Abstract/Outline: Childcare and CMV: Protect Your Pregnancy

by Lisa Saunders

(click for pdf)

Abstract: Another good read to wash your hands! Annually, 8 - 20% of caregivers/teachers contract cytomegalovirus (CMV), the #1 birth defects virus. The American Academy of Pediatrics recommends counseling caregivers of their increased exposure to CMV, importance of hand-washing, and avoiding contact with urine, saliva, and nasal secretions. 

Presentation reviewed by 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.

OUTLINE:

1.      Congenital Cytomegalovirus:

According to the CDC, “Cytomegalovirus (pronounced sy-toe-MEG-a-low-vy-rus), or CMV, is a common virus that infects people of all ages. Over half of adults by age 40 have been infected with CMV...Most people infected with CMV show no signs or symptoms. However, CMV infection can cause serious health problems for people with weakened immune systems, as well as babies infected with the virus before they are born (congenital CMV).” Congenital CMV causes more disabilities than Down syndrome, fetal alcohol syndrome, spina bifida, and pediatric HIV/AIDS (NationalCMV.org).

2.      Connecticut Became 2^nd State in U.S. to Pass a CMV Testing Law 

On January 1, 2016, Public Act Number 15-10 amended existing newborn screening requirements by mandating that infants who fail a newborn hearing screening also be screened for cytomegalovirus (CMV).  The Connecticut Department of Public Health provides resources for CMV prevention at: 
http://portal.ct.gov/DPH/Family-Health/EHDI/CMV
(You can check your state's policy on CMV education for child care providers by clicking here. To check your state's CMV laws, or to find out how you can get a CMV law, click here.) 

3.      Recommendations from the American Academy of Pediatrics (AAP)--Caring for Our Children, (2011): Caregivers/teachers should be informed about their increased exposure to CMV and: “The importance of hand hygiene measures (especially handwashing and avoiding contact with urine, saliva, and nasal secretions) to lower the risk of CMV… Female employees of childbearing age should be referred to their primary health care provider …for counseling about their risk of CMV infection.”

4.      Caregivers/teachers are at increased risk for CMV:

·        General population: 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).

·        Caregivers/teachers: 8- 20% of contract CMV infection every year (AAP et al.. 2011)

·        44% to 100% of two-year-olds in a group daycare study were excreting CMV for two years or more (Pass et al., 1986).

5.      Toddlers in group care spread infections such as CMV:

Toddlers put each other’s toys in their mouths, mouth each other’s cups, utensils, and toothbrushes, and need adults to wipe their noses, feed them, and change their diapers.

6.      Hand hygiene protocols reduce transmission of CMV: Study, “Cytomegalovirus Survival and Transferability and the Effectiveness of Common Hand-Washing Agents against Cytomegalovirus on Live Human Hands” (Stowella et al., 2014).

·        “After cleansing, no viable virus was recovered using water, plain soap, antibacterial soap, or sanitizer…Our data support the use of alcohol-based sanitizer or almost any hand-cleansing method that involves washing with water as a way to significantly reduce levels of viable CMV on hands and, presumably, reduce transmission risk.”

·        Diaper wipes are NOT EFFECTIVE for sanitizing hands and surfaces! “Viable CMV was recovered from 4/20 hands 10 min after diaper wipe cleansing. CMV remains viable on hands for sufficient times to allow transmission…”

7.      Data from five studies on the effectiveness of CMV prevention through hand hygiene and avoiding bodily fluids:  

“In each report, the efficacy of hygienic precautions has been [greater than] 75%...For seronegative pregnant women who are at high risk because of exposure to a young child in the home or in large group childcare, hygienic precautions are simple, inexpensive, and highly effective.” (Prevention of Maternal–Fetal Transmission of Cytomegalovirus, Adler, 2015)

8.      Why it is so important child care providers understand their increased risk for CMV:

Survey of In-Home Child Care Providers: Child Care Provider Awareness and Prevention of Cytomegalovirus and Other Infectious Diseases (Thackeray et al., 2016):

·        Only 18.5% of licensed “in-home” daycare providers have heard of CMV.

