Congenital
Cytomegalovirus (cCMV) and Connecticut’s New Law
by
Lisa Saunders
In May 2015, Connecticut became the second
state in the U.S., after Utah, to pass a law on the leading viral cause of
birth defects, which causes more disabilities than Down syndrome. Governor Dan Malloy signed House Bill 5525-An Act Concerning Cytomegalovirus:
This act states: "any newborn infant who fails a newborn hearing screening, as described in section 19a-59, a screening test for cytomegalovirus, provided such screening test shall be administered within available appropriations on and after January 1, 2016. Such screening tests shall be administered as soon after birth as is medically appropriate."
"With bipartisan support, the legislature
approved and the governor signed a bill that will help mitigate the devastating
impact that this disease has on families. The bill requires that hospitals and
other health care institutions test newborn infants for CMV if they fail a
newborn hearing test. This will help parents intervene early and get their
newborn child the help it needs," states the State Senate Democrats of the Connecticut General
Assembly in a press release.
Ever since Lisa Saunders, the parent representative of the Congenital Cytomegalovirus (CMV) Foundation and mother of
Elizabeth born severely disabled by this preventable virus, learned Utah passed a CMV bill in 2013, she has been asking Connecticut to do the same. A
Connecticut CMV bill was passed by the House in 2014, but the Senate failed to
vote on it before the end of the legislative session. So, Lisa and others parents
whose children were disabled by congenital CMV, plus those in the medical
community who supported the bill (see their Public Hearing Testimonies), had to start
their campaign all over again in January 2015. House Bill 5525: "An Act
Concerning Cytomegalovirus" finally became law when passed by the Public
Health Committee, House (watch Lisa’s representative urge support and remember her daughter),
Senate, and signed by Governor Dan Malloy on May 26, 2015.
When Lisa learned the governor had signed the bill, she was ecstatic. She hopes that
testing will not only save Connecticut’s residents heartache by quickly
diagnosing and providing early intervention for children born with cCMV, but
that the money saved by the state will lead to more funds being invested in
prevention education until an effective vaccine is developed.
Q. What is Congenital Cytomegalovirus (cCMV)?
- Every
hour, cCMV causes one child to become disabled.
- Approximately
1 in 150 children is born with cCMV infection (30,000 each year).
- About
1 in 750 children is born with or develops permanent
problems due to congenital CMV infection.
- More than 5,000 children in the U.S. each
year suffer permanent problems caused by cCMV.
- Between 50% and 80% of adults in the U.S. are infected
with CMV by 40 years of age.
Q. What is the benefit of this law?
A. “CMV is known to cause hearing loss and therefore to test for it is
reasonable. Testing infants who fail their newborn hearing screen
will not only increase awareness and hopefully prevention of CMV transmission,
but we will be able to identify early those infants with congenital CMV and
therefore have the opportunity to intervene earlier to optimize their
outcomes,” states Dr. Brenda Kinsella Balch, a Connecticut pediatrician and
Chapter Champion for the American Academy of Pediatrics Early Hearing Detection
and Intervention Program.
“The law encourages the proper timing of
the test, so that diagnosis is not delayed beyond the critical time period of
diagnostic accuracy for congenital CMV--the first three weeks of life,” states
Dr. Demmler-Harrison of Texas, Director, Congenital CMV
Disease Research, Clinic & Registry.
"This is a
game-changing step forward in our ability to determine CMV causality and give
parents a viable option for early treatment," said Scott R. Schoem, MD,
FAAP, Director of Otolaryngology, Connecticut
Children’s Medical Center.
Q. What does this law mean to health care
providers?
A. According to Clinical Advisor’s article, Connecticut passes cytomegalovirus screening
law for newborns, “Timing
is key when identifying CMV infection. Providers should test via viral urine
culture or urine PCR within the first three weeks of life. If a newborn tests
positive, the next step is to refer the infant immediately to a pediatric
disease specialist…”
According to Dr. Demmler-Harrison,
Director, Congenital CMV
Disease Research, Clinic & Registry, “This law is not dictating what doctors should do, but rather
provides them the tools to practice good medicine in all arenas, including
newborn care of babies with congenital hearing loss. Often, CMV is the last
thing doctors think of, and it should be one of the first things they think
of.”
