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To end CMV birth defects: Celebrate Handwashing Awareness Week

Hoping for Law to Protect CT Child Care Providers and Their Pregnancies from CMV Birth Defects

Connecticut Childcare Givers

Wash Away CMV!

Moms2B

Protect your pregnancy!

Diaper wipes do not kill CMV—this #1 birth defects virus disables 4,000 babies each year in the U.S. 

Would you like to get involved in protecting the unborn babies of child care providers?

As a result of caregivers/teachers of toddlers being at increased risk for contracting cytomegalovirus (CMV), the leading viral cause of birth defects, I am trying to get a CMV prevention education law passed in Connecticut (a CMV testing law passed in 2015, but not the prevention education part because of funds). 

“Increasing risk perception is important because [child care] 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).


If you would be in support of ensuring childcare givers know their CMV risk and how to prevent it,  please let me know so I can make you aware of opportunities to express your support--either through writing a letter and/or voicing your support on my TV show and other speaking events. 

Diaper wipes do not kill CMV, the virus that disables 4,000 babies each year in the U.S. Many caregivers use diaper wipes as a short cut to sanitizing hands and surfaces. 

According to the New York Times, CMV Is a Greater Threat to Infants Than Zika, but Far Less Often Discussed. 

FACTS ABOUT TODDLER CHILD CARE AND CMV

·        8- 20% of child care providers contract CMV infection every year (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).

·        Mothers of children in daycare are also at increased risk for 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).

I am a former licensed child care provider who was unaware of my increased risk for CMV, the danger it posed to my pregnancy, and my need to diligently practice the proven prevention measures already in place. Like me, less than 20% of child care providers in a recent survey knew about CMV and used diaper wipes to clean hands and surfaces (Thackeray et al., 2016).  As you are probably aware, diaper wipes do not kill CMV (Stowell et.al, 2014). Although CMV did no harm to the toddlers in my care, my daughter Elizabeth was born severely disabled by congenital CMV and passed away at the age of 16 in 2006. 

Shortly after moving to Connecticut in 2010, I received a call from a local grandmother who said her grandson was just born disabled by congenital CMV. The baby's mother had been a college student interning at a Connecticut day care center while pregnant. She, too, had not been educated about CMV and how to protect her pregnancy. When I visited the mother and baby in the hospital, the attending nurse asked me why more wasn’t being done to raise awareness of this leading viral cause of birth defects. 

To learn more about CMV, see the flyer put out by the Connecticut Department of Public Health by clicking here. For specifics of CMV in child care, click on this two-sided flyer, which also includes content from the CT Dept Public Health webpage. 

For policy makers/daycare directors who want to see a sample memo for child care employees and learn the "15 Reasons Child Care Providers Need to Know about CMV," click on my pamphlet: CT Child Care Providers Against CMV. If interested in having me speak to your group, click the following for my outline and talking points for a presentation on CMV in Child Care or download the pdf.

ChildCare Aware of America published my article, "The Danger of Spreading CMV: How We Can Protect Our Children," but there needs to be a law to ensure all child care providers learn about CMV and the recommendations made by the American Academy of Pediatrics et al., in Caring for Our Children, and NAEYC: National Association for the Education of Young Children in its "Early Childhood Program Standards and Accreditation Criteria and Guidance for Assessment (10.D.01, p.91), which" includes: "a. steps to reduce occupational hazards such as infectious diseases (e.g., exposure of pregnant staff to CMV [cytomegalovirus], chicken pox)..."

Thank you in advance for any help and advice you can give me!

Want to learn more about why I'm seeking a law?

I have learned through years of trying to raise CMV awareness that despite successfully interesting the media in CMV, to ensure a real change in awareness takes a change in public policy, such as Utah’s 2013 CMV law. Its new law requires prevention education to daycare providers in addition to all women of childbearing age. The CMV mother behind getting the Utah law passed, Sara Menlove Doutre, an Education Policy Consultant, states in her article, “Reducing congenital cytomegalovirus infection through policy and legislation in the United States,” that “Policy and legislation, backed by accurate science, are viable tools to change behaviour to reduce congenital cytomegalovirus (CMV) infections. Addressing CMV through public policy can provide increased awareness among public health officials, access to existing venues for disseminating information, and much needed funds for awareness campaigns.”

