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Friday, December 28, 2018

Doctor observes that babies with congenital CMV are often born to mothers of toddlers in daycare. All Women Should Know Precautions

Lisa Saunders, child care provider, holds her baby Elizabeth, born with a severely damaged brain from congenital cytomegalovirus (CMV) in 1989. Lisa didn't know that pregnant women who care for toddlers or have one in group care are at greater risk for contracting CMV and therefore need to take extra precautions (all women of childbearing age, however, should learn how to reduce their chances of contracting the virus--see flyer/CDC links below).

SummaryIn U.S., 4,000 babies are born disabled by congenital cytomegalovirus (CMV) annually. Pregnant moms of toddlers in daycare and child care providers/teachers are at increased risk for contracting CMV so need to learn how to reduce their chances of contracting CMV (all women should). Lisa Saunders, a licensed in-home child care provider when pregnant, was not told of her occupational risk for CMV until after her daughter, Elizabeth, was born with a severely damaged brain. Women can reduce risk of CMV with CDC prevention tips found at: www.cdc.gov/cmv/fact-sheets/parents-pregnant-women.html


The #1 Birth Defects Virus, Cytomegalovirus (CMV), is Often Found in Daycare Centers

All women of childbearing age need to learn CMV prevention

Mystic, Conn.--"There is an 'inconvenient truth' about cytomegalovirus (CMV), the leading viral cause of birth defects, because it is often found in the child care setting," says former child care provider Lisa Saunders, leader of the Child Care Providers Education Committee, National CMV Foundation. "Although women who care for or have young children in daycare are at increased risk for CMV, all women of childbearing age should learn how to reduce their chances of contracting the virus," she says. 

“Almost all the babies that I see who have congenital CMV, there is an older toddler at home who is in daycare. That is a very common presentation: the mom gets her primary infection through her older child who is in daycare and that is when it goes to the baby,” said Dr. Jason Brophy, a pediatric infectious disease specialist, in the Ottawa Citizen (Payne, 2018).


Toddlers can spread CMV to each other, their child care providers and families. "Up to 70% of children ages 1 to 3 years in group care settings excrete the virus...With regard to child-to-staff transmission, studies have shown increased rates of infection with CMV in caregivers/teachers ranging from 8% to 20%” (Caring for Our Children, American Academy of Pediatrics (AAP), et al, revised 2017).


According to the Centers for Disease Control and Prevention (CDC), “About one out of every 200 babies is born with congenital CMV infection. However, only about one in five babies with congenital CMV infection will be sick from the virus or have long-term health problems....A pregnant woman can pass CMV to her unborn baby.” Every year, congenital CMV (cCMV) causes disability in an estimated 4,000 babies in the U.S. (4 million annual births/200 born with cCMV/5 sick or long-term health problems = 4,000 disabled by cCMV).


Prevention tips from the CDC: “The saliva and urine of children with CMV have high amounts of the virus. You can avoid getting a child’s saliva in your mouth by, for example, not sharing food, utensils, or cups with a child. Also, you should wash your hands after changing diapers. These cannot eliminate your risk of getting CMV, but may lessen the chances of getting it” ("Congenital CMV Facts for Pregnant Women and Parents" flyer at: cdc.gov/cmv).


Lisa Saunders, a former in-home licensed child care provider, was trained in CPR, etc., but not educated about her occupational risk for CMV until after her daughter Elizabeth was born severally disabled by congenital CMV in 1989. At the time of Elizabeth's birth, Saunders was operating a daycare center for toddlers in her home, volunteering in her church nursery on Sunday, and was the mother of a toddler--all things that put her pregnancy at greater risk for CMV. Elizabeth had an abnormally small, damaged brain (microcephaly), was profoundly mentally and visually impaired, and had cerebral palsy. After Elizabeth's birth, Saunders was then given educational materials stating that people who care for or work closely with young children may be at greater risk of CMV infection. "This information came too late for my family," says Saunders. "Had I known this before I was pregnant with Elizabeth, I would have been extra diligent about taking preventative measures." Elizabeth died at 16 during a seizure in 2006. Although Saunders was instrumental in helping Connecticut pass a CMV testing law in 2015, wrote a book about Elizabeth’s life, "Anything But a Dog: the perfect pet for a girl with congenital CMV" (Unlimited Publishing, 2008) and other CMV prevention articles and books, CMV prevention steps remain little known. 

Recent surveys show that most women have never heard of CMV (Doutre et al, 2016)—including child care providers (Thackeray and Magnusson, 2016).


According to the New York Times, OB/GYNs are discouraged from discussing CMV prevention with their patients. “Guidelines from ACOG [American College of Obstetricians and Gynecologists] suggest that pregnant women will find CMV prevention ‘impractical and burdensome,’ especially if they are told not to kiss their toddlers on the mouth — a possible route of transmission”( "CMV Is a Greater Threat to Infants Than Zika, but Far Less Often Discussed,"Saint Louis, 2016). 

Caring for Our Children (AAP, et al.), the book used as a standard for child care centers, states: "Female employees [caregivers/teachers] of childbearing age should be referred to their primary health care provider or to the health department authority for counseling about their risk of CMV infection. This counseling may include testing for serum antibodies to CMV to determine the employee’s immunity against CMV infection…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” (see: nrckids.org/CFOC/Database/7.7.1.1).


How Can the Public Help Educate Women About CMV?


1) Share CDC prevention tips at: www.cdc.gov/cmv/fact-sheets/parents-pregnant-women.html. Scroll to the bottom where you will find this pdf to print and share: https://www.cdc.gov/cmv/downloads/pregnant-patients-cmv.pdf

2) The following flyer produced by the National CMV Foundation is great for hanging on walls and posting on Facebook:


This is also a good flyer from the National CMV Foundation: 
https://www.nationalcmv.org/NCMVF/media/ncmvf/download-content/CMV_Awareness-Flyer_11x17.pdf?ext=.pdf

3) You can share the Facebook link to this blog post at:   https://www.facebook.com/1157396207678254/posts/2035429836541549/  


###

Contact information:

Lisa Saunders
PO Box 389, Mystic, CT 06355
Child Care Providers Education Committee
lisa.saunders@nationalcmv.org


ADDITIONAL NOTES:
An excerpt of the above press release was posted on PR.com. See: https://www.pr.com/press-release/773215
An Australian publication, The Sector: Early Education News,  revised it for their country in the article, "Pregnant and working in ECEC [early childhood education and care]? Make sure you know the risks of contracting CMV" by Lyndsie Clark (January 6, 2019). Read more at https://thesector.com.au/2019/01/07/pregnant-and-working-in-ecec-make-sure-you-know-the-risks-of-contracting-cmv/?fbclid=IwAR3sg1ntfNLfQ50VOIjubuqdFZ6QUwv12QJa5JjewzE_PJIj4i2g_FFQsTI

Examples of CMV Protocols in Other Countries:

In Queensland, Australia, suggested control measures include: "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" (Queensland Government).


In Germany, to protect day care workers from primary CMV infection, their “CMV serostatus must be checked at the beginning of their pregnancy.” If the worker “is seronegative, she is excluded from professional activities with children under the age of three years” (Stranzinger et al., 2016).

Congenital CMV remains little-known in the U.S. for several reasons:

A.   CMV prevention education is not part of a doctor’s “standard practice of care.” The following reasons have been cited for this lack of prevention education: 

1.     Don’t want to frighten their patients: An OB/GYN quoted in FitPregnancy magazine (June/July '08) said, "The list of things we're supposed to talk about during women's first visit could easily take two hours and scare them to death.”

2.     …most CMV infections go undiagnosed—“The virtual absence of a prevention message has been due, in part, to the low profile of congenital CMV. Infection is usually asymptomatic in both mother and infant, and when symptoms do occur, they are non-specific, so most CMV infections go undiagnosed.” (Article, “Washing our hands of the congenital cytomegalovirus disease epidemic,”by Cannon MJ, Davis KF, published in BMC Public Health 2005, 5:70).

3.     Feel prevention measures are “impractical or burdensome."  According to the New York Times, “Guidelines from ACOG suggest that pregnant women will find CMV prevention ‘impractical and burdensome,’ especially if they are told not to kiss their toddlers on the mouth — a possible route of transmission.”

4.     Concerns about effectiveness of CMV prevention instructions.  “…because of concerns about effectiveness (i.e., Will women consistently follow hygienic practices as the result of interventions?), the medical and public health communities appear reluctant to embrace primary CMV prevention via improved hygienic practices, and educational interventions are rare,” state Drs. Cannon and Davis in “Washing our hands of the congenital cytomegalovirus disease epidemic.”

B.  Still no national public awareness campaign: “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 articleEducate pregnant women to prevent congenital CMV.” (2014)

C.  No central U.S. daycare center licensing procedures to enforce daycare licensing education and methods of CMV control. According to the Department of Labor, "Education and training requirements vary by setting, state, and employer."



D. Low media coverage about congenital CMV: According to the article, "Why does CMV get so much less news coverage than Zika — despite causing far more birth defects? (Shipman, 2018),” published in HealthNewsReview.org, “Researchers we spoke with identified the same factors – fear and the epidemic/endemic nature of the diseases – as driving the media disparity.” Media silence is a problem in regard to prevention, diagnosis and treatment.
TO SEE POSSIBLE CHILD CARE PROTOCOLS, CLICK ON 

POSSIBLE CMV PROTOCOLS FOR CHILDCARE CENTERS





Saturday, December 8, 2018

Holiday Gift: Tell caregivers/teachers how to protect their unborn children from #1 birth defects virus, CMV





I’m Lisa Saunders, a former licensed child care provider who was unaware of my occupational hazard for contracting cytomegalovirus (CMV) until it was too late. My daughter Elizabeth was born at Christmas time in 1989 with a severally damaged brain because I caught CMV when pregnant. Surrounded by Christmas decorations in the hospital, I tried to recover from the shock when I was given a pamphlet stating that women who work in child care are at greater risk for CMV. Mothers of young children in group care are also at increased risk for contracting CMV (Pass et al., 1986).  

Each year, congenital CMV disables 4,000 babies in the U.S.* 

Caution: My following letter reveals a very "inconvenient truth" about CMV and toddler saliva and includes links to the CDC's flyers on CMV prevention (English/Spanish), so you can ensure moms/caregivers/teachers know how to protect their unborn children. If you are a reporter wondering why you have never heard of this, I tell you who to investigate here.


The Facts About CMV: 
According to the Centers for Disease Control and Prevention (CDC), About one out of every 200 babies is born with congenital CMV infection...about one in five babies with congenital CMV infection will be sick from the virus or have long-term health problems...” Congenital CMV can cause hearing and vision loss, developmental delays, microcephaly and seizures.    

You May Be Able to Reduce Your Risk: 
“The saliva and urine of children with CMV have high amounts of the virus. You can avoid getting a child’s saliva in your mouth by, for example, not sharing food, utensils, or cups with a child. Also, you should wash your hands after changing diapers. These cannot eliminate your risk of getting CMV, but may lessen the chances of getting it” ("Congenital CMV Facts for Pregnant Women and Parents" flyer at: cdc.gov/cmv).  

CMV in Child Care:
"Up to 70% of children ages 1 to 3 years in group care settings excrete the virus...With regard to child-to-staff transmission, studies have shown increased rates of infection with CMV in caregivers/teachers ranging from 8% to 20%” (Caring for Our Children, American Academy of Pediatrics et al., revised 2017).