Q. How many people know about congenital
CMV?
Q. Why haven’t most people heard of this
leading cause of birth defects before?
Q. Is this the “kitty litter” disease?
A. No, that is toxoplasmosis, which causes
fewer birth defects than cCMV. Like toxoplasmosis, cCMV is
preventable, but most women of childbearing age have never heard of the
precautions to take.
Q. What about a vaccine against CMV?
Q. Overall numbers of newborns
affected by cCMV in Connecticut?
A. In 2013, the number of live births in
Connecticut was 36,085. Assuming that is the approximate number born in
Connecticut each year, and using the CDC's statistics that 1 in 750 babies are
born disabled by cCMV, then it can be estimated that there are 47 children
born disabled by cCMV in Connecticut each year [ 36,085
births X .0013 (1/750)
cCMV disabled = 47 babies born with cCMV in Connecticut].
Q. How many women are infected with
cytomegalovirus while pregnant?
A. “The annual rate of a pregnant woman
who is CMV antibody negative catching CMV for the first time in pregnancy has
been estimated to be between 1-4% of all pregnant women. Higher risk groups may
have higher rates of infection per year: day care workers estimated 10%, and
women who have a toddler shedding CMV in the home, who do not practice
precautions, up to 50%,”states Dr. Demmler-Harrison of Texas, Director, Congenital CMV Disease Research, Clinic and Registry.
Q. Which women are most at risk for
contracting CMV?
A. “75% of women with a primary infection
during pregnancy acquire CMV from their own child under two years of age,” said
Stuart Adler, M.D.
Q. What is the estimated cost of caring
for children disabled by cCMV in Connecticut?
A. “In the early 1990s, the expense to the
US health care system associated with congenital HCMV [Human Cytomegalovirus]
infection was estimated at approximately $1.9 billion annually, with a average cost per child of over
$300,000." Although
$300,000 per child annually is an old cost figure, Connecticut’s annual cost of
caring for children disabled by cCMV can still be estimated at: 36,085
births X .0013 cCMV
disabled = 47 babies (born disabled by cCMV in Connecticut each year) X
$300,000/year = $14,100,000, or, over $14 million annually.
“This figure is almost certainly an
underestimate, especially now with enhanced mobility aids, surgical
interventions, cochlear implants, antiviral therapies, occupational and
physical therapies, etc., which were not likely included in the older cost estimates,”
says Dr. Demmler-Harrison of Texas, Director, Congenital CMV Disease
Registry and Research Program. For example, one of her patients born in 2001 needed a
hemispherectomy [half of her brain removed] to control intractable seizures
from polymicrgyria cortical malformation of one side of her brain caused by
congenital CMV.
The little girl’s mother, Sandra Salerno
of Texas, who resigned from her position as a financial analyst to be the
primary caretaker of Lillian, said of her daughter’s medical costs, “I have tried to sum up
her medical costs for the first three years of life and they exceed $1.4
million. The surgery and five-week subsequent hospital stay was probably half
of the total costs. She attends ten weekly therapies that last an hour each. At
one point, she was taking seven medications. I believe she's been sedated 20
times in her life. Multiple MRI's, heart echos, PET scan, brain surgery, ear
tube placement and several Auditory
Brainstem Response studies. Something that is probably underappreciated is
also the cost of education for people with significant disabilities due to
congenital cytomegalovirus. Lillian was offered (but we turned down) placement
at the age of three for a full day school program with our district. The class
ratio is 3:1 and she also qualified under multiple impairments for additional
services. I have no idea how much that costs the state, and my daughter is
probably higher functioning than others with cCMV, so I can't imagine the costs
of children more disabled.”