The Utah CMV law includes the following mandate: “…directs the Department of Health to create a public education program to inform pregnant women and women who may become pregnant about the occurrence of CMV, the transmission of CMV, the birth defects that CMV can cause, methods of diagnosis, and available preventative measures; requires the Department of Health to provide this information to: licensed child care programs and their employees…”

What are other countries doing?

Queensland, Australia, has very precise measures in place to protect all of their childcare workers from contacting CMV, which, in addition to infection control methods includes: “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.”

Germany places a complete ban on seronegative daycare providers from working with children under the age of three. "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 in order to prevent feto- or embryopathy in her offspring." (See: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4844919/).

(You can download this flyer by clicking here).

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

(for pdf, click here)

1)  Congenital CMV is the #1 Birth Defects Virus (Carlson et al., 2010). "More children will have disabilities due to congenital CMV than other well-known infections and syndromes, including own Syndrome, Fetal Alcohol Syndrome, Spina Bifida, and Pediatric HIV/AIDS" (NationalCMV.org).

2) 1% of live born infants are infected prenatally with CMV (American Academy of Pediatrics [AAP] et al., Caring for Our Children, 2011). 

3)  “Women who are exposed to CMV prior to conception or within the first trimester of pregnancy and seroconvert have increased risk of their infant being infected with CMV.”(Thackeray et al., 2016).

4)  CMV is an “occupational risk" for daycare educators (Joseph, et al., 2006). Caregivers/teachers should be told about CMV because of increased probability of exposure (AAP et al.. 2011). 

5)  General public: 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).

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

7)  44% to 100% of two-year-olds in group daycare are excreting CMV (Pass et al., 1986).

8)  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).

9)  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)..."

10)  It is a worker's right to know occupational hazards according to the Occupational Safety and Health Administration (OSHA). 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. 

11) “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).

12) “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).

13)  Mothers of children in daycare are also at increased risk for CMV (Pass et al., 1986). “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).

14)  $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).

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).  “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).

...

Here is my One-Page CMV Fact Sheet for Policy Makers, which includes cost estimates. The Connecticut Department of Public Health, http://www.ct.gov/dph/cwp/view.asp?a=3138&q=527824, provides the following information and flyers about Congenital CMV:

1. National CMV Foundation flyer: Are You Pregnant? (2017). Retrieved from Connecticut Department of Public Health: http://www.ct.gov/dph/lib/dph/ehdi/ncmvf_awareness_flyer_ct_dph.pdf
2. About Cytomegalovirus (CMV) FOR OBSTETRIC HEALTH CARE PROVIDERS. (2017). Retrieved from Connecticut Department of Public Health: http://www.ct.gov/dph/lib/dph/ehdi/about_cmv_obs.pdf
3. About Cytomegalovirus (CMV): TESTING FOR OBSTETRIC HEALTH CARE PROVIDERS. (2017). Retrieved from Connecticut Department of Public Health: http://www.ct.gov/dph/lib/dph/ehdi/cmv_testing_info_obs.pdf

Prior Connecticut CMV Bills: 

2014: The following CMV education and testing bill passed the House, but was never brought to the Senate floor: 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

2015: The following CMV testing bill passed in 2015: H.B. No. 5525: An Act Concerning Cytomegalovirus. (2015). Retrieved from Connecticut General Assembly: https://www.cga.ct.gov/asp/cgabillstatus/cgabillstatus.asp?selBillType=Bill&which_year=2015&bill_num=5525+

