Care of Children Infected with Cytomegalovirus

The risk for transmission of congenital cytomegalovirus (cCMV), a common in-utero infection and a leading cause of childhood hearing loss, in healthcare settings, daycare and schools including for pregnant workers is low. In fact, healthcare workers, regardless of the type of patient contact, do not have an increased risk of developing CMV infection when compared with the general population.12-16 The annual seroconversion rate for primary infection among healthcare providers was 2.3% compared with 2.1% among pregnant women in the community.12,17 Adults are at a much higher risk of acquiring CMV from children living in the same household than from an occupational exposure.18

Members of the Joint OHA/OMA Communicable disease Surveillance Protocols Committee published a cytomegalovirus surveillance protocol for all Ontario Hospitals in 2017.18 They concluded that CMV is not an occupational health and safety risk even for pregnant women if routine practices are followed. Routine practices include careful hand hygiene after all patient and patient environment contact, and the wearing of gloves if healthcare workers expect to contact body secretions or mucous membranes. They also recommend avoidance of kissing or cuddling infants and young children and not sharing utensils which risk bringing secretions from mucous membranes of the ears, eye, nose and mouth into close proximity of the worker. The National Institute for Occupational Safety and Health of the Centers for Disease Control and Prevention (CDC) website published similar recommendations for Healthcare workers, and childcare workers and teachers, regarding CMV and other infectious agents.19 The CDC’s 2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings includes hand hygiene and personal protective equipment (gloves). Since not all children undergo CMV testing and most with CMV show no signs of this infection, workers and staff must follow these precautions for all children. These precautions should also apply to daycare workers or staff who work in schools and who are in contact with young children.

Adopted 01/11/2019

References:

1. Demmler GJ. Summary of a workshop on surveillance for congenital cytomegalovirus disease. Rev Infect Dis. 1991;13:315-329.
2. Kenneson A, Cannon MJ. Review and meta-analysis of the epidemiology of congenital cytomegalovirus (CMV) infection. Rev Med Virol. Jul-Aug 2007;17(4):253-276.
3. Park AH, Duval M, McVicar S, Bale JF, Jr., Hohler N, Carey JC. A Diagnostic Paradigm Including Cytomegalovirus Testing for Idiopathic Pediatric Sensorineural Hearing Loss. The Laryngoscope (in press). 2014.
4. Hicks T, Fowler K, Richardson M, Dahle A, Adams L, Pass R. Congenital cytomegalovirus infection and neonatal auditory screening. J Pediatr. Nov 1993;123(5):779-782.
5. Ross DS, Dollard SC, Victor M, Sumartojo E, Cannon MJ. The epidemiology and prevention of congenital cytomegalovirus infection and disease: activities of the Centers for Disease Control and Prevention Workgroup. J Womens Health (Larchmt). Apr 2006;15(3):224-229.
6. Stratton KR, Durch JS, Lawrence RS e. Vaccines for the 21st century: a tool for decision making. Washington, DC: National Academy Press; 2001.
7. Gantt S., Dionne F., Kozak F., et al. Cost-Effectiveness of Universal and Targeted Screening for Congenital Cytomegalovirus Infection. Journal of Pediatrics. in press.
8. Bergevin A, Zick CD, McVicar SB, Park AH. Cost-benefit analysis of targeted hearing directed early testing for congenital cytomegalovirus infection. International journal of pediatric otorhinolaryngology. Sep 25 2015.
9. Adamczyk L, Adkins JK, Agakishiev G, et al. LambdaLambda Correlation function in Au+Au collisions at radical[S(NN)]=200 GeV. Physical review letters. Jan 16 2015;114(2):022301.
10. Park AH, Shoup AG. Should infants who fail their newborn hearing screen undergo cytomegalovirus testing? Laryngoscope. Feb 2018;128(2):295-296.
11. Cannon MJ, Hyde TB, Schmid DS. Review of cytomegalovirus shedding in bodily fluids and relevance to congenital cytomegalovirus infection. Rev Med Virol. Jul 2011;21(4):240-255.
12. Hyde TB, Schmid DS, Cannon MJ. Cytomegalovirus seroconversion rates and risk factors: implications for congenital CMV. Rev Med Virol. Sep 2010;20(5):311-326.
13. Dworsky ME, Welch K, Cassady G, Stagno S. Occupational risk for primary cytomegalovirus infection among pediatric health-care workers. N Engl J Med. Oct 20 1983;309(16):950-953.
14. Balfour CL, Balfour HH, Jr. Cytomegalovirus is not an occupational risk for nurses in renal transplant and neonatal units. Results of a prospective surveillance study. JAMA. Oct 10 1986;256(14):1909-1914.
15. Brady MT. Cytomegalovirus infections: occupational risk for health professionals. Am J Infect Control. Oct 1986;14(5):197-203.
16. Balcarek KB, Bagley R, Cloud GA, Pass RF. Cytomegalovirus infection among employees of a children’s hospital. No evidence for increased risk associated with patient care. JAMA. Feb 9 1990;263(6):840-844.
17. Lamarre V, Gilbert NL, Rousseau C, Gyorkos TW, Fraser WD. Seroconversion for cytomegalovirus infection in a cohort of pregnant women in Quebec, 2010-2013. Epidemiol Infect. Jun 2016;144(8):1701-1709.
18. Association OHAatOM. Cytomeaglovirus: Surveillance Protocol for Ontario Hospitals. OHA/OMA Communicable Diseases Surveillance Protocols. May 2017 2017.
19. Infectious Agents. Reproductive Health and the Workplace 2016; https://www.cdc.gov/niosh/topics/repro/infectious.html. Accessed November 3, 2018, 2018.

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Position statements are approved by the American Academy of Otolaryngology—Head and Neck Surgery or Foundation (AAO-HNS/F) Boards of Directors and are typically generated from AAO-HNS/F committees. Once approved by the Academy or Foundation Board of Directors, they become official position statements and are added to the existing position statement library. In no sense do they represent a standard of care. The applicability of position statements, as guidance for a procedure, must be determined by the responsible physician in light of all the circumstances presented by the individual patient. Adherence to these clinical position statements will not ensure successful treatment in every situation. As with all AAO-HNS/F guidance, this position statement should not be deemed inclusive of all proper treatment decisions or methods of care, nor exclusive of other treatment decisions or methods of care reasonably directed to obtaining the same results. Position statements are not intended to and should not be treated as legal, medical, or business advice.