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Wednesday, May 17, 2017

Sample Letter to Child Care Workers/Volunteers

Please educate your childcare workers of their occupational risk for cytomegalovirus (CMV), the leading viral cause of birth defects. Referred to as "America's Zika," there are prevention measures women of childbearing age who care for toddlers can take.

I am the parent representative of the Congenital Cytomegalovirus Foundation and advocate for providing women of childbearing age information about congenital cytomegalovirus (CMV), which causes more birth defects than fetal alcohol syndrome and has been referred to as America's Zika. 

According to the New York Times in 2016, CMV Is a Greater Threat to Infants Than Zika, but Far Less Often Discussed. I did not know I was putting my pregnancy at risk by running an in-home licensed childcare center until after my daughter Elizabeth was born disabled.

FACTS ABOUT CHILDCARE AND CMV

·        8- 20% of child care providers contract CMV infection  (AAP et al., 2011) versus 1-4% in general population (Demmler-Harrison, 2014).  



·        44% to 100% of two-year-olds in group daycare are excreting CMV (Pass et al., 1986).

·        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.” Many use diaper wipes to clean surfaces, which do not sanitize (Thackeray et al., 2016).

“Despite being the leading cause of mental retardation and disability in children, there are currently no national public awareness campaigns to educate expecting mothers about congenital CMV,” states Clinical Advisor article, “Educate pregnant women to prevent congenital CMV” (2014).

Of the four million infants born each year in the U.S., approximately 1% are infected prenatally with CMV (American Academy of Pediatrics et al., Caring for Our Children, 2011).  Ten percent of those infants (about 4,000) may have one or multiple abnormalities.

CMV is often found in the bodily fluids of otherwise healthy toddlers. Toddlers can spread the disease to other toddlers by mouthing each other’s toys, and to their adult caregivers who may be unaware of how to properly handle bodily fluids such as saliva and nasal secretions. Unfortunately, most women of childbearing age don’t know about CMV, and don’t realize they should avoid kissing toddlers around the mouth or share cups and utensils with them.

Although CMV did no harm to the toddlers in my in-home licensed childcare center, my daughter  Elizabeth was born severely disabled by congenital CMV. After her birth, I was then given information from the Centers for Disease Control and Prevention (CDC) stating, "People who care for or work closely with young children may be at greater risk of CMV infection than other people because CMV infection is common among young children..." This information came too late to spare Elizabeth. Nowhere in my daycare licensing training was CMV mentioned. CMV prevention was not discussed in my prenatal doctor visits.

You may wish to click into my list of 15 reasons why childcare givers need to know about CMV. 

Children disabled by congenital CMV are estimated to cost the U.S. healthcare system, $1.86 billion annually at $300,000/year each. (Modlin et al., 2004). 

 CMV prevention education works according to several studies. The New York Times stated, “pregnant mothers shown a video and offered hygiene tips were much less likely to get CMV (5.9 percent) than those not given information on prevention (41.7 percent)” (Saint Louis, 2016). Five CMV prevention education studies published between 1993 and 2015 were analyzed in the article, Prevention of Maternal–Fetal Transmission of Cytomegalovirus: “In each report, the efficacy of hygienic precautions has been [greater than] 75%” (Adler, 2015).

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: http://cfoc.nrckids.org/StandardView/7.7.1.1
  2. Fact sheet from MotherToBaby.org on CMV  includes child care providers.
  3. National CMV Foundation features several types of CMV flyers for downloading.
  4. Daycare.com: 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): http://portal.ct.gov/dph/Family-Health/EHDI/Home-page--Early-Hearing-Detection-and-Intervention-Program-Home-Page%20
2.     Flyer: Are You Pregnant?  http://www.ct.gov/dph/lib/dph/ehdi/ncmvf_awareness_flyer_ct_dph.pdf
3.     Flyer FOR OBSTETRIC HEALTH CARE PROVIDERS: http://www.ct.gov/dph/lib/dph/ehdi/about_cmv_obs.pdf
4.     Flyer: TESTING FOR OBSTETRIC HEALTH CARE PROVIDERS: http://www.ct.gov/dph/lib/dph/ehdi/cmv_testing_info_obs.pdf

 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. 


 Lisa Saunders

This is

TO CONNECTICUT PROVIDERS

 Wash Away CMV: Protect Your Pregnancy!

Childcare Providers Have Another Good Reason to Wash Their Hands

by Lisa Saunders*

As we who work in childcare know, toddlers can spread diseases--some serious such as CMV, "America's Zika"-- to each other and to their adult caregivers who wipe their noses, mouths, and change their diapers.  For caregivers considering pregnancy, it is especially imperative to follow proven handwashing and sanitizing procedures. Remember, diaper wipes may clean surfaces, but they do not kill viruses such as CMV (cytomegalovirus), the leading viral cause of birth defects. Approximately 44% to 100% of two-year-olds in group daycare are excreting CMV (Pass et al., 1986). 