Q. What are the costs of screening?
A. “The cytomegalovirus test costs
approximately $150.00. As only a few infants annually fail the newborn hearing
screening at UCHC [University of Connecticut Health Center], any cost incurred
at UCHC is expected to be minimal,” states the House Bill 5525 webpage.
Q. How does the cost of screening compare
to the costs saved through early detection?
A.
1. “Usually, if the CMV test is positive,
no further testing, such genetic testing (which can cost thousands of dollars
and may require pre-approvals), is done, unless there are unusual
circumstances. Certainly, on rare occasion, a poor baby can be born with two
conditions, but that is not at all common. Therefore, early diagnosis of a
clear condition with a clear diagnostic test saves the doctor and the family a
costly and heart breaking/stressful diagnostic odyssey,” states Dr.
Demmler-Harrison, Director, Congenital CMV
Disease Registry and Research Program. Fox News reported on the terrible consequences of a delayed cCMV diagnosis for the child Lillian
Salerno mentioned above.
2. In addition to saving on the cost of more
expensive diagnostic tests by first testing for CMV when a baby fails their
hearing screen, an earlier diagnosis of cCMV means earlier intervention,
which can mean a less disabled child. The less disabled a child is, the less
they cost the state to care for.
“The Connecticut legislation
extends important education and protection to families and infants from
the devastating effects of CMV. The impact on lives and the reduction of state
dollars needed to serve those impaired by CMV is immeasurable,” said
Ronda Rudd Menlove, Ph.D., the representative responsible for passing and
enacting the bill in Utah. She is the co-founder of the Utah CMV Council,
along with her daughter Sara Menlove Doutre, a special education and early
intervention policy consultant whose daughter is affected by congenital
CMV.
Q. What do we do if a baby tests positive
for cCMV?
There, you will find:
PRINTABLE BROCHURES:
For Health Care and Newborn Hearing Screening Providers:
***FREE ONLINE WEBINAR!***
"cCMV 101: Congenital Cytomegalovirus from Prevention to Treatment"
Presented by: Dr. Michael Cannon of the Centers for Disease Control and Prevention (CDC)
Q. Can cCMV be treated if diagnosed?
A. The treating physician may recommend
treating the child with an antiviral. “CMV infection in newborns can be treated
with ganciclovir by IV or valganciclovir by oral route -- treatment reduces
hearing loss progression and improves growth and head size/brain growth and
improves developmental milestones,” says Dr. Demmler-Harrison, Director, Congenital CMV
Disease Research, Clinic and Registry.
Q. How much does this cCMV antiviral cost?
A. Cost is estimated at $1,000 TO
$1500 per 100 ML bottle. One bottle is needed each month for a
6-month treatment. [This figure needs confirmation.]
Q. Will all babies destined to lose their
hearing from cCMV show a hearing loss in the newborn screen?
A. No. Hearing loss from cCMV is known to
be progressive, and therefore, not all children who will have disabilities from cCMV will
be detected early. That is why many in the medical community are proponents of
screening every newborn for CMV. But this law will at least help 25% of the
children who will experience a hearing loss from cCMV receive early
intervention.
Q. How can CMV be avoided?
·
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.
·
Use
soap and water or a disinfectant to clean hard surfaces that have been
contaminated by secretions.
·
Don’t
kiss young children on the lips or share food, drinks, or eating utensils with
them.
·
If
you work in a day care center, limit close contact with children younger than
2½ years of age, especially if you've never been infected with CMV or don't know if you've been infected.
Q. Will Connecticut save money if CMV
prevention is taught?
A. Yes, because teaching prevention reduces the
rate of transmission of CMV, according to studies in the U.S. and France. “Studies have shown that women who know
they are CMV seronegative, know they are pregnant, and know about their
toddler's CMV shedding are the most likely to prevent CMV transmission and
reduce their risk from over 50 percent during pregnancy to a risk of less
than 5 percent during pregnancy. It is not likely that isolated
instances of exposure to saliva or drool will result in transmission. Most
studies suggest prolonged repeated exposures over time are important for CMV
transmission,” says Dr. Demmler-Harrison.
