"Increasing Child Care Provider Awareness of Congenital Cytomegalovirus (CMV)"
Lisa Saunders, Leader of Childcare Providers Education and Outreach, National CMV Foundation; Brenda Balch, MD, American Academy of Pediatrics (AAP) Early Hearing Detection and Intervention Connecticut Chapter Champion
Presented at: CMV Public Health and Policy Conference, September 23-25, 2018 (poster session: Mon., Sept 24, 2018), DoubleTree Hotel, Burlington, Vermont: https://cmv.usu.edu/schedule.cfm
ØEvery year, 8 - 20% of child care providers contract CMV (AAP, 2012) as compared to 1-4% of women in the general population (CDC, 2018).
Ø“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” (March of Dimes).
ØSixty one percent “of children under the age of 5 are cared for in a child care facility” (Thackeray and Magnusson, 2016).
ØMothers of toddlers in group care are also at increased risk for CMV (Pass and Hutto, 1986).ØMany child care providers use diaper wipes to clean, but diaper wipes do not kill CMV (Thackeray and Magnusson, 2016).
ØMost child care providers have never heard of CMV despite recommendations from the American Academy of Pediatrics (AAP): “Staff of childbearing age who care for infants and children should be provided the following information...The availability of counseling and testing for serum antibody to CMV to determine the caregiver/teacher’s immune status...child care staff members should receive counseling in regard to the risks of acquiring CMV from their primary health care provider. However, it is also important for the child care center director to inform infant caregivers/teachers of the increased risk of exposure to CMV during pregnancy” (AAP et al., 2017).ØLicensed child care providers are typically trained in first aid, CPR, etc., to ensure the health of children in their care. CMV prevention can be included in training on infectious diseases.
IS A PROBLEM FOR CHILD CARE PROVIDERS
child care providers already have a protocol for sanitizing hands and surfaces
but must understand the need to diligently follow this protocol. “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 and Magnusson, 2016).
have habits that facilitate the dissemination of
diseases, such as putting their hands and objects in
their mouths, very close interpersonal contact…(Nesti et
ØMany caregivers use diaper wipes to
clean. “Viable CMV was recovered from 4/20 hands 10 min after diaper wipe
cleansing. CMV remains viable on hands for sufficient times to allow
soap and water are not available, hand sanitizer may be used: “After cleansing,
no viable virus was recovered using water (0/22), plain soap (0/20),
antibacterial soap (0/20), or sanitizer (0/22)”
et al., 2014).
providers don’t always have access to a sink:
“As a child care worker, I remember
being pregnant and eating snacks and lunch on the playground without washing my
hands first.” Jessica
of the Idaho
CMV Advocacy Project, former child care provider and
mother of Natalie
born with congenital CMV in 2006.
EDUCATION PREVENTS CMV
studies published between 1993 and 2015, the efficacy of hygienic
precautions in CMV seronegative pregnant women was shown to be greater than 75%
ABOUT CMV BEFORE PREGNANCY
Ø“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 and
ØForty-nine percent of pregnancies
are unplanned—“Unintended pregnancy is associated with an increased risk of
problems for the mom and baby. If a pregnancy is not planned before conception,
a woman may not be in optimal health for childbearing” (CDC).
OTHER COUNTRIES ARE DOING ABOUT CMV IN
ØIn Germany, “to protect [day care
workers] from primary infection, their CMV serostatus
must be checked at the beginning of their pregnancy. When the [day care worker]
is seronegative, she is excluded from professional activities with children
under the age of three years in order to prevent feto-
in her offspring“
(Stranzinger et al., 2016).