You can access the flyer, "Are You Pregnant?", for handing out or hanging on your wall, by clicking here:
What is CMV?

According to the Connecticut Department of Public Health**: 

CMV infection during pregnancy can seriously harm your baby. 
Cytomegalovirus (pronounced: sy-toe-MEG-a-low-vy-rus), or CMV, is a common virus that infects people of all ages. The majority of people who are infected with CMV have no signs or symptoms of the virus, and there are no harmful effects. However, when CMV occurs during a woman’s pregnancy, it is possible for the unborn baby to become infected, which is then called “congenital CMV”. Congenital CMV can potentially damage the brain, eyes, and/or inner ears of the unborn infant. Health problems or disabilities due to congenital CMV infection may appear immediately, or any time after birth, or they may never appear.

CDC Recommendations for People Who Care for Infants and Children

  • Persons who work with children should follow standard hand washing procedures after contact with body fluids, such as urine and saliva, which could contain CMV.
  • Over half of adults have already been infected with CMV by the age of 40 years. Adults who have not had CMV and who work with young children, especially children 1 to 2 ½ years of age, may be exposed to CMV and can become infected.
  • Healthy adults face little risk of getting seriously sick from CMV infection. However, if a woman who has never had CMV infection becomes infected with CMV while pregnant; there is a risk that her fetus will also become infected. Infants born with CMV infection are at risk for CMV-related complications.
  • Persons who work closely with children in settings, such as child care facilities, may be at greater risk of CMV infection than persons who do not work in such settings. There are certain steps everyone can take to reduce their risk of exposure to CMV and other infection.
  • Women who are pregnant or plan to become pregnant and who have close contact with young children should discuss their risk for CMV infection with their medical provider. Also see Pregnant Women(http://www.cdc.gov/cmv/risk/preg-women.html) .
  • Although CMV is spread through contact with infected body fluids, including urine and saliva, 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.
Prevention

If you're pregnant or planning a pregnancy, the best way to protect your baby from CMV is to protect yourself by avoiding exposure to saliva and urine that might contain CMV.
Pregnant women may want to take the following steps to reduce their risk of exposure to CMV and so reduce the risk of CMV infection of their fetus: 
  • Wash your hands often with soap and water for 15-20 seconds, especially after:
    • Changing diapers
    • Feeding a young child
    • Wiping a young child’s nose or drool
    • Handling children’s toys 
  • Do not share food, drinks, or eating utensils used by young children.
  • Do not put a child’s pacifier in your mouth.
  • Do not share a toothbrush with a young child.
  • Avoid contact with saliva when kissing a child.
  • Clean toys, countertops, and other surfaces that come into contact with children’s urine or saliva.

As with anything, the effectiveness of the hygiene measures is impacted by how well individuals follow appropriate protocol. The CDC provides instructions on when and how to wash your hands, and what to do if soap and water are not available, at: https://www.cdc.gov/handwashing/when-how-handwashing.html

To learn more about CMV in the childcare setting,  see "Staff Education and Policies on Cytomegalovirus (CMV)," American Academy of Pediatrics (AAP) et al., Caring for Our Children: http://cfoc.nrckids.org/StandardView/7.7.1.1. 

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*Lisa Saunders of Connecticut compiled this message. She is a former licensed childcare provider, the parent representative of the Congenital Cytomegalovirus Foundation, and the mother of a girl born disabled by congenital CMV. She was instrumental in helping Connecticut become to second state to pass a CMV testing law in 2015. 

Lisa is the author of the fairy tale, “Once Upon a Placemat: A Table Setting Tale,” which includes a free, downloadable school/childcare program kit to instruct children on table setting and germ prevention. Contact Lisa for her availability to present her fairy tale to your students or to speak to your colleagues about CMV. For her talking points to adults, click here or see her article,“The Danger of Spreading CMV: How We Can Protect Our Children” (ChildCare Aware of America, 2017). 



**If you don't live in Connecticut, you may wish to link your message to your state's health websites such as these for New York:

Remember:

 The American Academy of Pediatrics states: "Staff of childbearing age who care for infants and children should be provided the following information:

  1. The increased probability of exposure to cytomegalovirus (CMV) in the child care setting;
  2. The potential for fetal damage when CMV is acquired during pregnancy;
  3. The importance of hand hygiene measures (especially handwashing and avoiding contact with urine, saliva, and nasal secretions) to lower the risk of CMV;
  4. The availability of counseling and testing for serum antibody to CMV to determine the caregiver/teacher’s immune status" (Caring for Our Children, 2011). 

“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).