A. There is a cost to prevention education.
In 2014, Connecticut estimated the cost to the state at $40,000 the
first year, then $26,000 the following years.
Q. Shouldn’t we try to educate the public
that pregnant women shouldn’t kiss their toddlers around the mouth or share
food with them? Shouldn’t that be common knowledge like pregnant women
shouldn’t change the kitty litter to prevent the birth defects caused by toxoplasmosis?
A. “Yes. In addition to
saving money, you can prevent indescribable human suffering by providing
prevention education,” said Lisa Saunders, parent representative, Congenital Cytomegalovirus (CMV) Foundation. “In fact, the United States Senate
passed legislation designating the month of June as National
Congenital CMV Awareness Month, while recommending that ‘more effort be
taken to counsel women of childbearing age of the effect this virus can have on
their children.’” Saunders’ daughter, Elizabeth, was born
severely disabled by cCMV. She didn’t know she was putting her pregnancy at
risk when operating a licensed daycare center in her home. Saunders hopes
Connecticut will now add cCMV prevention information to their daycare licensing
literature and post cCMV flyers at daycare centers.
Q. The cost for prevention education
seems minimal compared to cost of caring for a child disabled by cCMV ($40,000 annually for prevention education versus $300,000 annually to care for EACH child disabled by cCMV).
Without using state dollars, how can we start our own prevention campaign?
A. "You can start by providing
cCMV prevention education on your website. Perhaps you know an organization that
would provide grant money for printing brochures and posters, and/or you can
contact colleges who have an internship programs for medical, public health or
marketing students. Since daycare workers are at higher risk for contracting
CMV and passing it onto their unborn, daycare centers can easily post
flyers on how to minimize one’s risk. You can easily post downloadable cCMV
prevention brochures such as the CDC's flyer: ‘What
Women Should Know About Cytomegalovirus (CMV)’ on your website, which can be found at: http://congenitalcmv.org/CDCbrochure.pdf,” states Lisa Saunders, parent
representative, Congenital Cytomegalovirus (CMV) Foundation.
If you would like to replicate Utah’s
prevention brochures for
doctors, parents, and daycare providers by inserting your organization’s contact information and logo, contact
Stephanie Browning McVicar, Au.D., CCC-A, Utah Department of Health, Director,
Early Hearing Detection and Intervention / Cytomegalovirus Public Health
Initiative. McVicar said, “I am so excited that another state is bringing attention
to congenital cytomegalovirus. Utah is looking forward to partnering with
Connecticut in their upcoming endeavors."
###
* Lisa Saunders of
Mystic, Connecticut, is author of memoir, "Anything But a Dog! The perfect pet for a girl with congenital CMV
(cytomegalovirus)," and
the parent representative of the Congenital Cytomegalovirus Foundation, which raises awareness about maternal
testing for first infection during pregnancy, newborn testing and the need to
develop a vaccine (Lenore Pereira, Ph.D., Professor,
Cell and Tissue Biology Department, University of California San Francisco, is
the Foundation founder and can be reached at: lenore.pereira@ucsf.edu).
Saunders said, “My OB/GYNs didn’t tell me how to
prevent congenital CMV, namely by avoiding kissing my toddler near the mouth or
sharing food with her, until after my second daughter was born profoundly
mentally and physically disabled by the disease. It was then that I received
literature stating women who work in daycare, or have a young child in daycare,
are at a higher risk for catching it as toddlers are the majority of carriers.
While I was pregnant with Elizabeth, I not only had a toddler of my own, I was
also running a licensed daycare center in my home. Nowhere in the licensing
literature was there a CMV prevention message. In milder cases, children
may lose hearing or struggle with learning, but Elizabeth's case was not a
mild one.” Elizabeth died at age 16 during a seizure in 2006.