In addition to the AAP, CMV is acknowledged as an occupational hazard by NAEYC: National Association for the Education of Young Childrenthe accrediting organization that promotes "steps to reduce occupational hazards such as infectious diseases (e.g., exposure of pregnant staff to CMV…” 

Workers have the right to “receive information and training about hazards” (Occupational Safety and Health Act of 1970) yet recent surveys show that most women have never heard of CMV (Doutre et al, 2016), including child care providers (Thackeray and Magnusson, 2016).   Many caregivers surveyed acknowledge using diaper wipes to clean, but diaper wipes do not effectively remove CMV from hands (Stowell et al., 2014). Although soap and water is best, hand sanitizer will reduce levels of CMV when a sink is not readily available.  Staff are usually trained in disinfecting procedures but this only helps reduce CMV transmission if they are motivated to follow them. CMV prevention can be built into infectious diseases training. CMV is also a blood-borne pathogen.

Please ask child care programs to adopt the following policy from the American Academy of Pediatrics (AAP): 

Staff Education and Policies on Cytomegalovirus (CMV)"Female employees of childbearing age should be referred to their primary health care provider or to the health department authority for counseling about their risk of CMV infection. This counseling may include testing for serum antibodies to CMV to determine the employee’s immunity against CMV infection…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” (Caring for Our ChildrenAAP, et al, revised 3/31/17,  nrckids.org/CFOC/Database/7.7.1.1).

Examples of CMV Protocols in Other Countries: 
In Queensland, Australia, suggested control measures include: "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" (Queensland Government). In Germany, to protect day care workers from primary CMV infection, their “CMV serostatus must be checked at the beginning of their pregnancy.” If the worker “is seronegative, she is excluded from professional activities with children under the age of three years” (Stranzinger et al., 2016).

Potential Cost of Not Warning Child Care Providers about CMV
In New South Wales, “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).  Meridian Lawyers stated: "The allegations of negligence were that Sydney Day Nursery breached its duty of care to Linda ...by failing to warn her of the risks of CMV in circumstances where the centre knew or ought to have known of the risks of CMV to pregnant women...” See their suggested policy at at: www.meridianlawyers.com.au/insights/infectious-diseases-child-care-what-about-staff-members/. 

The U.S. book, Model Child Care Health Policies, includes a sample document to be signed by staff (paid or volunteer) to show “Acceptance of Occupational Risk by Staff Members,” which includes “exposure to infectious diseases (including infections that can damage a fetus during pregnancy)” (Pennsylvania Chapter AAP, Aronson, SS, ed., 2014, p.116). 



RESOURCES FOR EDUCATING CHILD CARE PROVIDERS/TEACHERS ABOUT CMV

1) CDC flyers: "Congenital CMV Facts for Pregnant Women and Parents" In English and En Español at: cdc.gov/cmv

2) Utah Department of Health, required by law to educate child care providers about CMV, has brochures in English and Spanish:

3) National CMV Foundation: Wall posters: www.nationalcmv.org/resources/educational-downloads

Ever since my Elizabeth died in 2006 when we were living in New York, I have dedicated my life to warning women about CMV. 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 high school student interning at a Connecticut day care center while pregnant. She, too, was unaware of 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 CMV. Although I wrote a book about Elizabeth’s life with CMV, “Anything But a Dog: the perfect pet for a girl with congenital CMV”, congenital CMV still remains largely unknown. 

Please let me know if you would like more ideas on ways to educate caregivers/teachers. For starters, you can hand out the above linked resources and hang flyers on your walls. For sharing this message on Facebook: https://www.facebook.com/504336809953884/posts/924569157930645/
For sharing this blog post: https://congenitalcmv.blogspot.com/2018/12/christmas-gift-tell-caregiversteachers.html

Thank you in advance for your help!   