 As with anything, the effectiveness of the hygiene measures is impacted by how well individuals follow appropriate protocol. The CDC provides instructions on when and how to wash your hands, and what to do if soap and water are not available, at: https://www.cdc.gov/handwashing/when-how-handwashing.html


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LETTER OF INTRODUCTION:

Does your group help protect childcare providers from occupational hazards that can effect their unborn children? Do you want to help protect the pregnancies of all women of childbearing age?

My name is Lisa Saunders, a former licensed daycare provider unaware I was putting my pregnancy at increased risk for CMV, the virus that severely disabled my newborn, Elizabeth. According to the New York Times, CMV Is a Greater Threat to Infants Than Zika, but Far Less Often Discussed (2016)


FACTS ABOUT TODDLER CHILD CARE AND CMV



·        8- 20% of child care providers contract CMV infection  (AAP et al., 2011) versus 1-4% in general population.  



·        44% to 100% of two-year-olds in group daycare are excreting CMV (Pass et al., 1986).


·        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.” Many use diaper wipes to clean surfaces, which do not sanitize (Thackeray et al., 2016).


CMV is often found in the bodily fluids of otherwise healthy toddlers. Toddlers can spread the disease to other toddlers by mouthing each other’s toys, and to their adult caregivers who may be unaware how to properly handle bodily fluids such as saliva and nasal secretions. Unfortunately, most women of childbearing age don’t know about CMV, and don’t realize they should avoid kissing toddlers around the mouth, as well as sharing cups and utensils with them. I was one of those women.

After Elizabeth was born severely disabled by congenital CMV, I was then given information from the Centers for Disease Control and Prevention (CDC) stating that, "People who care for or work closely with young children may be at greater risk of CMV infection than other people because CMV infection is common among young children..." This information came too late to spare my daughter the years of suffering that lay ahead. Nowhere in my daycare licensing training was CMV mentioned. CMV prevention was not discussed in my prenatal doctor visits. 

Congenital (present at birth) CMV is a more common cause of disabilities than fetal alcohol syndrome and spina bifida. Approximately 1% of the four million infants born each year are infected prenatally with CMV in the U.S. according to the American Academy of Pediatrics (AAP).  Ten percent of those infants, about 4,000 babies each year, are born with one or multiple abnormalities including hearing and vision loss; intellectual challenges; cerebral palsy; and seizures.

To learn why you should tell childcare workers/volunteers and preschool teachers about CMV, click on: 15 Reasons to Tell Child Care Providers About CMV.

 Here is the link to a sample letter to childcare providers for social media:  http://congenitalcmv.blogspot.com/2017/05/what-to-say-to-caregivers-about-cmv.html and/or you may wish to share my article, The Danger of Spreading CMV: How We Can Protect Our Children (ChildCare Aware of America, 2017).

RESOURCES :

1."Staff Education and Policies on Cytomegalovirus (CMV)," American Academy of Pediatrics (AAP) et al., Caring for Our Children: http://cfoc.nrckids.org/StandardView/7.7.1.1

2."Situations that Require Hand Hygiene" (AAP et al., Caring for Our Children): http://cfoc.nrckids.org/StandardView/3.2.2

3. National CMV Awareness Flyer with the Connecticut Department of Public Health (DPH) logo found under the "Information for Healthcare Providers” section at: http://www.ct.gov/dph/cwp/view.asp?a=3138&q=527824

4. Fact sheet from MotherToBaby.org on CMV  includes child care providers.

5.Connecticut Department of Public Health posts on its website: CDC Recommendations for People Who Care for Infants and Children

6.National CMV Foundation features several types of CMV flyers for downloading.

7.Congenital CMV Disease Research Clinic and Registry provides resources for women of childbearing age.

8. CMV prevention brochure specifically for child care providers: Utah's brochure for childcare providers).

9.For students and families: Free CMV Teaching Tool Kit: "Once Upon a Placemat: A Table Setting Tale" by Lisa Saunders—Educational coloring book and fairytale emphasizes hand-washing and refraining from sharing cups/utensils. Click the following for the  free pdf version of Once Upon a Placemat: A Table Setting Tale

10, Henry The Hand teaching supplies/programs for schools. Created newsletter campaign on CMV.

11. Congenital CMV Foundations that help women of childbearing age protect their pregnancies.

12. Connecticut CMV Law: "Update on Statewide Neonatal CMV Screening" (December 8, 2015): "New legislation that requires screening for congenital CMV infection in neonates who fail their hearing tests... In this talk we will review the background to the legislation as well as the rationale behind CMV screening and the limitations of the available literature in guiding management. The steps that should occur as part of the CMV screening process will be outlined and discussed." Meeting Materials:
13. 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)..."
2.       
RESOURCES FOR TRAINING CHILD CARE WORKERS

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