What is cytomegalovirus infection?
Cytomegalovirus (CMV) is a very common viral infection that can infect people of all ages, most commonly in early childhood. After an initial infection, CMV can remain dormant in the body and may reactivate later.
What are the signs or symptoms?
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Generally, no symptoms occur in young children.
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Older children and adults may have a generalized illness with fever. Sometimes the liver or spleen may become temporarily enlarged.
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CMV 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 or intellectual disabilities, cerebral palsy, or vision disturbances.
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Immunocompromised individuals can develop serious symptoms from CMV.
What are the incubation and contagious periods?
Typically, several weeks to months. Once a person is infected, the virus is shed intermittently in the saliva and urine for the rest of that person's life. Between 30% and 40% (as high as 70%) of children ages 1 to 3 years in early childhood education (ECE) settings excrete CMV in their saliva and urine. Nearly everyone is infected with CMV during their lifetime.
How is it spread?
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Person-to-person contact with blood, saliva, urine, human (breast) milk, and other secretions from infected people
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From a pregnant individual to a baby before, during, and after birth
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Blood transfusions or organ transplants from an infected person
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During kissing and sexual activities
How do you control it?
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Use good hand-hygiene technique at all the times listed in Chapter 2 of
Managing Infectious Diseases in Child Care and Schools: A Quick Reference Guide, 7th Edition . This is especially important for individuals of childbearing age who work with young children or have young children enrolled in ECE settings. Avoid exchange of saliva directly or via objects (eg, moistening a pacifier with the mouth), and wash hands and objects thoroughly after contact with urine or saliva. -
The risk of CMV exposure is greatest in settings in which children who are younger than 3 years are cared for. Exposure to the virus among children, educators, and caregivers is inevitable. Although hand hygiene substantially reduces the spread of infection, it cannot eliminate it entirely, as young children have frequent runny noses, drool on and mouth objects, touch many surfaces, and need diapering or toileting assistance.
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Do not kiss children on the lips or allow them to put their fingers or hands in another person's mouth.
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Do not share cups or eating utensils.
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CMV is commonly shed by individuals of all ages, even in the absence of symptoms. Therefore, children with congenital CMV should not be treated differently from other children.
What are the roles of the educator and the family?
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Review Standard Precautions (see Chapter 2 of
Managing Infectious Diseases in Child Care and Schools: A Quick Reference Guide, 7th Edition ), particularly hand hygiene, especially for individuals of childbearing age who work with or have their own children younger than 3 years who participate in educational settings. -
Ensure staff members follow the control measures listed in the section How do you control it?
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Cytomegalovirus exposure risk during pregnancy: Although most adults have their first CMV infection during childhood and develop immunity, a pregnant individual who is exposed to CMV for the first time or to a strain to which they are not immune can pose risks to the fetus. Risk-reduction measures include conscientious handwashing (see the steps listed in the section How do you control it?). Pregnant staff members may consider working with older children or in administrative roles.
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Programs should inform individuals of childbearing age who work with children or have children younger than 3 years in ECE settings about the potential risks to their fetus if they become pregnant, advise them to consult their health professional, and have them sign a document acknowledging their understanding of the risks (see Letter to Staff About Occupational Health Risks and Child Care Staff Health Assessment Form in Chapter 8 of
Managing Infectious Diseases in Child Care and Schools: A Quick Reference Guide, 7th Edition ).
Exclude from educational setting?
No, unless
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The child is unable to participate and staff members determine they cannot care for the child without compromising their ability to care for the health and safety of the other children in the group.
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The child meets other exclusion criteria (see Conditions Requiring Temporary Exclusion in Chapter 4 of
Managing Infectious Diseases in Child Care and Schools: A Quick Reference Guide, 7th Edition ).
Readmit to educational setting?
Yes, when all the following criteria are met:
When exclusion criteria are resolved, the child is able to participate, and staff members determine they can care for the child without compromising their ability to care for the health and safety of the other children in the group
Comments
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In ECE settings, exclusion of a CMV-infected child does not reduce disease transmission. Testing for CMV excretion or CMV antibody tests in young children are unnecessary and inappropriate due to the widespread prevalence of the virus.
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To ensure that health professionals assessing staff members of childbearing age are aware of the need to counsel their patients about CMV risk, ECE program directors/administrators should include CMV risk assessment and counseling in the staff health assessment form. It may also 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 following box to help health professionals in reviewing the increased risk of exposure to the fetus if the individual becomes infected during pregnancy. Health professionals may not be aware of the higher risk of exposure to these viruses for individuals of childbearing age who work with young children in ECE programs.
Dear Health Professional:
Your patient works in a setting where they have contact with young children in groups. Cytomegalovirus (CMV) and human parvovirus B19 infections occur commonly and are often asymptomatic among young children. Exposure to these viruses in individuals of childbearing age who lack immunity to CMV and/or human parvovirus B19 during pregnancy poses some risk to a pregnancy. Please discuss with your patient their reproductive intentions and whether they might want to consider the following risk-reduction measures when they 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 early childhood education programs, 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.
Disclaimer
Adapted from
The American Academy of Pediatrics (AAP) is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists, and pediatric surgical specialists dedicated to the health, safety, and well-being of all infants, children, adolescents, and young adults.
Any websites, brand names, products, or manufacturers are mentioned for informational and identification purposes only and do not imply an endorsement by the American Academy of Pediatrics (AAP). The AAP is not responsible for the content of external resources. Information was current at the time of publication. The information contained in this publication should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.