Does your organization help mothers have healthy newborns? Do they want prevent the deafness, blindness and brain damage caused by cytomegalovirus (CMV), the leading viral cause of birth defects?
featured in the New York Times article, "CMV Is a Greater Threat to Infants Than Zika, but Far Less Often Discussed" (Saint Louis, 2016). Her letter illustrates why cytomegalovirus (CMV) is more dangerous to a child care provider's pregnancy than other childhood diseases in childcare centers and why it should be discussed with all pregnant women. Click on CMV Law Support Gail J. Demmler-Harrison MD, and note Dr. Demmler-Harrison's heartbreaking last sentence: "When mothers and fathers sit across from me in my CMV clinic holding their little baby and ask, 'Why weren't we warned about CMV,' it's heart-breaking. All I can say is, 'I don’t know, I’ve been trying for over 30 years to educate pregnant women about CMV.'”
2) National CMV Foundation (click for letter by Amanda Devereaux RN, BSN)
3)New York Stop CMV (click for letter by Lisa Saunders, mother of child born with congenital CMV)
4)Group B Strep International by Marti Perhach, GBSI CEO/Cofounder
Lisa Saunders
216 Peakwood Lane
Baldwinsville, NY 13027
Music Video "Had I known (about CMV)"
- Requires childcare providers to be trained on the impacts and dangers of congenital cytomegalovirus infection and the treatments and methods of prevention of cytomegalovirus infection
- The commissioner shall distribute such cytomegalovirus informational materials to licensed physicians who practice obstetric and/or gynecology in this state. Such physicians shall provide such informational material to each pregnant patient during such patient's first appointment with such physician. Such physician shall also discuss the risks associated with and the transmission of cytomegalovirus with such patient.
- New York State Assembly proclaimed June 2021 Cytomegalovirus Awareness Month, stating, " It is difficult for mothers to protect themselves from a virus carried by the children they care for, especially if they are unaware of the virus itself... less than half of obstetrician-gynecologists tell pregnant patients how to avoid CMV;...". CMV prevention education is not "part of standard prenatal care” (Washington Post, "How a common, often harmless virus called cytomegalovirus can damage a fetus," May 15, 2021.)
- CMV education has been proven to help prevent women from contracting CMV. According to the New York Times, "A study in a French hospital found five to 10 minutes of counseling about CMV prevention resulted in fewer women contracting the virus. In another study, pregnant mothers shown a video and offered hygiene tips were much less likely to get CMV (5.9 percent) than those not given information on prevention (41.7 percent).(New York Times, "CMV Is a Greater Threat to Infants Than Zika, but Far Less Often Discussed", Catherine Saint Louis, 2016).
- New York Commissioner of Health said CMV education was "Imperative": Howard A. Zucker, M.D., J.D , stated in 2018: “it is imperative that we give women of reproductive age the information they need to make informed decisions for themselves and their families...According to the Centers for Disease Control and Prevention (CDC), female workers of reproductive age in child care centers should be educated on CMV and its potential risks, and should have access to appropriate hygiene measures to minimize occupationally-acquired infection..."
- Compliance with OSHA, which recognizes CMV as a “hazard” for childcare workers. New York's current childcare worker training law does not require specific education on CMV. Recent surveys show that most child care providers do not know about CMV and many acknowledge using diaper wipes to clean hands instead of following proper protocols (Thackeray and Magnusson, 2016). Diaper wipes do not effectively remove CMV from hands (Stowell et al., 2014).
