Dawn just visited her health care provider and learned she is pregnant. Because Dawn works in a childcare program and has an increased risk of exposure to cytomegalovirus (CMV), her physician recommends that she be tested for immunity to the virus. Exposure to CMV during pregnancy could potentially create a serious health risk for her baby.

Cytomegalovirus (CMV) is a very common virus that infects most people by the time they reach adulthood. CMV is a member of the herpesvirus family and spreads from person to person by direct contact.

The virus is found in body fluids, including urine, saliva, breast milk, blood, tears, semen, and vaginal fluids. Once CMV is present in the body, it stays there for life.

Usually, there is little to no illness associated with CMV and most people who have the virus do not know they are infected. When symptoms occur, they are generally mild and include fever, sore throat, swollen glands in the neck, rash, and fatigue.

Symptoms rarely occur in young children even if they are infected. Some people with CMV are contagious for a short period of time while others remain contagious for months or even years.

Infants and CMV

Most babies who are born with CMV (also called congenital CMV) do not display symptoms. However, approximately 10-20 percent of children develop permanent disabilities as a result of prenatal CMV infection.

The Centers for Disease Control and Prevention (CDC) estimates that approximately 8,000 children each year are born with or develop disabilities as a result of CMV infection before they were born. Some disabilities may appear at birth, while others may not be apparent until later in life.

Temporary symptoms include liver, spleen, and lung problems; jaundice; purple skin blotches; small size at birth; and seizures.

Permanent disabilities associated with CMV include hearing and vision loss; mental disability; lung, spleen and liver problems; bleeding problems (such as a low platelet count); small head size; lack of coordination; seizures; growth problems (including restricted prenatal growth), and death. Babies who are infected after birth are not at risk for CMV-related disabilities.

CMV in Childcare

CMV infection is very common in children who attend childcare, but usually is not harmful to them. In fact, younger children are less likely than older children to suffer symptoms. Caring for our Children: National Health & Safety Performance Standards does not recommend testing children for CMV or excluding them from childcare if they are known to be infected. Infection in early childhood is so common that the Standards advise to assume that all infants and toddlers are infected.

If you work in a childcare program, you have an increased risk of being exposed to CMV. Research indicates that rates of CMV infection among childcare providers range annually from 14-20 percent. You are at a particularly high risk of contracting CMV if you work with children who are 1-2½ years old.

Toddlers have higher secretion rates of the virus than other age groups, which puts adults who work with those children at higher risk of exposure and infection. Most childcare providers, with the exception of those who have compromised immune systems or are pregnant or may become pregnant, should not be overly concerned about CMV infection.

The virus rarely causes more than the discomfort of a fever, sore throat, and tiredness, which occasionally last one to two weeks. However, if you are a woman of childbearing age who works in childcare, you should be aware of the risks and potential consequences of CMV should you become pregnant and then acquire the virus.

The Caring for Our Children standards recommend that staff members be educated about the risks involved with CMV infection, steps to take to reduce the change of becoming infected, and tests that can determine an individual’s immune status. The standards further advise that female employees of childbearing age be referred to their personal health care provider for counseling and testing.

Pregnancy and CMV

Most adults do not know if they are immune to CMV. If you are a childcare provider and are or could become pregnant, it is important to talk to your health care provider about CMV.

While CMV is not a major health concern for most people, it can be dangerous for individuals with compromised immune systems and for women who become infected during pregnancy and risk passing CMV to their babies.

A CMV blood test for women who are considering pregnancy helps them determine their risk of infection. If you have the test and it is positive, that means that you have antibodies to CMV and there is little chance your baby is at risk. If your test is negative and you do not have immunity to CMV, there are several steps you can take to reduce your risk of infection during pregnancy.

If you are pregnant, your CMV antibody test was negative, or you do not know your immunity status, then it is best that you work with children who are three-five years of age or younger than a year. There is less viral circulation in these age groups than higher-risk toddlers.

Many childcare providers work alone in home-based programs or work in facilities where it is not possible to avoid contact with some age groups. If that is the case, there are other precautions that can be implemented which will limit the spread of CMV in the childcare setting.

Avoiding CMV

CMV, like many other illnesses, spreads from lack of hygiene. Frequent and thorough handwashing for children and staff is the most important tool you have to reduce transmission of infection. Take a few minutes to refresh yourself, your co-workers, and children about proper handwashing.

Consistently implementing standard and universal precautions in childcare is another way to fight CMV. Standard precautions include handwashing, using latex gloves, environmental sanitizing, and proper disposal of infected materials.

Avoiding the sharing of food, pacifiers, bottles, toothbrushes, eating utensils, and drinking cups will help reduce the spread of CMV. Discourage children from placing hands, fingers, toys and other contaminated objects in their mouths.

CMV is spread by contact with body fluids. Contact with children that does not involve exposure to those fluids should not be feared or avoided because of concerns about CMV.

Marna Holland, EdD
Parent Educator, Asheville City Schools Preschool, Asheville, NC

Internet Resources

About CMV, Centers for Disease Control, www.cdc.gov/cmv/facts.htm

Cytomegalovirus (CMV), Caring for Our Children: National Health and Safety Performance Standards, nrc.uchsc.edu/SPINOFF/PROV/HTML/Providers.html#1101857

Cytomegalovirus (CMV) in the Child Care Setting. Health and Safety Notes, California Childcare Health Program, www.ucsfchildcarehealth.org/pdfs/healthandsafety/cytoen081803_adr.pdf

Cytomegalovirus (CMV): People Who Work with Infants and Children, Centers for Disease
Control, www.cdc.gov/cmv/daycare.htm

Signs and Symptoms of CMV, Centers for Disease Control, www.cdc.gov/cmv/signs.htm

What Child Care Providers Should Know About Cytomegalovirus (CMV), California Childcare Health Program. www.ucsfchildcarehealth.org/pdfs/illnesses/CMVEN0509.pdf