ØIn Queensland, Australia, they
relocate workers who are pregnant, or expect to become pregnant, to care only
for children over two years old in order to reduce contact with urine and
ØIn New South Wales, Australia, in a
landmark decision, a childcare worker and her severely disabled son were
awarded $4.65 million. A Court of Appeal ruled that the child's disabilities
resulted from the woman being infected with cytomegalovirus (CMV) at work
(Hughes v SDN
Children's Services 2002)” (Queensland Government, Australia, 2017).
not a doctor’s “standard of care” to educate women about CMV, child care
licensing programs can reach a large number of high risk women.
at highest risk are those caring daily for children less than 24 months of age.
should they become pregnant, should either request to care for children over
age 2 years for the duration of pregnancy or be tested for IgG antibodies to
CMV. If they lack antibodies to CMV (immunity) they should care for children
over age 2 years for the duration of pregnancy. If this is not possible they
should carefully follow hygienic precautions and be retested for CMV monthly
for the first 5 months of pregnancy,“ states Stuart P.
Director, CMV Research Foundation.
child care providers and parents through child care facilities are key
opportunities to reduce prevalence of CMV infection and other diseases”
(Thackeray and Magnusson, 2016).
been estimated to cost the US health care system $1.86
billion annually, with a cost per child of more than $300,000 (Modlin et
al., 2004). Since prevention education has
been shown to reduce the spread of CMV by more than 75%,
improving a child care provider’s awareness of CMV could mean a substantial
the US health care system.
YOU CAN DO TO HELP
Contact your state’s Departments
of Health, Labor, OSHA, and Child Care Licensing (found at:
childcareaware.org/providers), and ask for CMV education to be featured on
their websites. Ask that CMV education be included in the training child care
providers receive on infectious diseases.
CMV flyer links are available at the CDC,
National CMV Foundation, some state websites, and CongenitalCMV.blogspot.com.
The “Staff Education and Policies on Cytomegalovirus” in Caring for Our
Children can be found at: nrckids.org/CFOC/Database/188.8.131.52
Child care directors may worry about
frightening their workers. Remind them they probably already have proper
sanitizing procedures in place through compliance with protocols set forth by
the National Association for the Education of Young Children (NAEYC), which
states, “Procedures are in place that address steps to reduce occupational
hazards such as infectious diseases (e.g., exposure of pregnant staff to
CMV…)" (NAEYC, 2014, p.90).
Contact state chapters of organizations that
promote the health of their members such as child care and teacher unions,
NAEYC, Early Head Start programs, and child care centers. Offer CMV flyers or
links to them.
In 2015, Connecticut passed a law requiring CMV
testing when an infant fails the hearing screen. Prevention education did not
pass, but the 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. We are still working on making CMV
training mandatory for child care providers.
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Adler refers to five prevention education
studies in his article, “Prevention of Maternal–Fetal Transmission of
Cytomegalovirus” (2015). They are:
S.P., Finney, J.W., Manganello, A.M., and Best, A.M. Best prevention of child-to-mother
transmission of cytomegalovirus by changing behaviors: a randomized
controlled trial. Pediatr. Infect. Dis. J. 1996; 15: 240–246
S.P., Finney, J.W., Manganello, A.M., and Best, A.M. Prevention of child-to-mother
transmission of cytomegalovirus among pregnant women. J.
Pediatr. 2004; 145: 485–491
J.W., Miller, K., and Adler, S.P. Changing protective and risky behaviors to prevent child-to-parent
transmission of cytomegalovirus. J. Appl. Behav. Anal. 1993; 26: 471–472
M.G., Tibaldi, C., Masuelli, G., Frisina, V., Sacchi, A., Furione, M.,
Arossa, A., Spinillo, A., Klersy, K., Ceccarelli, M., Gerna, G., Todros,
T., and the CCPE Study Group. Prevention
of primary cytomegalovirus infection in pregnancy.EBioMedicine. 2015; 2: 1205–1210
C., Picone, O., Cordier, A.G. et al. Does hygiene counseling have an impact on the rate of CMV primary
infection during pregnancy? Results of a 3-year prospective study in a
French hospital. J. Clin. Virol. 2009;46: S49–S53
WHAT YOU CAN DO TO HELP
Adler refers to five prevention education studies in his article, “Prevention of Maternal–Fetal Transmission of Cytomegalovirus” (2015). They are:
Links to read the PREVENTION STUDIES listed in Adler's 2015 summary paper,
"Prevention of Maternal–Fetal Transmission of Cytomegalovirus"
For more information, contact: