Raise awareness to protect pregnant staff from CMV

Women who have regular contact with young children, especially early educators and parents of children in child care, are at a greater risk of contracting a virus known as Cytomegalovirus (CMV).

For a small number of expectant mums, this virus can pose a serious risk to their baby and yet, according to support groups, the virus remains largely unknown in the general community.

CMV is harmless to most children and adults with healthy immune systems, but if a pregnant woman is infected with CMV, there is a risk that her unborn baby will also become infected (this is also referred to as congenital CMV).

In Australia, 2000 babies are born with congenital CMV every year. Of those, 400 will develop physical or intellectual disabilities.

CMV can cause damage to the baby’s developing brain, leading to epilepsy, hearing loss, intellectual impairment, cerebral palsy and, in rare cases, death. Despite the risks, Australian research has found that awareness of CMV infection in pregnancy is low among pregnant women – just one in six pregnant women have heard of CMV, and only ten per cent of maternal health professionals regularly talk to pregnant women about the virus.

"CMV can cause serious problems for the unborn fetus. The most susceptible to CMV infection are women who have not had it previously – which is about half of all pregnant women," says Professor Michael Permezel, president of The Royal Australian and New Zealand College of Obstetricians and Gynaecologists in a Stuff article.

Early childhood service operators have a duty of care to all workers regarding infectious diseases and workplace risks and must ensure strong health and hygiene policies and practices are in place.

The occupational risks of CMV infection in child care services should be managed using a risk management approach. Centre managers should routinely inform all workers of the increased risks of exposure to CMV especially those who are pregnant or considering pregnancy.

The impacts of CMV are sobering:

• Every year, more than 400 Australian children are born with lifelong disabilities caused by CMV – according to a 2020 study the burden of CMV disease in New Zealand is unknown
• CMV is the most common viral and infectious cause of disabilities in newborn babies
• One to two babies are severely affected by CMV every day in Australia
• CMV is more common than down syndrome, spina bifida and toxoplasmosis – with 1 in 150 babies born with congenital CMV
• Research has shown that taking steps to reduce risk of exposure will halve the risk of contracting CMV during pregnancy.

What is CMV?

CMV, a member of the herpes family, is an often-harmless viral infection that can cause mild flu symptoms, if any, in healthy people. Fifty per cent of people have been infected by the time they reach young adulthood and up to 88 per cent by the age of 40-years. Peaks of infection occur in children aged under two-years-old, and during adolescence.

Once a person becomes infected, the virus remains alive but usually inactive in a person’s body for life. It is rare for a person to get symptoms after the initial infection unless their immune system is weakened by severe illness and treatments such as for cancer.

But, in pregnancy, CMV can be passed onto a woman’s unborn baby through the placenta and there’s a small risk this can cause developmental delays, miscarriage, stillbirth, hearing loss and mental disability.

How is it spread?

CMV is spread occupationally from person-to-person by contact with body substances, including urine and saliva. An infected person can pass the virus to another person even though they do not have symptoms. CMV can also be transmitted from a mother to her baby during pregnancy – this is called congenital infection.

For early educators the primary transmission points are the handling of children’s toys that have saliva or mucous on them, or handling contaminated items like dirty tissues or soiled nappies then touching the eyes, nose or mouth without first washing hands.

Risk management in early childhood services

As there is an increased risk for infection amongst early childhood staff, operators and managers must ensure a robust system is in place to inform and protect workers in their care.

It is very important for women to know about CMV before they are pregnant. By the time a woman is pregnant they are already at risk. Considering that many women are unaware of the infection and risks, there’s an opportunity for early childhood services to raise awareness within their child care community especially with pregnant mothers.

CMV control measures could include:

• Pregnant workers or those who are planning a pregnancy, should be given the opportunity to relocate and care for children aged over two-years-old to reduce contact with urine and saliva. For example, if an educator who usually works in the infant's room becomes pregnant, she could be relocated to a preschool room, where she is less likely to be exposed to CMV through nappy changing and feeding
• For a pregnant worker the centre director should advise her to see her GP to consider the risks of working in child care and to take advice from her GP about undergoing blood tests to check for susceptibility to issues like primary CMV infection
• Installing hand washing facilities close to nappy changing areas
• Washing hands frequently, especially after contact with urine and saliva and after removing disposable gloves
• Using disposable hand wipes or alcohol-based hand rub for situations where hand washing facilities are not readily available
• Covering cuts with water-resistant dressings
• Using disposable gloves for activities that involve contact with urine and saliva
• Providing information to workers about CMV risks and work practices to reduce the risk of infection
• Purchasing equipment and toys that are easily cleaned
• Instructing workers not to kiss children on the mouth and face
• Implementing cleaning programs for surfaces and items that are soiled with urine and saliva, including nappy change mats, potties, feeding utensils and toys
• Implementing procedures for hygienic nappy changing and the storage and disposal of soiled nappies
• Taking steps to prevent urine from spraying into the face of workers if infants pass urine during nappy changing (especially infant boys)
• Implementing laundry procedures for linen that is soiled with urine and saliva, e.g. make sure that soiled personal clothing and linen are placed in a sealed bag and sent home with the child for washing
• Implementing procedures for cleaning up accidental spills of urine that could occur during toilet training.

Currently there is no vaccine to prevent against infection with CMV. But Moderna, the biotech company famous for developing an effective mRNA vaccine for COVID-19, has recently announced the beginning of phase three trials as part of research into a vaccine for CMV.

References and further reading

The Royal Australian and New Zealand College of Obstetricians and Gynaecologists: Prevention of congenital CMV infection

CMV Australia

Sydney Morning Herald: “We were preparing for the worst” – CMV vaccine hope for pregnant women