Prevalence of cytomegalovirus carriage among childcare staff

Citations Over Time

Abstract

Primary cytomegalovirus (CMV) infection during pregnancy carries a high risk (~30%) of transplacental transmission to the developing fetus, which may result in congenital CMV and consequent disease in the newborn. An estimated 2000 Australian children are born with congenital CMV each year, with 25% developing life-long sequelae, including hearing loss and mental disability.1 Higher rates of CMV infection occur with increasing age (seroprevalence: 34.9% for 50 years of age), household crowding and attendance at childcare.2 Children shed high levels of CMV in saliva and urine and frequently acquire CMV from other children.1, 2 Exposure of childcare staff through changing nappies (diapers), feeding and contact with contaminated environmental surfaces potentially increases their risk of acquiring CMV. Data from France and other developed countries show higher rates of paediatric shedding in childcare (50% in childcare vs. 20% in controls in emergency department at age of 3 months to 6 years), measured using sensitive and specific assays such as salivary real-time polymerase chain reaction.2 However, no published study has determined prevalence of CMV in childcare staff in Australia, and shedding of this virus from saliva or other sites has not been examined systematically. We examined CMV excretion among childcare staff from two childcare centres in Sydney using our published methods for viral sampling of nasal and clothing surfaces3 under South Eastern Sydney Local Health District ethics approval no. 10332. We tested 114 clothing samples and 125 nasal samples collected from 20 childcare staff from two university childcare centres in Sydney over 5 weeks in 2011.3 DNA was extracted and real-time polymerase chain reaction (assay limit of detection 10 copies) was performed using CMV major immediate early gene primers. Of 125 nasal swabs tested, 6 (5%) were positive for CMV DNA, giving rise to an overall CMV excretion rate of 30% (6/20) among childcare staff. However, of 114 clothing swabs tested, none were positive for CMV DNA, which suggests clothing was unlikely to be a vector of fomite transmission at these childcare centres, contrasting our previous findings for respiratory virus detection on clothes of childcare staff.4 The CMV detection rate among nasal secretions of childcare staff suggests there is a need for education regarding effective hygiene measures to prevent CMV transmission and acquisition, particularly for pregnant staff. Measures shown to reduce CMV infection include not sharing food, utensils, cups or washcloths with a child; regular handwashing; and not kissing a child on or near the mouth.4 Until an effective therapy is available, educating childcare staff regarding these hygiene measures remains the best preventive strategy for congenital CMV infection and subsequently congenital CMV disease.

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