CONGENITAL
CYTOMEGALOVIRUS CONTACTS
Dr. Brenda K. Balch, MD, CT’s American Academy of Pediatrics Early Hearing Detection & Intervention Chapter
Champion. She has a strong interest because congenital CMV is a major cause of
hearing loss. bkbalch@sbcglobal.net. (Sent Testimony to
CT’s HB 5525).
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, gjdemmle@texaschildrens.org. The CMV Registry supports CMV research, disseminates information and
provides parent support. (Sent Letter
of Testimony to CT’s HB 5525).
CDC’s Michael Cannon, Ph.D.
mrc7@cdc.gov, a research epidemiologist at
the Centers for Disease Control and Prevention. Dr. Cannon is particularly
interested in developing strategies to prevent congenital CMV infection through
public awareness and education.
Lenore Pereira, Ph.D., Founder of
Congenital Cytomegalovirus Foundation, and Professor, Cell and Tissue Biology
Department, University of California San Francisco. lenore.pereira@ucsf.edu, or visit www.congenitalcmv.org. The Congenital CMV Foundation raises awareness about
maternal testing for first infection during pregnancy, newborn testing and the
need to develop a vaccine.
Sara Menlove Doutre, President and Education Policy Consultant at
Doutre Consulting (her daughter was affected by congenital cytomegalovirus) and
co-founder of Utah CMV Council. Contact: sara@doutreconsulting.com
Stephanie Browning McVicar, Au.D., CCC-A, DOCTOR OF AUDIOLOGY (worked tirelessly to pass the Utah bill),
Specialty Services Program Manager, State EHDI Director, State of Utah
Department of Health, Children with Special Healthcare Needs, Children's
Hearing and Speech Services, (801) 584-8218, smcvicar@utah.gov.
Ronda Rudd Menlove, PhD. She was the representative responsible for passing and
enacting the bill in Utah (2013) and has offered to advise CT politicians about
the legislation and needed funding. Utah CMV Council, Ronda.menlove@gmail.com.
Sources
Carlson, Amanda, MD; Norwitz, Errol R MD, PhD;
Stiller, Robert J , MD. (Fall 2010). Cytomegalovirus Infection in
Pregnancy: Should All Women Be Screened? . Retrieved from National Center
for Biotechnology Information : http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3046747/
Adler SP, Finney JW, Manganello AM, Best AM. (2004,
October). Prevention of child-to-mother transmission of cytomegalovirus
among pregnant women. Retrieved from National Center for Biotechnology
Information: http://www.ncbi.nlm.nih.gov/pubmed/15480372
Adler, Stuart, MD, Emeritus Professor of Pediatrics
and Chairman, Division of Infectious Disease. (2014, Feb. 28). Public
Hearing Testimony, Raised H.B. No. 5147 . Retrieved from Connecticut
General Assembly: http://www.cga.ct.gov/2014/PHdata/Tmy/2014HB-05147-R000228-Stuart%20Adler,%20Emeritus%20Professor%20of%20Pediatrics%20and%20Chairman,%20Division%20of%20Infectious%20Disease-TMY.PDF
Armstrong, Farah,President and Founder, Maddie's
Mission. (2014, Feb. 28). Public Hearing Testimony, Raised H.B. No. 5147 .
