Wednesday, April 26, 2017

15 Reasons Why Caregivers/Teachers Should Know About CMV

15 Reasons Why Child Care Providers (and all women of childbearing age) Should Be Informed About Congenital CMV

(for pdf, click here)

The American Academy of Pediatrics states: “child care staff members should be counseled about risks. This counseling may include testing for serum antibody to CMV to determine the child care provider’s protection against primary CMV infection..."

The following are 15 good reasons childcare givers of toddlers should know about CMV:
1) Approximately 1 - 4% is the estimated “annual rate of a pregnant woman who is CMV antibody negative catching CMV for the first time in pregnancy” Demmler-Harrison, MD, CMV in Pregnancy: What Should I Know?, 2014).
2) Approximately 8 - 20% of caregivers/teachers contract CMV infection every year (American Academy of Pediatrics). March of Dimes states, “As many as 7 in 10 children (70 percent) between 1 and 3 years of age who go to day care may have CMV. They can pass it on to their families, caretakers and other children.”
3) 44% to 100% of two-year-olds in group daycare are excreting CMV (Pass et al., 1986). CMV is an “occupational risk" for daycare educators (Joseph, et al., 2006).
4) Caregivers/teachers should be told about CMV because of increased probability of exposure (AAP et al.. 2011). Teachers/caregivers of young children are at greater risk for contracting diseases as are the children in their care: "Children cared for at daycare or in preschool education exhibit a two to three times greater risk of acquiring infections...control measures are indispensable to the prevention and control of infectious diseases." (Nesti et al, 2007)
5) Congenital CMV is the #1 Birth Defects Virus (Carlson et al., 2010). Disabilities from congenital CMV" exceeds those from the fetal alcohol syndrome, spina bifida, and childhood infections..."(Boppana and Fowler, 2017).
6) Approximately 1% of the four million infants born each year in the U.S., are infected prenatally with CMV (American Academy of Pediatrics [AAP] et al., Caring for Our Children, 2011).  Ten percent of those infants (about 4,000) may have one or multiple abnormalities.
7) “Providers do not know how to appropriately sanitize surfaces to reduce spread of disease.” Many providers use diaper wipes to clean a surface. Diaper wipes do not sanitize (Thackeray et al., 2016).
8) Mothers of children in daycare are also at increased risk for CMV (Pass et al., 1986). “Studies in industrialized countries have confirmed that children attending daycare have higher excretion rates of CMV than children not attending day-care…” (Joseph, et al, 2006). 
9) Only 18.5% of licensed “in-home” daycare providers have heard of CMV according to “Child Care Provider Awareness and Prevention of Cytomegalovirus and Other Infectious Diseases” (Thackeray et al., 2016).
10) “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 et al., 2016).
11) $1.86 billion annually, with a cost per child of more than $300,000, is the estimated cost of congenital CMV to the US health care system (Modlin, Arvin, et al., 2004).
12) Many childcare providers have not heard of CMV despite the guidelines set forth by the NAEYC: National Association for the Education of Young Children. Its "Early Childhood Program Standards and Accreditation Criteria and Guidance for Assessment (10.D.01, p.91)" includes: "steps to reduce occupational hazards such as infectious diseases (e.g., exposure of pregnant staff to CMV [cytomegalovirus], chicken pox)..."
13) It is a worker's right to know occupational hazards according to the Occupational Safety and Health Administration (OSHA). As CMV is also a bloodborne pathogen, see:
14) “Increasing risk perception is important because providers may not be concerned about taking measures to reduce the probability of infection if they feel that they are at low risk” (Thackeray et al., 2016).
15) The CDC "suggests that pregnant women reduce their risk of CMV acquisition during pregnancy using simple hygienic precautions but this suggestion is not often followed...the efficacy of hygienic precautions has been [greater than] 75%.” (Adler, 2015).  

There are more than half a million child care workers (573,430) in the U.S. according to the Child Care in America: 2016 State Fact Sheet report (pdf) published by Child Care Aware of America.

“Perhaps no single cause of birth defects and developmental disabilities in the United States currently provides greater opportunity for improved outcomes in more children than congenital CMV…women deserve to be informed about how they can reduce their risk of CMV infection during pregnancy…” (Cannon et al., 2005).


Your may find the following resources helpful:

  1. "Staff Education and Policies on Cytomegalovirus (CMV)," American Academy of Pediatrics (AAP) et al., Caring for Our Children
  2. Fact sheet from on CMV  includes child care providers.
  3. National CMV Foundation features several types of CMV flyers for downloading.
  4. Cytomegalovirus
  5. The Danger of Spreading CMV: How We Can Protect Our Children (ChildCare Aware of America, 2017).
  6.  NAEYC: National Association for the Education of Young Children and its "Early Childhood Program Standards and Accreditation Criteria and Guidance for Assessment (10.D.01, p.91)," includes: "a. steps to reduce occupational hazards such as infectious diseases (e.g., exposure of pregnant staff to CMV [cytomegalovirus], chicken pox)..."
I helped Connecticut pass a law requiring babies to be tested for CMV if they fail their newborn hearing test. Although prevention education didn't pass because of funds, the Connecticut Department of Public Health (DPH) now provides these educational materials: 

1.     Congenital Cytomegalovirus (CMV):
2.     Flyer: Are You Pregnant?

Just FYI, this is what a few other countries do about CMV in daycare: 

In Queensland, Australia, they relocate “workers who are pregnant, or who expect to become pregnant, to care for children aged over two to reduce contact with urine and saliva.” In Germany: "Based on the German Maternity Protection Law (Mutterschutzgesetz)… to protect DCWs [day care 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..."

Please let me know if I can meet with you to discuss ways we can prevent the suffering caused by congenital CMV. 

Thank you!

Lisa Saunders

Lisa Saunders compiled "15 Reasons Child Care Providers Should be Informed About  Congenital CMV". She is the author of author of  "The Danger of Spreading CMV: How We Can Protect Our Children" published in ChildCare Aware of America (June 2017). 

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