·        “Providers do not know how to appropriately sanitize surfaces to reduce spread of disease.” For example, many providers use diaper wipes to clean a surface. Using diaper wipes will not sanitize hands or surfaces.

·        “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.”

According to the Connecticut Department of Public Health, unlike childcare providers, “The risk of CMV infection among healthcare workers appears to be no greater than that among the general public. This may be due in part to adherence to standard precautions by healthcare providers when handling body fluids and the lower amount of personal contact in the healthcare setting.”

9.      Sample memo to educate child care workers:

“CMV—Another Good Reason to Wash Your Hands!” Remind your employees of your handwashing and sanitizing procedures, which provide strong protection against CMV. Staff should also be reminded not to share cups or eating utensils, kiss children on the lips, or allow children to put their fingers in another person’s mouth. Employees of childbearing age should be referred to their primary health care provider to discuss CMV.

10.   Resources to educate women of childbearing age about CMV prevention:

Mothers of children in daycare are also at increased risk for CMV (Pass et al., 1986). Provide caregivers and parents with flyers and information from Connecticut Department of Public Health, the  Centers for Disease Control and Prevention, Congenital CMV Disease Research Clinic and Registry, Congenital Cytomegalovirus Foundation, or National CMV Foundation, which has flyers for downloading and CMV Q and A at: https://www.nationalcmv.org/resources/faqs.aspx

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Working copy of PowerPoint includes music video: 
https://drive.google.com/file/d/0B9Klfxar2CmjWUFWY3M5TTBwQTQ/view?usp=sharing

PREVIOUS CMV PRESENTATIONS BY LISA SAUNDERS

·        Society of Maternal Fetal Medicine, Las Vegas, NV (January 26, 2017).

"Congenital CMV and Research" – Caesars Palace. www.smfm.org/meetings/2-37th-annual-pregnancy-meeting. 

·        Maternal and Child Health (MCH) Coalition, Hamden, CT (December 13, 2016).

“What Caregivers and Pregnant Women Need to Know About CMV.” Womensconsortium.org.

·        Congenital CMV Public Health & Policy Conference, Austin, TX (September 27, 2016).

“Connecticut Congenital CMV Initiative”, co-presented with Brenda K. Balch, MD, Chapter Champion for the American Academy of Pediatrics Early Hearing Detection and Intervention Program, CMVconference.org  

·        Medical Assistance Program Oversight Council's Women’s Health Committee, Hartford, CT (July 13, 2015). “Connecticut and Congenital CMV”. www.cga.ct.gov/med/default.asp.

·        Connecticut Public Health Committee, Hartford, CT (February 20, 2015). Public Testimony for H.B. 5525:

“AN ACT CONCERNING CYTOMEGALOVIRUS”

·        CMV Public Health & Policy Conference, Salt Lake City, UT (September 26, 2014).

“Parents Can Raise CMV Awareness (includes getting a bill passed).” Cmvconference.org/archive/cmv2014/index.html

·        Infection Control Nurses of Connecticut Annual Spring Seminar, Plantsville, CT (April 2013).

“CMV: Threat to immunocompromised persons.” http://infectioncontrolct.org/.

·        CMV 2012 Conference, San Francisco, CA (October 29-November 2, 2012).

“Raising CMV Awareness by Writing” - www.congenitalcmv.org.

·        Siemens Healthcare Diagnostics, Tarrytown, NY (2010).

“Living With Congenital CMV” (webinar). https://usa.healthcare.siemens.com.  

·        Maternal-Infant Services Network, Orange, Sullivan and Ulster Counties, NY (March 20, 2009).

“Pregnant Women Need to Know about CMV” - Perinatal Update 2009. misn-ny.org.

·        Centers for Disease Control and Prevention (CDC), Atlanta, GA (November 5-7, 2008).

“Congenital CMV: My Daughter’s Life and Death” - International Congenital CMV Conference. See: http://congenitalcmv.blogspot.com/2008/11/cdc-congenital-cmv-cytomegalovirus-and.html.