Sincerely,

Lisa Saunders
Child Care Providers Education Committee
PO Box 389, Mystic, CT 06355

About Lisa Saunders
Lisa Saunders was instrumental in helping Connecticut become the second state in the U.S. to pass a law requiring newborns be tested for CMV if they fail their hearing screen. She is still trying to raise awareness through public speaking, TV interviews, books, and through articles such, "The Danger of Spreading CMV: How We Can Protect Our Children" (ChildCare Aware of America, June 2017).  Visit her blog at: congenitalcmv.blogspot.com.

*Congenital CMV (cCMV) can cause hearing loss, developmental and motor delay, vision loss, microcephaly and seizuresIn the U.S., cCMV causes disability in an estimated 4,000 babies annually (4 million annual births/200 born with cCMV/5 sick or long-term health problems = 4,000 disabled by cCMV).




Tuesday, December 4, 2018

POSSIBLE CMV PROTOCOLS FOR CHILDCARE CENTERS


by 
Lisa Saunders


Most child care providers have never heard of CMV despite NAEYC: National Association for the Education of Young Children  including "a. steps to reduce occupational hazards such as infectious diseases (e.g., exposure of pregnant staff to CMV…”

Perhaps if the following protocols can be put in place, child care providers/teachers will reduce chances of contracting CMV:

  1. CMV prevention education added to the licensing training. Childcare providers are typically trained in first aid, CPR, and other topics. CMV prevention should be included in training about preventing infectious diseases.  
  2. Give each childcare employee/volunteer a CMV brochure (see Utah's brochure for childcare providers).
  3. CMV prevention added to a childcare center’s handbook. See Staff Education and Policies on Cytomegalovirus (Caring for Our Children, American Academy of Pediatrics, et al.): "Female employees of childbearing age should be referred to their primary health care provider or to the health department authority for counseling about their risk of CMV infection. This counseling may include testing for serum antibodies to CMV to determine the employee’s immunity against CMV infection…Up to 70% of children ages 1 to 3 years in group care settings excrete the virus...With regard to child-to-staff transmission, studies have shown increased rates of infection with CMV in caregivers/teachers ranging from 8% to 20%...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.” Print Staff Education and Policies on CMV by clicking "Save as PDF" at: nrckids.org/CFOC/Database/7.7.1.1 
  1. CMV information added to a New Staff Orientation Form. The form should be signed to show the childcare provider read and understood they should consult their healthcare provider about their risk for CMV. See sample wording below.*
  2. CMV Prevention discussed at a childcare center’s parent orientation.
  3. Signs about CMV prevention hanging in day care centers so staff and parents can see them (see CMV resources below).
  4. See the guide,  “Infectious Disease in Child Care Settings Training Module version 3, revised 4/23/13,” at: https://www.ncemch.org/child-care-health-consultants/Part1/1-10_m_infectious_disease.pdf (citation: The National Training Institute for Child Care Health Consultants. Infectious disease in  child care settings version 4. Chapel Hill (NC): The National Training Institute for Child  Care Health Consultants, Department of Maternal and Child Health, The University of  North Carolina at Chapel Hill; 2013. )
  5. Consider the protocol posted on the website in Queensland, Australia. They  relocate workers who are pregnant, or “expect to become pregnant, to care for children aged over two to reduce contact with urine and saliva.” See their list of safety measures in “Cytomegalovirus (CMV) in early childhood education and care services,” on the Workplace Health and Safety webpage. See: https://www.worksafe.qld.gov.au/injury-prevention-safety/workplace-hazards/hazardous-exposures/biological-hazards/cytomegalovirus-cmv-in-early-childhood-education-and-care-services
  6. Potential Cost of Not Warning Child Care Providers about CMV
    In New South Wales, “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).  Meridian Lawyers stated: "The allegations of negligence were that Sydney Day Nursery breached its duty of care to Linda ...by failing to warn her of the risks of CMV in circumstances where the centre knew or ought to have known of the risks of CMV to pregnant women...” See their suggested policy at: www.meridianlawyers.com.au/insights/infectious-diseases-child-care-what-about-staff-members/, which states: 