- Prevention education should save tax dollars on educating and treating children disabled by CMV. Licensed child care providers are typically trained in first aid and CPR, etc., to ensure the health of the children in their care. CMV prevention can easily be included in their training on infectious diseases by distributing the CDC's flyers on CMV in English and Spanish: https://www.cdc.gov/
cmv/resources/pregnant-women- parents.html. They flyers can also be distributed at a patient's first prenatal appointment. (The medical costs of cCMV are high. (https://cmv.usu. edu/Uploads/pdfs/17739_ 9664Scott%20D.Grosse.pdf). The median cost of healthcare for a child with a symptomatic case of cCMV is 25.2 times higher than that of a child without cCMV over the course of the first four years. In the general population, the median out-of-pocket expenditures throughout the first four years of a child’s life is $1,508. Among children with symptomatic cCMV, that cost is almost four times as high, at $6,766 per child. Among children with neurological complications resulting from cCMV, the median out-of-pocket cost increased to $8,511.) - Educating child care providers about CMV can reach mothers who use group care--hopefully before they become pregnant with their next child. Women who have young children in group child care are at an increased risk for CMV. "Parents of children in day-care centers are also at increased risk for contracting CMV" (Pass et al, 1986). One pediatrician in Canada stated, “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 (Ottawa Citizen, Payne, 2018).
- United States Congress "Recommends that more effort be taken to counsel women of childbearing age of the effect this virus can have on their children" - https://www.
congress.gov/bill/112th- congress/senate-resolution/215. Utah and Idaho passed legislation to ensure those who work with children know about their occupational risk for CMV. - Respects Women's Rights: According to Amnesty International, women have the right "to enjoy the highest attainable standard of physical and mental health". We believe women have the right to protect their pregnancies from infections and all other known causes of preventable birth defects.
- Compliance with 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, https://nrckids.org/CFOC/
Database/7.7.1.1).
Subject and content could be something like:
Subject: Children and Families Committee: Vote for "Elizabeth's Law" (A7560 / S6287A) to prevent cytomegalovirus (CMV), a leading cause of brain damage, hearing loss
Dear Assembly Children and Families Committee:
My name is ____ from [organization if you are part of one]. I would like you co-sponsor "Elizabeth's Law" (A7560 / S6287A), named in memory of a girl who died from complications of congenital CMV (a seizure) in New York. "Elizabeth's Law" would ensure pregnant women and child care providers are educated on how to protect their pregnancies from the leading viral cause of birth defects, cytomegalovirus or CMV. Many new mothers are stunned to learn their child's brain damage, vision or hearing loss might have been prevented had they known the precautions to take around the toddlers in their care just prior to or during her pregnancy. As you may be aware, the New York Assembly and Senate proclaimed June 2021 as Cytomegalovirus Awareness Month, stating, that "It is imperative that women are educated about the virus itself and simple preventative measures, such as not sharing food with toddlers, and washing one's hands after changing infants and toddlers diapers..." The CDC has a lot of information about this preventable disease at: cdc.gov/cmv.
"Elizabeth's Law" (A7560 / S6287A) was passed by the New York Senate in 2021.
Sincerely,
[Name/address]
- New York State Assembly--they proclaimed June 2021 Cytomegalovirus Awareness Month: " It is difficult for mothers to protect themselves from a virus carried by the children they care for, especially if they are unaware of the virus itself; less than one in five pregnant women are aware of cytomegalovirus...Few women are warned about this infection, and according to a federal survey, less than half of obstetrician-gynecologists tell pregnant patients how to avoid CMV;..."
- New York State Senate - They unanimously passed "Elizabeth's Law" in 2021 ( "NY Senate passes bill, named for CNY couple's daughter, to boost CMV awareness", The Citizen, Robert Harding (June 2, 2121).
- New York Commissioner of Health (Dr. Zucker). In 2018, Howard A. Zucker, M.D., J.D , stated: “it is imperative that we give women of reproductive age the information they need to make informed decisions for themselves and their families...According to the Centers for Disease Control and Prevention (CDC), female workers of reproductive age in child care centers should be educated on CMV and its potential risks, and should have access to appropriate hygiene measures to minimize occupationally-acquired infection..."
- New York Department of Health: "The risk of CMV infection in hospital workers is not greater than it is in others in the community and is probably low because of careful hand washing practices. In daycare centers, where hand washing practices may not be as good, there may be a greater risk of infection. In both settings, good hygiene and careful hand washing are the most important control measures. Pregnant women working in child care facilities should minimize direct exposure to saliva and avoid kissing babies or young children on the mouth. Hugging is fine and is not a risk factor." (https://www.health.ny.gov/
diseases/communicable/ cytomegalovirus/fact_sheet.htm ) - National CMV Foundation wrote to the New York Assembly Children and Families Committee stating, "We enthusiastically support this bill and its goals of including congenital CMV as part of a public health education program for childcare providers and women seeking prenatal care." Click for letter.
- Sallie Permar, M.D., Ph.D., Chair, Department of Pediatrics, Weill Cornell Medicine, and pediatrician-in-chief, New York-Presbyterian Komansky Children’s Hospital. Dr. Permar stated that CMV is “'a virus that has a PR problem...It’s a virus we have recognized for over 60 years as the cause of birth defects and brain damage in infants...'" (Dr. Sallie Permar’s Work Protecting Mothers, Infants from HIV, CMV Lands Her Among ‘Giants’, Weill Cornell Medicine, 2021).
- Sunil K. Sood, M.D., Chair of Pediatrics, South Shore University Hospital, Attending Physician, Infectious Diseases, Cohen Children's Medical Center and Professor, Zucker School of Medicine at Hofstra/Northwell. He stated, "Since young children commonly carry CMV, pregnant women and women planning pregnancies should take extra care to avoid urine and saliva from young children” (NYMetroParents, 2016).
NATIONAL ORGANIZATIONS
- U.S. Congress: "Recommends that more effort be taken to counsel women of childbearing age of the effect this virus can have on their children"(https://www.congress.gov/bill/112th-congress/senate-resolution/215).
- Centers for Disease Control and Prevention (CDC) - "People who have frequent contact with young children may be at greater risk of CMV infection because young children are a common source of CMV. " (https://www.cdc.gov/cmv/
congenital-infection.html) - Occupational Safety and Health Administration (OSHA) recognizes CMV as a “hazard” for childcare workers (https://www.osha.gov/
cytomegalovirus/hazards). - 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, https://nrckids.org/CFOC/
Database/7.7.1.1). Model Child Care Health Policies includes a 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). - American College of Obstetricians and Gynecologists (ACOG) - “CMV can be spread by contact with an infected child’s urine or other body fluids. Pregnant women who work with young children, such as day care workers or health care workers, should take steps to prevent infection...(https://www.acog.
org/womens-health/faqs/ reducing-risks-of-birth- defects ). - March of Dimes - "CMV often spreads during diaper changes, bathing and other close contact with babies and young children. Children can get infected with CMV at child care or school and pass it on to their families, caregivers and other children... CMV spreads easily in child care centers or preschools where children share toys that may carry CMV." (https://www.
marchofdimes.org/ complications/cytomegalovirus- and-pregnancy.aspx) - National CMV Foundation - "Cytomegalovirus, or CMV, is a public health issue... we support a policy agenda aimed at ensuring access to education for women of childbearing age, accelerating research funding, screening newborns for congenital CMV, and advocating for a vaccine. Congenital CMV infection is largely undetected because the majority of affected infants are asymptomatic at birth." https://www.
nationalcmv.org/about-us/ advocacy Wall Poster “Are You Pregnant?”:
https://www.nationalcmv.org/NCMVF/media/ncmvf/download-content/CMV_Awareness-Flyer_11x17.pdf?ext=.pdf - Congenital CMV Disease Research Clinic & Registry - "Our mission is to provide continuous research on the biology, epidemiology, clinical manifestations, methods to diagnose treatment and prevention of congenital CMV disease as well as to raise public awareness of the life-long impact it may have. We also strive to improve the quality of life of children through prevention of disease by providing community resources and a parent support worldwide network." Dr. Gail J. Demmler Harrison
- National Association for the Education of Young Children and its document, “NAEYC Early Childhood Program Standards and Accreditation Criteria & Guidance for Assessment,” acknowledges the need to "reduce occupational hazards such as infectious diseases (e.g., exposure of pregnant staff to CMV…)”p.90.
- ChildCare Aware of America: "if you are a childcare worker, a nursery volunteer, or have a toddler in child care, you need to know about cytomegalovirus (CMV)." (The Danger of Spreading CMV: How We Can Protect Our Children (June 2017).