MORE RESOURCES

• Child Care and  CMV (American Academy of Pediatrics [AAP] et al., Caring for Our Children, 2011).
• Flyers: National CMV Foundation: Click the following for simple flyers for downloading. The National CMV Foundation allowed the Connecticut Department of Public Health to include its logo in this flyer. 
• Recent survey of child care providers (most have never heard of CMV).  
• Study showing that diaper wipes do not kill CMV. 
• Study: "In the past, the hazards facing child care workers have largely been ignored by health and safety professionals, due in part to a lack of awareness of hazards and inconsistencies in state health and safety requirements" (Bright et al., 1999).
• Rights of child care providers:  Occupational Safety and Health Administration (OSHA) states it is a worker's right to know occupational hazards. 
• State child care licencing departments: click here. 
• States with a CMV law: click here. 
• Study:  "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). 
• Child with Congenital CMV in Your Childcare Center? What to tell your staff
• 15 Reasons to Tell Child Care Providers About CMV (for pdf, click here)
• Fact sheet from MotherToBaby.org on CMV  includes child care providers. 
• CMV prevention brochure specifically for child care providers: Utah's brochure for childcare providers.
• 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)..."
• UTAH WAS FIRST STATE TO PASS CMV EDUCATION AND PREVENTION LAW: 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
• ChildCare Aware of America article, "The Danger of Spreading CMV: How We Can Protect Our Children."

2017 Tool Kit: CMV in Child Care Awareness

Child care providers should be educated about CMV in child care. If you would like to ask your legislator to pass a law to ensure that they are, the following are some suggested print outs to place in a three ring binder in plastic sheets for your representatives:

1. Flyer for healthcare providers and those who care for toddlers--either their own or professionally: Two-sided flyer includes poster for hanging and content from CT Public Health webpage. CT Dept Public Health CMV flyer/web content.
2. Pamphlet for policy makers/daycare directors: six panel, two page flyer, front and back, for those who want to ensure child care providers learn how to protect their pregnancies: CT Child Care Providers Against CMV
3. Assorted Flyers: National CMV Foundation: Click the following for simple flyers for downloading. The National CMV Foundation allowed the Connecticut Department of Public Health to include its logo in this flyer. 
4. One-Page CMV Fact Sheet for Policy Makers includes cost estimates
5. Recommendations made by the American Academy of Pediatrics or: "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
6. ChildCare Aware of America:  "The Danger of Spreading CMV: How We Can Protect Our Children."
7. Recent survey of child care providers (most have never heard of CMV).  
8. Study showing that diaper wipes do not kill CMV. 
9. Study: "In the past, the hazards facing child care workers have largely been ignored by health and safety professionals, due in part to a lack of awareness of hazards and inconsistencies in state health and safety requirements" (Bright et al., 1999).
10. Rights of child care providers:  Occupational Safety and Health Administration (OSHA) states it is a worker's right to know occupational hazards. 
11. State child care licencing departments: click here. 
12. States with a CMV law: click here. 
13. Study:  "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). 
14. Child with Congenital CMV in Your Childcare Center? What to tell your staff
15. 15 Reasons to Tell Child Care Providers About CMV (for pdf, click here)
16. Fact sheet from MotherToBaby.org on CMV  includes child care providers. 
17. CMV prevention brochure specifically for child care providers: Utah's brochure for childcare providers.
18. 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)..."
19. LOUIS, C. S. (2016, Oct. 24). CMV Is a Greater Threat to Infants Than Zika, but Far Less Often Discussed. The New York Times. Retrieved from http://www.nytimes.com/2016/10/25/health/cmv-cytomegalovirus-pregnancy.html?_r=0
20. 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

Connecticut: 