Retrieved from Connecticut General Assembly :
http://www.cga.ct.gov/2014/PHdata/Tmy/2014HB-05147-R000228-Farah,%20Armstrong-TMY.PDF
Arvin, A. et. al., . (2004). Vaccine Development
to Prevent Cytomegalovirus Disease: Report from the National Vaccine Advisory
Committee. Retrieved from Oxford Journals:
http://cid.oxfordjournals.org/content/39/2/233.long
Bailey, Jenny Meeden, Texas, baby first in Houston
to receive ganciclovir treatment. (2014, Feb. 28). Public Hearing
Testimony, Raised H.B. No. 5147. Retrieved from Connecticut General
Assembly:
http://www.cga.ct.gov/2014/PHdata/Tmy/2014HB-05147-R000228-Jenny%20Meeden%20Bailey-TMY.PDF
Balch, Brenda K., MD. (2015, February 20). HB
5525. Retrieved from Connecticut General Assembly: http://www.cga.ct.gov/2015/PHdata/Tmy/2015HB-05525-R000220-Brenda%20Kinsella%20Balch,%20MD.%20AAP%20Connecticut%20Chapter%20Champion%20for%20the%20Early%20Hearing%20Detection%20and%20Intervention-TMY.PDF
Blazek, Nicole, Senior Clinical Content Editor.
(2014, June 21). Educate pregnant women to prevent congenital CMV.
Retrieved Reference: 1.Pina AL. “Breaking the Silence About Congenital CMV.”
Presented at: AAPN 2014. Jun 17-22; Nashville, Tenn., from The Clinical
Advisor: http://www.clinicaladvisor.com/educate-pregnant-women-to-prevent-congenital-cmv/article/357115/
Cannon MJ, Westbrook K, Levis D, Schleiss MR,
Thackeray R, Pass RF. . (2012, May). Awareness of and behaviors related to
child-to-mother transmission of cytomegalovirus. Retrieved January 9,
2015, from National Center for Biotechnology Information, U.S. National
Library of Medicine : http://www.ncbi.nlm.nih.gov/pubmed/22465669
Cannon, Michael J.; Davis, Katherine Finn. (2005,
June 20). Washing our hands of the congenital cytomegalovirus disease epidemic.
Retrieved from BMC Public Health: http://www.biomedcentral.com/1471-2458/5/70
Centers for Disease Control and Prevention. (n.d.). Retrieved from Congenital CMV Infection
Trends and Statistics: http://www.cdc.gov/cmv/trends-stats.html
Centers for Disease Control and Prevention (CDC).
(n.d.). Cytomegalovirus (CMV) and Congenital CMV Infection. Retrieved
from Centers for Disease Control and Prevention (CDC):
http://www.cdc.gov/cmv/index.html
Centers for Disease Control and Prevention (CDC).
(n.d.). Infant Health. Retrieved from Centers for Disease Control and
Prevention (CDC): http://www.cdc.gov/nchs/fastats/infant-health.htm
Centers for Disease Control and Prevention (CDC).
(n.d.). State and Territorial Data. Retrieved from Centers for Disease
Control and Prevention (CDC):
http://www.cdc.gov/nchs/fastats/state-and-territorial-data.htm
Children's Hearing and Speech Services. (n.d.). Retrieved from Utah Department of Health:
http://www.health.utah.gov/cshcn/CHSS/CMV.html
Cody, S. (2015, May 6). CT Now. Retrieved
from CT Moms Fight for CMV Legislation : "Connecticut Moms Fight for CMV
Legislation":http://www.ctnow.com/family/ctnow-ct-moms-fight-for-cmv-legislation-20150505,0,3850658.column
Cody, S. (2015, May 27). New law in Connecticut
to fight number one viral cause of birth defects. Retrieved from Fox CT:
http://foxct.com/2015/05/27/new-law-in-connecticut-to-fight-number-one-viral-cause-of-birth-defects/
Congenital Cytomegalovirus Infection Time To Test
Newborns. (2014, July 1). Retrieved
December 6, 2014, from ENT Today:
http://www.enttoday.org/article/congenital-cytomegalovirus-infection-time-to-test-newborns/
Cytomegalovirus (CMV) education bill on hold for now. (2014, May 8). Retrieved from Fox CT: http://foxct.com/2014/05/08/cytomegalovirus-cmv-education-bill-on-hold-for-now/
Cytomegalovirus-CMV: H.B. 81 (2013) Public Health
Initiative in conjunction with the Utah Department of Health. (n.d.). Retrieved from Utah Department of Health:
http://www.health.utah.gov/cshcn/PDF/CMV%20Utah%20Flyer.pdf
Demmler-Harrison,Gail, MD,Director, Congenital CMV
Disease Registry and Research Program. (2015, Feb. 20). Public Hearing
Testimony, Raised H.B. No. 5525. Retrieved from Connectictut General
Assembly: http://www.cga.ct.gov/2015/PHdata/Tmy/2015HB-05525-R000220-Gail%20Demmler%20Harrison,%20MD-TMY.PDF
Doutre, Sara, co-founder, Utah CMV Council;
Menlove,Ronda, Utah House of Representatives,. (n.d.). Retrieved from Utah
CMV Council: http://www.utahcmvcouncil.org/about-us/
Goderis, Julie, MD, et al. (2014, October 27). Hearing
Loss and Congenital CMV Infection: A Systematic Review. Retrieved from
Pediatrics:
http://pediatrics.aappublications.org/content/early/2014/10/21/peds.2014-1173.abstract#aff-1
Greenlee, Janelle, President and Founder, Stop CMV.