- Group B Strep International: "Are you pregnant or plan to be and have a toddler in group care or work/volunteer in early childhood education or daycare? If you don’t know about your increased exposure to cytomegalovirus (CMV), you should."
- MotherToBaby.org: "Close contact with children less than three years old, such as in daycare settings, is a common way to become infected with CMV."
- Moderna: "Moms-to-be should talk to their doctors about CMV and take precautions."
For more information about CMV as an occupational hazard, contact:
Nellie Brown, MS, CIH, Director of Workplace Health & Safety Programs, Lead Programs Manager, Certified Industrial Hygienist, ILR Outreach Statewide, ILR School, Cornell University. She authored and presented: "Occupational Exposure to Cytomegalovirus (CMV): Preventing Exposure in Child Care and Educational Settings, Including OSHA Advisories" (https://ecommons.cornell.edu/
The following is my "Letter of Support," which you are welcome to revise:
Memo
of Support
“Elizabeth’s Law”
A7560 (Rosenthal. L.) / S6287A (Mannion, J.)
Named in memory of Elizabeth Saunders, born with a severely damaged brain to a licensed child care provider and mother of a toddler uneducated about her risk for cytomegalovirus (CMV). "Elizabeth's Law" requires the education of pregnant women and child care providers about CMV prevention.
TITLE: AN ACT to amend the social services law, in relation to requiring child care providers to be trained on the impacts and dangers of congenital cytomegalovirus infection and the treatments and methods of prevention of cytomegalovirus infection; and to amend the public health law, in relation to requiring certain physicians to distribute informational materials concerning cytomegalovirus.
PROBLEM: Congenital Cytomegalovirus (cCMV) is acquired in utero and can result in serious birth defects in the baby. cCMV is the most common congenital (present from birth) infection in the U.S. About 1 in every 200 babies is born with a cCMV infection. Of these babies, around 1 in 5 will have long-term health problemsi such as hearing and vision loss, microcephaly (small head), developmental and motor delays, and seizures (CDC).ii
In New York, every year an estimated 222 babies are born permanently disabled by cCMV iii
“CMV can be spread by contact with an infected child’s urine or other body fluids. Pregnant women who work with young children, such as day care workers or health care workers, should take steps to prevent infection...(American College of Obstetricians and Gynecologists (ACOG)).
“Pregnant women with young children at home also are at risk and should take these steps”(ACOG)).iv
“Nearly half of women have been infected with CMV before their first pregnancy. Of women who have never had a CMV infection, it is estimated that 1 to 4% of them will be infected during pregnancy.”v
OSHA recognizes CMV as a “hazard” for childcare workersvi and the American Academy of Pediatrics (AAP) states, “With regard to child-to-staff transmission, studies have shown increased rates of infection with CMV in caregivers/teachers ranging from 8% to 20%.”vii
Women who have young children in group child care are at an increased risk for CMV.viii
Racial and ethnic minorities are at higher risk for CMV.ix
“The risk of CMV infection in hospital workers is not greater than it is in others in the community and is probably low because of careful hand washing practices. In daycare centers, where hand washing practices may not be as good, there may be a greater risk of infection.”x
cCMV is largely preventable, but 91% of women do not know about the disease or prevention.xi
SOLUTION: “You may be able to lessen your risk of getting CMV by reducing contact with saliva and urine from babies and young children. 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.”xii
SUPPORT A7560 / S6287A, “Elizabeth’s Law”
Dr. Howard A. Zuckers, New York State Commissioner of Health, stated, "it is imperative that we give women of reproductive age the information they need to make informed decisions for themselves and their families.”xiii
Supporters of cCMV prevention: CDC, OSHA, AAP, ACOG and NY Commissioner of Health. The NY Senate/Assembly proclaimed June 2021 Cytomegalovirus Awareness Month. Utah and Idaho have cCMV legislation accompanied by ongoing funding. The NY Senate passed “Elizabeth’s Law” in 2021.
To learn more, contact me, Lisa Saunders of NY Stop CMV, at LisaSaunders42@gmail.com.