1. Flyers from the Connecticut Department of Public Health website,  Congenital Cytomegalovirus (CMV): http://www.ct.gov/dph/cwp/view.asp?a=3138&q=527824
2. National CMV Foundation flyer: Are You Pregnant? (2017). Retrieved from Connecticut Department of Public Health: http://www.ct.gov/dph/lib/dph/ehdi/ncmvf_awareness_flyer_ct_dph.pdf
3. About Cytomegalovirus (CMV) FOR OBSTETRIC HEALTH CARE PROVIDERS. (2017). Retrieved from Connecticut Department of Public Health: http://www.ct.gov/dph/lib/dph/ehdi/about_cmv_obs.pdf
4. About Cytomegalovirus (CMV): TESTING FOR OBSTETRIC HEALTH CARE PROVIDERS. (2017). Retrieved from Connecticut Department of Public Health: http://www.ct.gov/dph/lib/dph/ehdi/cmv_testing_info_obs.pdf
5. 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
6. H.B. No. 5525: An Act Concerning Cytomegalovirus. (2015). Retrieved from Connecticut General Assembly: https://www.cga.ct.gov/asp/cgabillstatus/cgabillstatus.asp?selBillType=Bill&which_year=2015&bill_num=5525+
7. Lisa's outline and talking points for a presentation on CMV in Child Care (click for pdf)

Yale: Sedative combats CMV--Michael J. Paidas, M.D.; Sara Ornaghi, MD; a...

Child with Congenital CMV in Your Childcare Center? What to tell your staff

Are you a childcare provider being asked to care for a child born with congenital CMV? 

Not sure what to tell your staff? 

Click on the following National CMV Foundation  flyer,  "Should you exclude a child born with CMV?" for an answer to this question and read below for more information. According to the flyer (which also includes prevention tips): "Most children born with congenital CMV (cytomegalovirus) will shed, or release, the virus in their body fluids throughout their toddler and preschool years. However, CMV is a very common childhood virus, affecting 70 percent of healthy children between 1 and 3 years of age... According to the Centers for Disease Control and Prevention (CDC), screening of children for CMV infection is not recommended, and infected children should not be excluded from school or other settings. Children born with congenital CMV pose no threat to their peers and no more of a threat to those at risk for CMV infection (ie. pregnant women) than would any other child." 

If a child is  KNOWN to be excreting the virus, this is what was posted in a newsletter by the Congenital CMV Disease Research Clinic & Registry:

Q. "There are pregnant teachers and other care givers at our school who work closely with children known to have CMV infection. For their safety, should these employees be relieved from their duties in caring for these children?"

A: “Changing the duties of a teacher or care giver from children known to have CMV infection to other children may not reduce their risk of acquiring CMV. It is a common virus in all children. In fact, studies reveal that between 30 and 80% of children between the ages of 1-3 years of age who attend some form of group care are excreting CMV. In this setting transmission of CMV is usually transmitted from child-to-child by direct contact with bodily fluids such as saliva or urine. It also may be transmitted to care givers. Therefore it is wise for care givers in this type of setting to be aware of CMV and consider knowing their CMV antibody status. If results are negative, they are susceptible to catching CMV for the first time and it is a potential risk to the fetus if they are pregnant. On the other hand, if results of a CMV antibody titer (IgG) is positive, they have already acquired CMV at some time in their life and their risk is greatly reduced. Additionally, it is important for all care givers to practice good hygienic measures. This is achieved by hand washing with soap and water, especially after diaper changes and any contact with a child's bodily fluids. Kissing and sharing food or drink also should be avoided.” 

(https://www.bcm.edu/web/pediatrics/documents/cmv2-2-96.pdf)

Childcare staff: 

You need to assume ALL young children are shedding CMV because between 44% to 100% of toddlers were shedding the virus in the study, “Group day care and cytomegaloviral infections of mothers and children.” Toddlers can shed CMV for many months in their saliva, urine and other bodily fluids. 

Pregnant child care givers need to be diligent about sanitizing surfaces used by toddlers and washing their hands after direct contact with bodily fluids. Licensed childcare facilities have hygiene protocols in place. 

The following article by me was written for caregivers and published by ChildCare Aware: 

 "The Danger of Spreading CMV: How We Can Protect Our Children."

If you have any more questions, please let me know.

Lisa Saunders, former licensed daycare provider Parent Rep., Congenital Cytomegalovirus Foundation LisaSaunders42@gmail.com | www.authorlisasaunders.com | http://congenitalcmv.org/ | PO Box 389, Mystic, CT 06355 |