Wednesday, February 21, 2018

Childcare Providers: FREE Tool Kit to Fight CMV, #1 Birth Defects Virus

Lisa Saunders

New book includes many links to free resources

(FREE CMV resource links, including the pdf manuscript of this book, are below this intro):

I'm a former licensed childcare provider who, like many across the U.S., never heard of my occupational risk for CMV, the #1 birth defects virus. To save time after changing diapers, many childcare providers use diaper wipes to remove urine from hands and surfaces, but diaper wipes do not kill CMV.  

The 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.” 

Every year, 8 - 20% of caregivers/teachers contract CMV, which is understandable given that approximately 44 - 100% of two-year-olds in group daycare are excreting CMV (Pass et al., 1986). 

In a recent survey, only 18.5% of licensed “in-home” daycare providers have heard of CMV  (Thackeray et al., 2016). CMV in childcare is a very "inconvenient truth" and many in the industry are afraid to alarm their workers. However, a few states such as Utah and countries including Germany and Queensland, Australia, have worked out a protocol to protect their childcare workers.

It is a worker’s right to know occupational hazards, yet very few childcare providers have been counseled about CMV in accordance with the recommendations made by the American Academy of Pediatrics in the book, Caring For Our Children, which 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..."  

To protect the unborn children of childcare providers and those who use their services, I published the book, Help Childcare Providers Fight CMV. People can contact me at LisaSaunders42[at] if they would like a FREE 133-page pdf version of it, or they can purchase the bound paperback for $6.99 on Amazon for distribution to those who care for children. 

The book is dedicated to mothers who find out too late about CMV and includes the lyrics to the new song, "Had I Known," by Debra Lynn Alt of North Branford, Connecticut. The heartfelt lyrics convey how a mother feels when she learns she could have reduced her chances of contracting CMV and spared her baby from the effects of congenital CMV.  

Help Childcare Providers Fight CMV begins with the story of four childcare providers unaware of CMV until it was too late (click first chapter, Had I Known, for excerpt), and continues with why the public is largely unaware of CMV, 15 reasons why childcare providers should be educated about CMV, what other countries are doing to protect their childcare workers, and what women who care for young children need to know to protect their unborn children. For example, the CDC states, "Women may be able to lessen their risk of getting CMV by reducing contact with saliva and urine from babies and young children. Some ways to do this are: kissing children on the cheek or head rather than the lips, and washing hands after changing diapers. These cannot eliminate a woman’s risk of catching CMV, but may lessen her chances of getting it.”

The book provides a toolkit of resources to educate childcare providers about CMV with a sample protocol and links to public health flyers such as the CDC's CMV prevention tips. It also includes my fairytale  "Once Upon a Placement: A Table Setting Tale," with "color-me-in" images to reach the whole family on how to "share a meal, not the germs!"

See below for links to flyers (English and Spanish), free pdfs, and more information about the "Help Childcare Providers Fight CMV" project.

Lisa Saunders
Founder, "Help Childcare Providers Fight CMV" Project
Parent rep, Congenital Cytomegalovirus Foundation

FREE CMV Prevention Resources

1. “Staff Education and Policies on Cytomegalovirus (CMV)," American Academy of Pediatrics (AAP) et al., Caring for Our Children

3. National CMV Foundation features several types of CMV flyers for downloading and hanging on your wall:

4. CDC’s CMV info available in English and Spanish:
Español: Acerca del citomegalovirus:

5.  Created by the "Help Childcare Providers Fight CMV" Project: 
Wall Flyer For Women Who Care for Toddlers: 
Share a Meal Not the Germs bathroom wall flyer on hand-washing: 

c. YouTube Presentation by Lisa Saunders:
 You will also find this and several other links to free resources from across the U.S. at:

7. Check your state’s childcare care licensing department, department of health, department of labor, and local universities with occupational medicine and public health programs. CMV is a bloodborne Pathogen. See Occupational Safety and Health Administration (OSHA) for bloodborne pathogens:

8. Handwashing: Centers for Disease Control and Prevention (CDC) has a video and posters on handwashing procedures and what to do if soap and water are not available:

9. provides factsheet on CMV and mentions childcare workers:

11. "The Danger of Spreading CMV: How We Can Protect Our Children" by Lisa Saunders published by ChildCare Aware of America (June 2017).