REFERENCES
i https://www.cdc.gov/cmv/awareness-month.html
ii https://www.cdc.gov/cmv/congenital-infection.html
iii In 2019, 221,539 babies were born in NY, with an estimated 1,108 born with cCMV. Using CDC’s averages, 222 of those babies were born permanently disabled from cCMV.
iv https://www.acog.org/womens-health/faqs/reducing-risks-of-birth-defects
v https://www.cdc.gov/cmv/clinical/overview.html
vi https://www.osha.gov/cytomegalovirus/hazards
vii https://nrckids.org/CFOC/Database/7.7.1.1
viii https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3046747/
ix https://pubmed.ncbi.nlm.nih.gov/29784513/
x https://www.health.ny.gov/diseases/communicable/cytomegalovirus/fact_sheet.htm
xi https://digitalcommons.usu.edu/jehdi/vol1/iss2/6/
xii https://www.cdc.gov/cmv/fact-sheets/parents-pregnant-women.html
xiii https://health.ny.gov/commissioner/letters/docs/2018-08.pdf
If you are an individual living in New York who would like your legislator to vote in favor if the bill, you may revise this statement:
Thank you in advance for your help.
Never heard of CMV? You are not alone. Here are six possible reasons why:
1) CMV prevention education is not "part of standard prenatal care” (Washington Post, "How a common, often harmless virus called cytomegalovirus can damage a fetus," May 15, 2021.)
2) Doctors don’t want to frighten, worry or “burden” patients. New York
3)"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).
4) Medical training downplays the dangers. Pediatrician Megan Pesch, M.D., of the University of Michigan’s C.S. Mott Children’s Hospital, whose third daughter was born with congenital CMV and a progressive hearing loss, said, "I went back and looked at my notes at what I’d learned in residency and medical school, and what we learned was so rudimentary and basic...I waver between feeling guilty and feeling furious. I have spent — how many years of my life in developmental pediatrics? — how could I not have known?”(Washington Post, "How a common, often harmless virus called cytomegalovirus can damage a fetus," May 15, 2021.)
5) Low media coverage. In the HealthNewsReview.org article, "Why does CMV get so much less news coverage than Zika — despite causing far more birth defects?" the author states, “Researchers we spoke with identified the same factors – fear and the epidemic/endemic nature of the diseases – as driving the media disparity” (Shipman, 2018).
6) Although U.S. workers have the right to “receive information and training about hazards” (Occupational Safety and Health Act of 1970), there are no federal laws governing CMV education policies for child care workers. The Department of Labor states, "Education and training requirements vary by setting, state, and employer." The Occupational Safety and Health Administration (OSHA) lists CMV as a "Recognized Hazard," yet recent surveys show that most child care providers do not know about CMV and many acknowledge using diaper wipes to clean hands instead of following proper protocols (Thackeray and Magnusson, 2016). Diaper wipes do not effectively remove CMV from hands (Stowell et al., 2014).
Relevant Media Coverage
- Eagle Newsroom, "Baldwinsville couple advocates for 'Elizabeth's Law' to stop cytomegalovirus:Bill named in memory of their daughter," Dec. 14, 2021.
- Spectrum News: "Couple pushes for law in memory of their daughter" by Jessica Houghtaling (Jul. 01, 2021). Includes interview with Dr. Sunil Sood.)
- Finger Lakes Times, "Trail of Hope celebration in Lyons marks CMV Month in New York", Steve Buchiere (Jun 11, 2021).
- Music video: "Had I Known [about CMV], Lyrics and Music by Debra Lynn Alt," produced by Mark De Cracker (June 2021).
- Finger Lakes Times: "MAKING A DIFFERENCE: Couple brings awareness to threat to infant health: CMV", Steve Buchiere (June 4, 2021).
- The Citizen: "NY Senate passes bill, named for CNY couple's daughter, to boost CMV awareness", Robert Harding (June 2, 2121).