(2014, Feb. 28). Public Hearing Testimony, Raised H.B. No. 5147 .
Retrieved from Connecticut General Assembly:
http://www.cga.ct.gov/2014/PHdata/Tmy/2014HB-05147-R000228-Janelle%20Greenlee,%20President%20and%20Founder,%20Stop%20CMV-TMY.PDF
H.B. 81 Second Substitute Cytomegalovirus Public
Health Initiative. (2013 General
Session). Retrieved from Utah State Legislature:
http://le.utah.gov/~2013/bills/static/hb0081.html
H.B. No. 5147. (2014). Retrieved from Connecictut General Assembly : http://www.cga.ct.gov/asp/cgabillstatus/cgabillstatus.asp?selBillType=Bill&bill_num=5147&which_year=2014
Kimberlin, David W., M.D., et al. (2015, March 5). Valganciclovir
for Symptomatic Congenital Cytomegalovirus Disease. Retrieved from The
New Enland Journal of Medicine:
http://www.nejm.org/doi/full/10.1056/NEJMoa1404599
Knowledge and Awareness of Congenital
Cytomegalovirus Among Women. (2006,
December 28). Retrieved from National Center for Biotechnology Information:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1779612/
Knowledge and Practices of Obstetricians and
Gynecologists Regarding Cytomegalovirus Infection During Pregnancy --- United
States, 2007. (n.d.). Retrieved
from Centers for Disease Control and Prevntion (CDC): http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5703a2.htm
Lopez, Adriana, M.H.S., et al. (n.d.). Preventing
Congenital Toxoplasmosis . Retrieved February 7, 2015, from CDC:
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr4902a5.htm
Maminta, J. (2015, March 3). Mystic mom raising
awareness about potentially deadly virus. Retrieved from News 8:
http://wtnh.com/2015/03/03/mystic-mom-raising-awareness-about-potentially-deadly-virus/
Mother on a mission to stop birth defects. (2014, April 28). Retrieved from Fox CT : http://foxct.com/2014/04/28/mother-on-a-mission-to-stop-birth-defects/
National Congenital CMV Disease Registry . (n.d.). Retrieved from Baylor College of Medicine:
https://www.bcm.edu/pedi/infect/cmv/
Ofgang, E. (2015, June). Mystic Mom 'Overwhelmed'
by Governor Signing Law on ‘Stealth Virus’ That Can Catch Pregnant Women
Unaware. Retrieved from Connecticut Magazine:
http://www.connecticutmag.com/Blog/Health-Wellness/February-2015/Mystic-Mom-Raises-Awareness-of-Stealth-Virus-That-Can-Catch-Pregnant-Women-Unawares/
Pass RF, Hutto C. (1986, Jul-Aug 8). Group day
care and cytomegaloviral infections of mothers and children. Retrieved
from National Center for Biotechnology Information:
http://www.ncbi.nlm.nih.gov/pubmed/3018892
Pereira, Lenore, PhD, Founder, Congenital CMV
Foundation. (n.d.). Retrieved from Congenital CMV Foundation:
http://www.congenitalcmv.org/foundation.htm
Preventing Congenital CMV During Pregnancy. (2015, Feb 9). Retrieved Feb 2015, 17, from News
