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.
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 Children, the 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 Children, AAP, et al, revised 3/31/17, nrckids.org/CFOC/
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:
“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/
3) National CMV Foundation: Wall posters: www.nationalcmv.org/
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/
For sharing this blog post: https://congenitalcmv.blogspot.com/2018/12/christmas-gift-tell-caregiversteachers.html
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 seizures. In 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).
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