- Syracuse Woman magazine, "Fighting CMV One Step at a Time (p.28)", Emma Vallelunga (May 2021) (p.29 image of Stop CMV hand, rock and shirt)
- The Citizen: "'Elizabeth's law,' named for CNY couple's daughter, would boost CMV awareness", Robert Harding (May 4,2021)
- The Citizen, "Challenge for Change: Walking across NY to raise awareness of CMV", David Wilcox (Mar 31, 2021)
- PAC-B TV: "Did You Know? - CytoMegaloVirus (CMV) - What Moms Wished They Knew" (Lisa Saunders interviews moms Angela and Brandi, May 7, 2021).
- New York Times, "CMV Is a Greater Threat to Infants Than Zika, but Far Less Often Discussed" By Catherine Saint Louis (Oct. 24, 2016).
- NYMetroParents, "Could CMV Be the Cause of My Baby's Failed Hearing Test?"(Sunil K. Sood, M.D., Chair of Pediatrics, South Shore University Hospital, Attending Physician, Infectious Diseases, Cohen Children's Medical Center and Professor, Zucker School of Medicine at Hofstra/Northwell, March 21, 2016).
- Times Herald Record: What every pregnant woman needs to know, Deborah J. Botti (2009)
- CMV LAW PASSED IN CT
- Cornell Alumni Magazine: "In Memory of Elizabeth: Her daughter's death from a preventable disability spurs Lisa Avazian Saunders '82 into action," Alexandra Bond (Sept/Oct 2015).
Ten Reasons Why Caregivers/Teachers Must be Educated About CMV
1) According to OSHA, CMV is a "Recognized Hazard". OSHA states that all workers have the right to “receive information and training on job hazards, including all hazardous substances in your workplace.” OSHA and CMV: "Childcare jobs may involve contact with children infected with CMV or their saliva, nasal secretions, or excrement. CMV is spread through exposure to infected body fluids. Since a person with CMV may show no symptoms, childcare workers should utilize proper handwashing and sanitization procedures. Childcare workers should also use personal protective equipment (PPE), such as gloves, to help prevent exposure to body fluids” (www.osha.gov/SLTC/cmv/hazards.html).
2) CMV is a viral infection that is common in children. Up to 70% of children ages 1-3 years in group care settings excrete CMV. The New York Health Department website states, "In daycare centers, where hand washing practices may not be as good, there may be a greater risk of infection...Pregnant women working in child care facilities should minimize direct exposure to saliva and avoid kissing babies or young children on the mouth. Hugging is fine and is not a risk factor...." Information is provided in English and Spanish at: https://www.health.ny.gov/diseases/communicable/cytomegalovirus/fact_sheet.htm
3) HOWARD A. ZUCKER, M.D., J.D ,Commissioner of Health for New York, stated: "According to the Centers for Disease Control and Prevention (CDC), female workers of reproductive age in child care centers should be educated on CMV and its potential risks, and should have access to appropriate hygiene measures to minimize occupationally-acquired infection " (August 2018).
4) American Academy of Pediatrics states: “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” (Staff Education and Policies on Cytomegalovirus (CMV), "Caring for Our Children: National Health and Safety Performance Standards; Guidelines for Early Care and Education Programs", American Academy of Pediatrics et al.).
5) Approximately 1 in 200 children are born in the U.S. with congenital CMV. The impact on the fetus may include deafness, blindness, cerebral palsy, developmental disabilities, seizures and even death (www.cdc.gov/cmv). Congenital cytomegalovirus is a more common cause of disabilities than Zika, Down syndrome and fetal alcohol syndrome. CMV is the leading viral cause of birth defects ("Cytomegalovirus Infection in Pregnancy: Should All Women Be Screened?", Carlson et al., 2010).
6) Free CMV educational tools available: CDC has flyers in English and Spanish.Cornell University and the University of Connecticut provide training videos. (A great Link to CMV resources: https://cmvmass.org/workplace-prevention-for-employers/)
7) Recent surveys show that most child care providers do not know about CMV and many acknowledge using diaper wipes to clean hands instead of following proper protocols (Thackeray and Magnusson, 2016). Diaper wipes do not effectively remove CMV from hands (Stowell et al., 2014). In the U.S., “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).
8) Child care providers serving children receiving assistance through the Child Care and Development Fund program must receive training on topics covered by the Child Care and Development Block Grant Act of 2014. “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)” (Caring for Our Children Basics).
