screen for CMV) and now provides information for child care providers on the Connecticut Department of Public Health (CT DPH) webpage at: http://portal.ct.gov/DPH/
Family-Health/EHDI/CMV. (The Congenital Cytomegalovirus” e and Prevention” on its website.) DiseasConnecticut child care centers may wish to download this CT DPH/National CMV Foundation flyer: “Are You Pregnant” National CMV Awareness.
Note from Lisa Saunders:
Note from Lisa Saunders:
"I’m Lisa Saunders, leader of Childcare Providers Education Committee with the National CMV Foundation. In 1989, I was a pregnant, licensed child care provider who didn’t know about CMV until it was too late. Like other licensed child care providers, I was trained in proper hand sanitizing protocols, but to save time, I used diaper wipes to clean my hands after handling toddler saliva not realizing diaper wipes don't kill CMV. My daughter Elizabeth was born with a small, damaged brain from congenital CMV. It wasn’t until after her birth that I received information stating child care providers are at increased risk for contacting CMV. This occupational hazard was not discussed in my child care licensing training. Had I known about CMV (hear song, "Had I Known") I would have been more careful to follow the hand sanitizing protocols in my home child care center, the church nursery I volunteered in, and with my own toddler as mothers of toddlers are also at increased risk for CMV). I realize that CMV in child care is a very “inconvenient truth,” yet I would have given anything to spare my daughter Elizabeth 16 years of suffering until she died during a seizure in 2006."
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