8's Connecticut Style: http://wtnh.com/2015/02/09/preventing-congenital-cmv-during-pregnancy/
Saunders, L. (2009). Anything But a Dog! The
perfect pet for a girl with congenital CMV (cytomegalovirus). Retrieved
from
http://www.amazon.com/Anything-But-Dog-Congenital-Cytomegalovirus/dp/1588329968/ref=sr_1_1?s=books&ie=UTF8&qid=1340644532&sr=1-1&keywords=anything+but+a+dog+lisa+saunders
Saunders, L. (2014, April 28). Parent
representative, Congenital Cytomegalovirus Foundation, and Dr. Brenda Balch
of Mystic, CT. Fox CT: Mommy Minute. (S. Cody, Interviewer)
https://www.youtube.com/watch?v=4lT2GpwzaMU&feature=youtu.be. Retrieved
from Youtube.
Saunders, Lisa, Parent Representative, Congenital
CMV Foundation. (2014, Feb. 28). Public Hearing Testimony, Raised H.B. No.
5147. Retrieved from Connecictut General Assembly:
http://www.cga.ct.gov/2014/PHdata/Tmy/2014HB-05147-R000228-Lisa%20Saunders,%20Parent%20Representative,%20Congenital%20CMV%20Foundation-TMY.PDF
Schleiss, M. R. (2008). Cytomegalovirus Vaccine
Development. Retrieved Januarary 14, 2015, from US National Library of
Medicine: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2831992/
Shapiro, Eugene, M.D., Professor of Pediatrics,
Epidemiology and Investigative Medicine, Yale University. (2014, Feb. 28). Public
Hearing Testimony, H.B. No. 5147. Retrieved from Connecticut General
Assembly:
http://www.cga.ct.gov/2014/PHdata/Tmy/2014HB-05147-R000228-Eugene%20Shapiro,%20M.D.,%20Professor%20of%20Pediatrics,%20Epidermiology%20and%20Investigative%20Medicine,%20Yale%20University-TMY.PDF
Tanner, L. (2014, May 17). Silent virus a rare,
dangerous risk for the unborn. Retrieved from Associated Press:
http://bigstory.ap.org/article/silent-virus-rare-dangerous-risk-unborn
Vaccines for the 21st Century: A Tool for
Decisionmaking--CMV. (1999, March
1). Retrieved from Institute of Medicine:
http://www.iom.edu/Reports/1999/Vaccines-for-the-21st-Century-A-Tool-for-Decisionmaking.aspx
Vauloup-Fellous,Christelle; Picone,Olivie;
Cordier,Anne-Gaëlle; Parent-du-Châtelet,Isabelle;Senat,Marie-Victoire;
Frydman,René; Grangeot-Keros, Liliane . (December 2009). Does hygiene
counseling have an impact on the rate of CMV primary infection during pregnancy.
Retrieved from Jounal of Clinical Virology:
http://www.journalofclinicalvirology.com/article/S1386-6532(09)00419-3/abstract
What Childcare Providers Need to Know about CMV. (n.d.). Retrieved Feb 17, 2015, from Utah
Department of Health, Children with Special Healthcare Needs, Children's
Hearing and Speech Services:
http://www.health.utah.gov/cshcn/PDF/CMV%20for%20Childcare%20Providers%20NEED%20TO%20KNOW.pdf
What Women Should Know About Cytomegalovirus (CMV). (n.d.). Retrieved from Congenital Cytomegalovirus
Foundation: http://congenitalcmv.org/CDCbrochure.pdf