9) Child care providers accredited by National Association for the Education of Young Children should already be familiar with the document, “NAEYC Early Childhood Program Standards and Accreditation Criteria & Guidance for Assessment,” which acknowledges the need to "reduce occupational hazards such as infectious diseases (e.g., exposure of pregnant staff to CMV…)”
10) Potential Cost of Not Warning Workers 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, 2017). 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…"
###
Education, Elizabeth’s Law Assembly Bill A7560
- Requires child care providers to be trained on the impacts and dangers of congenital cytomegalovirus infection and the treatments and methods of prevention of cytomegalovirus infection
- Requires certain physicians to distribute informational materials concerning cytomegalovirus
Why We Need a CMV Education Law
- NY State Assembly proclaimed June CMV Awareness Month, stating, "CMV is also transmitted by contact with saliva and urine, often from diaper-wearing children to adults...It is difficult for mothers to protect themselves...especially if they are unaware of the virus itself..less than half of obstetrician-gynecologists tell pregnant patients how to avoid CMV...It is imperative that women are educated about the virus itself and simple preventative measures, such as not sharing food with toddlers, and washing one's hands after changing infants and toddlers diapers…”
- Education helps prevent CMV: Pregnant mothers “offered hygiene tips were much less likely to get CMV (5.9 percent) than those not given information on prevention (41.7 percent)” (New York Times).
- United States Congress: "Recommends that more effort be taken to counsel women of childbearing age of the effect this virus can have on their children"
- American Academy of Pediatrics: “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” (Staff Education and Policies on Cytomegalovirus (CMV).
- Child Care Providers Unaware of CMV: Surveys show that most caregivers do not know about CMV and many acknowledge using diaper wipes to clean hands instead of following proper protocols (Thackeray and Magnusson, 2016). Diaper wipes do not effectively remove CMV from hands.
- OSHA: CMV is a "Recognized Hazard" for child care providers. Workers have the right to “receive information and training on job hazards...”
- New York Child Care Training: NY’s law for the training of childcare providers does not require education on CMV (or any particular illnesses). Yet because CMV can be so devastating to a pregnancy, NY Health Commissioner Dr. Zucker stated "female workers of reproductive age in child care centers should be educated on CMV and its potential risks..." ( 2018). Training already includes infection control, so CMV can be included there. CMV infections are often “silent,” meaning the person infected has no signs or symptoms. The AAP states, "Because this virus is so common in child care settings, exclusion of a CMV-infected child to reduce disease transmission has no benefit.”
Additional notes for those in child care industry:
Child care providers would not need to identify or “recognize CMV”--especially since "Most infections with CMV are 'silent,' meaning the person infected has no signs or symptoms" (National Congenital CMV Disease Registry). Also, the American Academy of Pediatrics states that it is inappropriate to remove a child with known congenital CMV from the child care group--especially since so many are excreting it - "Because this virus is so common in child care settings, exclusion of a CMV-infected child to reduce disease transmission has no benefit: https://www.
Assembly Bill A7560 is meant to inspire child care workers to diligently follow the infection control measures they are already given.
The current New York law for child care provider training does not require specific education on any other particular illnesses. It is important to note, however, that CMV is different--it is much more dangerous to the child care provider's pregnancy than the common cold.
Perhaps some of the following points will help explain why states like Utah and Idaho follow recommendations from the CDC and American Academy of Pediatrics to educate caregivers/teachers about CMV:
Why is CMV more dangerous than other common illnesses transmitted by children?
1. The current New York law for the education of childcare providers does not require specific education on any particular illnesses, despite Dr. Zucker’s statement that "According to the Centers for Disease Control and Prevention (CDC), female workers of reproductive age in child care centers should be educated on CMV and its potential risks, and should have access to appropriate hygiene measures to minimize occupationally-acquired infection..." (Newsletter, August 2018).
