Feb is International Prenatal Infection Prevention Month. CDC Warns CMV, #1 Birth Defects Virus, Can Be in Saliva of Young Children: Moms, Teachers and Child Care Providers Use Precaution

Lisa Saunders (pictured above with daughter Elizabeth in 1994)

Feb: Prenatal Infection Prevention Month. CDC Warns CMV in Tots, says: 

"Women may be able to lessen their risk of getting CMV by reducing contact with saliva and urine from babies and young children."

February is International Prenatal Infection Prevention Month. The Centers for Disease Control and Prevention (CDC) lists cytomegalovirus (CMV) first of four infections on its webpage, Protect Your Unborn Baby or Newborn from Infections:

• Cytomegalovirus

• Group B strep

• Listeriosis

• Zika virus

According to the CDC, "A pregnant woman infected with CMV can pass the virus to her baby during pregnancy. 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. CMV is passed from infected people to others through body fluids, such as saliva, urine, blood, vaginal secretions, and semen. Infants and young children are more likely to shed CMV in their saliva and urine than older children and adults. 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 by not sharing food and utensils with babies and young children, and washing hands after changing diapers."

"It's been 13 years this February since my daughter Elizabeth died during a seizure at age 16. Epilepsy was one of her many health complications as a result of me contracting CMV when I was pregnant with her," says Lisa Saunders, leader of Child Care Providers Education Committee, National CMV Foundation. "I was a licensed, in-home child care provider, church nursery volunteer and the mother of a toddler, yet I didn't  know about CMV. I always washed my hands after changing diapers, but often too busy chasing toddlers to get to the sink after wiping noses and picking up toys, I used diaper wipes to clean my hands not realizing they didn't kill CMV. I had known about CMV, I would have taken extra precautions, such as always washing my hands with soap and water and never sharing  cups with my own toddler."

Saunders says, "The prevalence of CMV in child care is a very inconvenient truth." Mothers of children in group care are at increased risk for CMV because their child is at greater risk for contracting CMV in daycare. In  the article, "Infectious diseases and daycare and preschool education," the authors state: “Children cared for at daycare or in preschool education exhibit a two to three times greater risk of acquiring infections… Small children have habits that facilitate the dissemination of diseases, such as putting their hands and objects in their mouths, very close interpersonal contact” (Nesti and Goldbaum, 2007).

“Almost all the babies that I see who have congenital CMV, there is an older toddler at home who is in daycare,” said Dr. Jason Brophy, a pediatric infectious disease specialist, in the Ottawa Citizen (Payne, 2018). 

On average, 30-40% of preschoolers in day care excrete CMV in their saliva and/or urine (Red Book: 2015 Report of the Committee on Infectious Diseases, AAP, p. 144). 

"Up to 70% of children ages 1 to 3 years in group care settings excrete the virus” (AAP et al., Caring for Our Children: National Health and Safety Performance Standards; Guidelines for Early Care and Education Programs, modified 2017)

Although Saunders has been shouting CMV prevention from the rooftops ever since her daughter died and helped get a CMV testing law passed in Connecticut in 2015, CMV prevention remains little known--even among child care providers and early childhood education teachers who have an occupational risk for the virus. "I've had so many people respond to my CMV warnings that, 'If CMV was really a problem, my doctor would have told me.'"

Saunders believes there are six reasons why most women have never heard of CMV: 

1)      CMV prevention education is not part of a doctor’s “standard of care.” 

2)      "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.” Cannon and Davis, 2005.)

3)      Doctors don’t want to frighten, worry or “burden” patients:

·        FitPregnancy magazine: "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,” said OB-GYN Laura Riley, M.D., director of infectious disease at Massachusetts General Hospital (June/July, 2008). 

·        The New York Times, "The American College of Obstetricians and Gynecologists [ACOG] used to encourage counseling for pregnant women on how to avoid CMV. But last year, the college reversed course, saying, ‘Patient instruction remains unproven as a method to reduce the risk of congenital CMV infection.’ Some experts argue that because there is no vaccine or proven treatment, there is no point in worrying expecting women about the virus...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.” (Saint Louis, 2016).  

4)      No national public awareness campaign in United States: “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” (Clinical Advisor,  2014).

5) Low media coverage about congenital CMV: In article, "Why does CMV get so much less news coverage than Zika — despite causing far more birth defects?"Matt Shipman  writes,  “Researchers we spoke with identified the same factors – fear and the epidemic/endemic nature of the diseases – as driving the media disparity” (HealthNewsReview.org, 2018).

6) Unlike Germany, there is no U.S. law regulating methods of CMV control in the child care setting. According to the Department of Labor, "Education and training requirements vary by setting, state, and employer." In most states, except Utah and Idaho, child care centers are not instructed to tell workers about CMV despite U.S. workers having the right to “receive information and training about hazards” (Occupational Safety and Health Act of 1970).

GERMANY AND AUSTRALIA

·        In 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- or embryopathy in her offspring“ (Stranzinger et al., 2016).

·        “In Australia, state governments have differing recommendations for pregnant ECEC [early childhood education and care educators] working with young children. Some states, such as Queensland, suggest relocating educators who are pregnant to care for children aged over two to reduce contact with urine and saliva” (Clark, 2019).

CMV LAWSUIT BY CHILD CARE WORKER

In 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). Meridian Lawyers of Australia state: “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 Meridian Lawyers' recommendations for educating child care providers about CMV at: 

https://www.meridianlawyers.com.au/insights/infectious-diseases-child-care-what-about-staff-members/

CONCLUSION

 “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 and Magnusson, 2016). 

To learn more about CMV and other prenatal infections, all are welcome to "attend" an online, free of charge, Prenatal Infection Prevention Symposium, February 25 - 28, 2019. CME credit will be available for physicians and midwives. 

Lisa Saunders will present, “Help Child Care Providers Fight Cytomegalovirus (CMV): Protect Newborns From #1 Birth Defects Virus,” on Tuesday, February 26 and respond to comments/questions about her presentation that day. Dr. Stuart P. Adler will present, "Prevention of CMV Infections During Pregnancy by Behavior Modification." 

To register for the Prenatal Infection Prevention Symposium, visit: gbsi.me/PIPS (registration is complimentary).The Prenatal Infection Prevention Symposium is a collaborative partnership between Group B Strep International and Star Legacy Foundation, both nonprofit 501(c)(3) organizations working towards more babies being born healthy and staying healthy.