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Cytomegalovirus is the most common viral infection that babies are born with, affecting 0.5% to 1.0% of all births. Most infected newborns do not have any illness or disability. However, 10% to 20% of infected newborns have sensorineural hearing loss, developmental disabilities, cerebral palsy, or vision disturbances.
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The risk of CMV exposure is greatest in settings that care for children who are younger than 3 years. It must be assumed that exposure to the virus among children and caregivers will occur. Hand hygiene substantially reduces but does not eliminate the spread of infection because young children have frequent runny noses, drool on and mouth objects, touch many surfaces, and need diapering or toileting assistance.
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Because this virus is so common in child care settings, exclusion of a CMV-infected child to reduce disease transmission has no benefit. Testing young children for excretion of the virus or performing CMV antibody tests for young children because they are in a group care setting is not appropriate because infection with the virus is so prevalent.
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Cytomegalovirus exposure risk during pregnancy: Although most adults have their first CMV infection during childhood and are immune to the strains of CMV that have infected them, a pregnant woman who works with infants and toddlers or who is a mother with a child in child care is at increased risk of having a CMV infection during her pregnancy and infecting her fetus. This could be her first CMV infection or an infection with a different strain of CMV than she previously experienced.
To alert health professionals responsible for the health assessment of staff members of childbearing age about the need of their patient to be counseled about CMV risk, early education/child care center directors/ administrators should be sure CMV risk assessment and counseling are items on the staff health assessment form. In addition, it may be helpful for directors/ administrators to attach this Quick Reference Sheet and the Fifth Disease (Human Parvovirus B19) Quick Reference Sheet to the note in the box below to help health professionals review with their patient the increased risk of exposure to the unborn child if the woman is infected during her pregnancy. Health professionals are not necessarily aware of the increased exposure to these viruses for women who work with young children in child care settings.
Dear Health Professional:
Your patient works in a setting where she has contact with young children in groups. Human parvovirus B19 and cytomegalovirus (CMV) occur commonly and are often asymptomatic among young children. Exposure of a woman who lacks immunity to human parvovirus B19 and/or CMV during pregnancy poses some risk to her fetus. Please discuss with your patient her childbearing intentions and whether she might want to consider the following risk-reduction measures when she might become pregnant:
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Conscientious handwashing after any contact with saliva, urine, or blood
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Care of children who are older than 3 years
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Working in a role other than direct care of young children
About Serologic Testing
Because different strains of CMV circulate among young children, especially those in group care, a serologic test for CMV informs about risk but does not completely guarantee immunity from exposure to novel strains. However, a serologic test for human parvovirus B19 is a reliable indicator of immunity.