2. According to OSHA, CMV is a "Recognized Hazard". OSHA states that all workers have the right to “receive information and training on job hazards, including all hazardous substances in your workplace.” OSHA and CMV: "Childcare jobs may involve contact with children infected with CMV or their saliva, nasal secretions, or excrement. CMV is spread through exposure to infected body fluids. Since a person with CMV may show no symptoms, childcare workers should utilize proper handwashing and sanitization procedures. Childcare workers should also use personal protective equipment (PPE), such as gloves, to help prevent exposure to body fluids” (www.osha.gov/SLTC/cmv/
3. American Academy of Pediatrics: “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” (Staff Education and Policies on Cytomegalovirus (CMV), "Caring for Our Children: National Health and Safety Performance Standards; Guidelines for Early Care and Education Programs", American Academy of Pediatrics et al.).
4. Recent surveys show that most child care providers do not know about CMV and many acknowledge using diaper wipes to clean hands instead of following proper protocols (Thackeray and Magnusson, 2016). Diaper wipes do not effectively remove CMV from hands (Stowell et al., 2014). In the U.S., “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).
5. Child care providers serving children receiving assistance through the Child Care and Development Fund program must receive training on topics covered by the Child Care and Development Block Grant Act of 2014. “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)” (Caring for Our Children Basics).
6. Child care providers accredited by National Association for the Education of Young Children should already be familiar with the document, “NAEYC Early Childhood Program Standards and Accreditation Criteria & Guidance for Assessment,” which acknowledges the need to "reduce occupational hazards such as infectious diseases (e.g., exposure of pregnant staff to CMV…)”
7. About 8 - 20% of child care providers contract CMV every year (Red Book, AAP, 2015) as compared to 1-4% of women (who have never had CMV) in the general population (CDC, 2018).
8. Several resources have been created for child care providers:
o CDC flyers in English and Spanish:https://www.cdc.gov/
o CMV Training Module (University of Connecticut):https://youtu.be/
o For Employers: Publication: Brown, N. J. (2019, November). "Occupational exposure to cytomegalovirus (CMV): Preventing exposure in child care and educational settings, including OSHA advisories." Ithaca, NY: Cornell University, ILR School. Download video workshop. This publication/presentation is by Nellie Brown, MS, CIH, Certified Industrial Hygienist, and Director, Workplace Health and Safety Program, Worker Institute, Cornell University – ILR School.
o See Utah's flier for child care providers: https://health.
o The book, Model Child Care Health Policies, 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).
MOTHERS IN NEW YORK
Edel Law of Tappan said, "Assembly Bill A7560 or Elizabeth's Law" is important to me because my three-year-old daughter has congenital CMV. It came as a total shock when at 31 weeks pregnant, I found out she had abnormal brain development. Upon further testing, we found out I had contracted and passed CMV onto my daughter. After learning about CMV, it was not shocking that I contracted the virus since I had a toddler in preschool and was an early childhood educator. My daughter has developmental delays, single sided deafness, wears a cochlear implant, and has a form of heart failure."
Kristin Schuster of Canandaigua said her first child, Autumn, was born with congenital CMV in 2015. Like Lisa Saunders, Kristin never heard of CMV or that she was at increased risk for the disease because of her occupation. She said, "I was teaching in a pre-kindergarten inclusion classroom while pregnant with Autumn and was unaware of the dangers of CMV exposure."
Jessica Keukelaar of Macedon, a child care provider while pregnant with Kyleigh, born with congenital CMV, was also unaware of her occupational risk for CMV.
Mother Kelly Smolar Gerne, a mechanical engineer from Brooklyn, NY, wants to expand the CMV testing requirements in New York so more babies can receive early intervention during the critical first three weeks of life. She said, "My daughter Alexis was born in August 2020 with congenital CMV. With the help of Northwell, Dr. Sood and Nurse Stellato, Alexis is thriving because she was diagnosed and treated early following a failed newborn hearing test. Thankfully, the sole impact of congenital CMV is the loss of hearing in Alexis's left ear. While I am angry about the lack of CMV education prior and during my pregnancy, the CMV testing law passed in 2018 meant our family was the recipient of those who had fought before us to get Alexis tested and treated early. I want to continue that forward so all babies in the State of New York will have the option for early intervention.