    As a starting point, unless already doing so, operators of child care centres should consider taking steps to implement the following policies:
    1. Ensure that Staying Healthy in Childcare (or its equivalent publication) is always visible and accessible to staff at the centre.
    2. That the induction process for new female employees, whether pregnant or not, include drawing the employees attention to Staying Healthy in Childcare (or its equivalent publication) and in particular the pages regarding CMV and infectious diseases.
    3. That written confirmation be obtained from the new employee that they have read and understood Staying Healthy in Childcare and in particular the sections regarding infectious diseases.
    4. That upon learning that a child care worker is pregnant, the worker again be referred to Staying Healthy in Childcare (or its equivalent publication), and given time to read all sections regarding infectious diseases including CMV, and that this be documented.
    5. That upon learning that a female child care worker is pregnant, she be advised by the centre director to see her GP to consider the risks of continuing to work in child care and to take advice from her GP about undergoing blood tests to check for susceptibility to things like primary CMV infection.
    6. That pregnant workers be given the option or be restricted to work with toilet trained children, and that pregnant workers not be permitted to perform nappy changing or to assist with toileting.

    If you operate a child care centre or work in child care, please contact Tamir Katz  (tkatz@meridianlawyers.com.au) or Kellie Dell’Oro (fkdelloro@meridianlawyers.com.au) or more information.
*The book, Model Child Care Health Policies, includes a sample document to be signed by staff (paid or volunteer) to show “Acceptance of Occupational Risk by Staff Members,” which includes “exposure to infectious diseases (including infections that can damage a fetus during pregnancy)” (p. 116). The book states that programs should describe their commitment “to best practice, as indicated in CFOC3 [Caring For Our Children 3rd Editionwhich includes CMV education]...A policy might specify intended compliance with accreditation standards, such as those of the National Association for the Education of Young Children (NAEYC) (www.naeyc.org) [which mentions CMV as an “occupational hazard”] for center-based care or the National Association for Family Child Care (www.nafcc.org)..." (page xviii). (Pennsylvania Chapter of the American Academy of Pediatrics. Model Child Care Health Policies, 5th Edition, Aronson, SS, ed. (2014). Elk Grove Village, IL. Copyright © 2014 Pennsylvania Chapter of the American Academy of Pediatrics. All rights reserved. Permission is granted to reproduce or adapt content for use within a child care setting. These policies are for reference purposes only and shall not be used as a substitute for medical or legal consultation, nor be used to authorize actions beyond a person’s licensing, training or ability.)


RESOURCES FOR EDUCATING CHILD CARE PROVIDERS/TEACHERS

·       CDC flyers: "Congenital CMV Facts for Pregnant Women and Parents" In English and En Español at: cdc.gov/cmv

·       Utah Department of Health, required by law to educate child care providers about CMV, has brochures in English and Spanish, “CMV What Childcare Providers Need to Know (English)” | “Lo qué los proveedores de cuidado infantil necesitan saber sobre CMV (Spanish)” at:health.utah.gov/cshcn/programs/cmv.html

·       National CMV Foundation: Wall posters: www.nationalcmv.org/resources/educational-downloads


Connecticut DPH logo in the “Are You Pregnant” poster by the National CMV Foundation at: https://drive.google.com/file/d/1AVG9RXGVsbBTwOImOb18NWDdG3rHbHbm/view?usp=sharing


Note: The Child Care and Development Block Grant Act of 2014 has created regulatory changes. The Administration for Children and Families published Caring for our Children Basics (based on Caring for Our Children) in 2015 to “align basic health and safety efforts across all early childhood settings." In the section, “Prevention of Exposure to Blood and Body Fluids,” it states: “Caregivers and teachers are required to be educated regarding Standard Precautions [developed by CDC] before beginning to work in the program and annually thereafter. For center-based care, training should comply with requirements of the Occupational Safety and Health Administration (OSHA).”