12. Utah created English/Spanish brochures specifically for childcare providers:

13. Connecticut Department of Public Health (CT DPH) website has flyers and information: The National CMV Foundation allowed the CT DPH to embed their logo in their “Are You Pregnant” National CMV Awareness Flyer.

For social media, a photo of the flyer will be easier to share. Find the jpeg of “Are You Pregnant” by the National CMV Foundation at:

If you need a pdf of the above flyer with information relevant for childcare providers from CT DPH, then:

14. Article, “Help Childcare Providers Fight CMV” by Lisa Saunders published by National CMV Foundation (March 5, 2018)

15. Book, Help Childcare Providers Fight CMV.: People can click here for the free 133-page pdf manuscript or at:

16. Fun Teaching Toolkit for Students and Families: Fairytale tells how to “Share a Meal, Not the Germs.” An educational “coloring book, Once Upon a Placemat: A Table Setting Tale by Lisa Saunders and Jackie Tortora. Free tools for presentation at: or see the FREE Teaching Program Tool kit here, which includes: 
Educational Coloring Book: Free pdf version of Once Upon a Placemat: A Table Setting Tale (or the educational fairy tale can be purchased as a bound coloring book to hand out on Amazon for $6.99).
Placemats: Side one: Placemat with tableware characters with space for your coloring artist's name (perfect for laminating and using as a table-setting reminder):
Side two: Germ prevention tips and hand-washing instructions.

17. 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)..." Find their accredited childcare centers/preschools

19. States providing CMV Resources about the "Help Childcare Providers Fight CMV" Project are listed below.

Note: These CMV-related paperback books by Lisa Saunders are not free, but are available on Amazon:
  1. Anything But a Dog! The perfect pet for a girl with congenital CMV 
  2. Surviving Loss: The Woodcutter’s Tale
  3. Once Upon a Placemat: A Table Setting Tale 
  4. Help Childcare Providers Fight CMV

Japan: Elizabeth and Riley the Miracle Dog (Japanese translation of Anything But a Dog! The perfect pet for a girl with congenital CMV). (S. Nakai, Trans.) Tokoyo: Thousands of Books Japan. Retrieved from

"Help Childcare Providers Fight CMV" Project:

The mission of the Help Childcare Providers Fight CMV project is to educate U.S. women who care for toddlers on how to reduce the spread of CMV to protect their pregnancies until the medical community makes doing so a “standard of care,” the U.S. government passes a law requiring CMV education, or an effective vaccine becomes available.

The Help Childcare Providers Fight CMV project disseminates materials to daycare directors, families, and policy makers. CMV prevention education is accomplished through workshops, public service announcements, health fairs, books, and writing articles such as, "The Danger of Spreading CMV: How We Can Protect Our Children" published by ChildCare Aware of America (2017).

2015 - 2017:  
  • Connecticut became the second state in U.S. to require CMV testing when an infant fails the hearing test. 
  • The Education Committee updated their CMV fact sheet to add a question specific to occupational exposure.
  • Henry the Hand Foundation ran a CMV prevention campaign during April’s National Public Health Week.
  • Child Care Aware published article on CMV prevention 
  • Connecticut Office of Early Childhood’s Division of Licensing for Child Care Providers/Operators now includes “Congenital Cytomegalovirus” under “Disease and Prevention” on its website, though my goal is for CMV prevention to be included in the required training for licensing.
  • Interviewed health and wellness experts about CMV on “The Lisa Saunders Show” (SEC-TV, channel 12 and YouTube).
  • Coordinating the planning and delivery of CMV information through press releases, newsletters, Facebook: CMV in Child Care and Congenital CMV News; educational campaigns through workshops, televised public service announcements, health fairs; and creating behavior change programs such as “Share a Meal, Not the Germs!” and “Keep Your Cups to Yourself."


THE COST OF NOT PROVIDING CMV PREVENTION EDUCATION: 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).


Check your state’s childcare care licensing department, department of health, local universities with occupational medicine and public health programs. 


