Tuesday, June 4, 2019

CMV Risk to Unborn Children of Child Care Providers/Teachers: Know OSHA's action regarding CMV precautions?

Can you help spread OSHA's CMV news to your state to help protect the unborn babies of caregivers/teachers? Click on these links to find your state's OSHA office, Child Care Licensing office and Department of Public Health office. This would be a great topic for the American Industrial Hygiene local and national chapter meetings. The following is what I have been emailing agencies but I could use your help. Please edit to fit your state and circumstances for any agency you have connections with: 

Dear [OSHA, Child Care Licensing, Department of Public Health, Child Care Director, etc]:

Please tell caregivers/teachers who work with young children about CMV and OSHA's new action regarding CMV precautions to protect their unborn children at: https://www.osha.gov/SLTC/cmv. Congenital CMV is the most common infectious cause of birth defects in the U.S. according to the Centers for Disease Control and Prevention (CDC). Approximately 4,000 babies each year in the U.S. are born disabled by congenital CMV.

On May 22, 2019, the Occupational Safety and Health Administration (OSHA) announced in "QuickTakes," its newsletter on workplace safety and health: "A common virus, Cytomegalovirus (CMV) affects thousands of workers in childcare centers and healthcare facilities. These workers are at the greatest risk of exposure because the virus is often spread through saliva and other body fluids of young children. OSHA's new webpage on CMV [https://www.osha.gov/SLTC/cmv/], explains how to minimize health risks associated with workers' exposure to this virus."

Although licensed child care providers learn infection control methods, surveys show that most do not know about their occupational risk for CMV and many acknowledge using diaper wipes to clean (Thackeray and Magnusson, 2016). Diaper wipes do not effectively remove CMV from hands (Stowell et al., 2014). Infection control methods can only reduce the transmission of CMV if workers are motivated to follow them.

CDC Provides Teaching Tools in English and Spanish

June is the perfect time to share CMV prevention tips because the CDC recognizes June as National Cytomegalovirus (CMV) Awareness Month. This year, CDC is featuring CMV as the Disease of the Week on June 24. and rolling out a re-designed, more digital friendly CMV website (https://www.cdc.gov/cmv/). "All of our CMV website content is syndicated, so you can copy the embedded code from CDC’s Public Health Media Library and place CDC’s content on your own website, mobile application, RSS feed, or similar digital channels," states Holly Patrick, MS, MPH, Communication Specialist, National Center for Immunization and Respiratory Diseases, Division of Viral Diseases, Centers for Disease Control and Prevention (CDC, Atlanta, GA, 404.718.5494, mdu8@cdc.gov).

CDC's information for child care providers: https://www.cdc.gov/cmv/congenital-infection.html#childcare-providers
CDC's flyers in English and Spanish , "Congenital CMV Facts for Pregnant Women and Parents":

CMV Facts:
I am a former licensed in-home child care provider who was unaware of my occupational risk for CMV until it was too late to help my daughter, Elizabeth, born severely disabled by congenital CMV.
Mothers of young children in group care are also at greater risk (Pass et al, 1986). "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).

In the U.S., more than half of mothers with young children work. "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).

In 2015, Connecticut become the second state in U.S. to pass CMV legislation, yet its child care workers are still unaware of their occupational risk for CMV. Although 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, linking to CT Department of Public Health's webpage, information on CMV is not included in the required training for child care licensing. (Learn about other state CMV legislation at: https://www.nationalcmv.org/about-us/advocacy)

For more information on CMV, please feel free to contact me. I am the leader of the Child Care Providers Education Committee with National CMV Foundation and can suggest several free resources to share.

Thank you for your time!

Lisa Saunders
Child Care Providers Education Committee
National CMV Foundation
PO Box 389, Mystic, CT 06355
Share the above info through Facebook at: https://www.facebook.com/1157396207678254/posts/2273483586069505/

PS: 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..."

Actions to consider:

1) Childcare providers are typically trained in first aid, CPR, and other topics. CMV prevention should be included in training about preventing infectious diseases. NAEYC (National Association for the Education of Young Children) includes "a. steps to reduce occupational hazards such as infectious diseases (e.g., exposure of pregnant staff to CMV…” 

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, AAP, 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...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/ 

4) 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 in Model Child Care Health Policies, which has 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)” (American Academy of Pediatrics, Pennsylvania Chapter, Aronson, SS, ed., 2014, p. 116). 

5) 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).”

6) Hang signs about CMV prevention in child care centers so staff and parents can see them (see CMV resources below--for Connecticut DPH logo in the “Are You Pregnant” poster by the National CMV Foundation, click here). Signs in child care centers are important because mothers of young children in group care are also at increased risk for contracting CMV (Pass et al., 1986) and are unaware of this. "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).

7) 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.

8) 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).

Note from me, Lisa Saunders:
I am the leader of the Child Care Providers Education Committee, National CMV Foundation. Using the song,"Had I Known (about CMV)," by Debra Lynn Alt, I created a public service announcement (PSA) on Congenital CMV: Music Video--"Had I Known (about CMV)". The video is geared to those who care for young children. YouTube version at https://youtu.be/1WoGjfieRhY. You are welcome to share this on TV, online, in presentations, etc.


1."Staff Education and Policies on Cytomegalovirus (CMV)," American Academy of Pediatrics, American Public Health Association, National Resource Center for Health and Safety in Child Care and Early Education. (Revised 2017). National Health and Safety Performance Standards: Guidelines for Early Care and Education Programs. Retrieved from Caring for Our Children: http://nrckids.org/CFOC/Database/ You can download that page as a pdf by clicking on the upper right side of the webpage: "Save as PDF"

2.  Centers for Disease Control and Prevention (CDC) CMV info available in English and Spanish:
"Congenital CMV Facts for Pregnant Women and Parents":https://www.cdc.gov/cmv/

3. CMV prevention video, "Why Moms-to-be Should Care About CMV" (3:37-minutes): https://youtu.be/OM7WKS7J2mA (content by research nurse, Anna Bartholomew of central Ohio; video by Joel Copeland, Chief Operating Officer of KMI Learning, pro bono, Youtube,  2015).

4. National CMV Foundation has flyers for downloadinghttps://www.nationalcmv.org/resources/educational-downloads

OSHA's new webpage on CMV (https://www.osha.gov/SLTC/cmv/), explains how to minimize health risks associated with workers' exposure to this virus.


Lisa Saunders is the mother of a Elizabeth born severely disabled by congenital cytomegalovirus (CMV) in 1989. Until Elizabeth's birth, Lisa was unaware of CMV and although she was a licensed, in-home child care provider, a church nursery volunteer and the mother of a toddler--all activities that put her at high risk for CMV--she was not educated about the disease and how to reduce her chances of contracting it. In 2015, Lisa was instrumental in helping Connecticut become the second state in the U.S. to enact a law requiring the testing of newborns for CMV if they fail their hearing screen. A graduate of Cornell University, Lisa is a public speaker, an award-winning writer and the author of several books--some with a CMV prevention message. She is the leader of the Child Care Providers Education Committee with the National CMV Foundation.