In 2015, Arizona saw 38,886 births. Assuming 1 out 750 (.001) are born permanently disabled by CMV, then you have 38,886 x .001= 38.88 or 39 babies born disabled by cCMV in Arizona each year. Estimated at costing the U.S. healthcare system $300,000 per child per year means that your state is spending $11,665,800 annually in medical costs. Since prevention education studies show greater than 75% effectiveness, that is a lot of money being spent on preventable medical expenses. 


1.     Connecticut Department of Public Health (DPH) website,  Congenital Cytomegalovirus (CMV):

2.     CT DPH and National CMV Foundation flyer: Are You Pregnant?



In 2015, Connecticut’s annual cost to the healthcare system of caring for children disabled by congenital CMV can be calculated at 35,746 total births x .001 congenital CMVdisabled = 36 disabled babies X $300,000/year  = $10,800,000 annually.

Connecticut requires each newborn that fails the newborn hearing screening to be tested for congenital CMV.
    Although prevention education didn't pass in Connecticut because of funds, the Connecticut Department of Public Health now provides the following information and flyers:

    This flyer includes info for childcare providers from CT DPH on back:

    According to my calculations, providing prevention education could annually save several million dollars in the State of Connecticut alone.  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).

    Connecticut Organizations that care:
    CT Child Care Association and Educational Playcare,
    Gerry Pastor,
    Eda diBiccari, Child Care Union
    CSEA SEIU Local 2001

     Hawaiirequires the state to educate the public and professionals about congenital CMV

    Idaho has legislation 

    Illinois has legislation that requires both education and screening.

    Iowa has legislation that requires both education and screening.

    In 2017, Maine proposed universal newborn CMV screening. While the legislation did not pass, the legislature established a committee to investigate universal CMV screening to provide a recommendation to the state in 2018.

      Michigan proposed legislation.

      Minnesota proposed legislation.

      NEW YORK

      Proposed Legislative Mandates: Education and Screening: New York 

      New York based health websites provide CMV information: 

      My work on the Connecticut CMV testing bill was featured in Cornell’s Alumni Magazine  out of Ithaca, NY.

      Legislation (2017-2018):

      New York Organizations that care:
      CSEA in Albany, AFCME, 518-257-1000
      Tammie Miller, Chapter Chair
       UFT Family Child Care Providers

      Oregon has legislation that requires both education and screening.


      Pennsylvania Proposed Legislative Mandates


      Tennessee requires healthcare providers to educate women of childbearing age.


      Texas has legislation. Texas Medical Association asks, “Have you talked with your pregnant patients about congenital CMV?” See its downloadable fact sheet


      Utah has legislation that requires both education and screening.

      About Lisa Saunders

      Lisa Saunders, a former licensed childcare provider and graduate of Cornell University, wrote "Help Childcare Providers Fight CMV" because she didn't find out about CMV until after her daughter Elizabeth was born severely disabled by congenital (present at birth) CMV. She was also the mother of a toddler and didn't know the precautions to take when handling bodily fluids such as saliva. Since the death of Elizabeth during a seizure in 2006 at the age of 16, Lisa has been raising CMV awareness through writing, speaking, helping Connecticut pass a CMV testing law in 2015, and working to ensure all childcare providers learn of their occupational risk for CMV. Lisa is the author of several books including her memoir, “Anything But a Dog! The perfect pet for a girl with congenital CMV,” and the article, "The Danger of Spreading CMV: How We Can Protect Our Children," published by ChildCare Aware of America (2017). 

      CMV books by Lisa Saunders include:

      1. Anything But a Dog! The perfect pet for a girl with congenital CMV (Unlimited Publishing 2008, Japan, 2017). Memoir.
      2. Surviving Loss: The Woodcutter’s Tale. Fairytale about losing a child to an illness and how to find a way to move forward.
      3. Once Upon a Placemat: A Table Setting Tale (2016). "Grandma" uses Miss Cup to teach germ prevention and Mr. Knife's fear the dish will run away with the spoon to teach table-setting.
      4. Help Childcare Providers Fight CMV: Protect Newborns from #1 Birth Defects Virus (2018)

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