CMV – A Bigger Threat Much Closer to Home Sharon Wood, Project Manager, CMV Action MMB Midwifery Exchange Wednesday, 1st February, 2017 1
CMV – A Bigger Threat Much Closer to Home In 2017 Zika Virus hit the headlines The risk in the UK is extremely low, but CMV, a world-wide virus, much closer to home, poses a much bigger threat to pregnant women
CMV – A Bigger Threat Much Closer to Home CMV also causes microcephaly in new born babies as well as other, often devastating conditions such as Physical and learning impairments Cerebral palsy Profound hearing loss Epilepsy Yet few pregnant women, and many health professionals have never heard of CMV
Learning Objectives 1. Understand how CMV 2. Know what you can can affect babies do to limit the impact 1.1 What CMV is and the symptoms 2.1 Give advice on reducing risks it can cause 2.2 Know what to do if infection in 1.2 How CMV is spread pregnancy is suspected 1.3 How risks of CMV infection in 2.3 Understand what would happen if pregnancy can be reduced a new-born baby was diagnosed with CMV
First, a short quiz ……
What is this?is this?
Q1: What is CMV? Congenital CMV is a common virus that can damage unborn babies 7
CMV is the leading preventable cause of hearing loss Some babies are obviously ill at birth (~15% of those affected by CMV ) Most will not show obvious symptoms yet account for two thirds of disease burden e.g. through hearing loss that develops in the months and years after birth 8
CMV affects more babies every year in the UK than other infections Approx number of babies affected per year by pregnancy infections B C F E G D A ~900 ~500 ~250 ‘extremely <30 small’ ~20 2 or 3 CMV Parvo- Listeriosis Toxo- Listeriosis Rubella Chicken virus plasmosis Toxo- pox plasmosis Sources : Dollard 2007, Griffiths 1991, NHS Choices, Public Health Laboratory Service Working Party 1990, Chapman 1993, Gay 1994, Public Health England 2014 10
CMV is mainly spread through small children’s bodily fluids • CMV is transmitted through close contact with bodily fluids • The main way women catch CMV is from the urine or saliva of young children • Younger children pose a greater transmission risk than older children • Saliva poses a greater risk than urine Pregnant woman who already have young children or work with young children are at greater risk 11
Experts recommend simple hygiene precautions to reduce risks There are simple ways a pregnant woman can reduce the risk of infection to her unborn child 13
There is currently no vaccine for CMV Research is currently being carried out to find a possible vaccine for CMV CMV Action will continue to raise awareness of the need for this through targeted communications work However, it's unlikely that a vaccine will be available for several years Until then, reducing the risk of acquiring CMV in pregnancy is the main route of limiting its effect
Learning Objective 2: Know what you can do to limit the impact 2.1 Give advice on reducing risks
Women want to get information about CMV from their midwife Whilst there are no UK guidelines on CMV education, British women are positive about getting more information (ComRes 2014) • 9 out of 10 women (91%) think that pregnant women should be given advice about CMV infection during pregnancy • Three quarters of British women of child-bearing age (75%) say that they would value the advice from a midwife • 100% of midwives, who do know about CMV, believe information should be given about risk reduction 16
Prevention Advice Don’t Share Wash with Care Avoid putting things in your mouth that Wash hands when “things get have just been in a child’s mouth, e.g. messy” e.g. after feeding a child, food, cups, utensils, dummies wiping a child’s nose/mouth or changing a nappy Avoid getting saliva in your mouth when kissing a child by trying to give more kisses on the head instead of Wash any items that may have the lips been in contact with bodily fluids
Practical tips on prevention advice There is a risk that CMV is seen as ‘one more thing to Evidence from worry about’ or that women feel overwhelmed by all the focus groups different prevention advice they receive gives some practical tips In focus groups (Levis 2014), women preferred realistic prevention messages that are not overly prescriptive and that encourage risk reduction (e.g., “whenever possible”, “try to avoid”) rather than risk elimination CMV Action is able to recommend suitable wording based on these focus groups
Learning Objective 2: • Know what you can do to limit the impact 2.2 Know what to do if infection in pregnancy is suspected
What to do if infection is suspected in pregnancy – symptoms in mother • Flu-like symptoms • Lack of energy • Fever • Rash (though rarely) • Enlarged lymph nodes • Enlarged liver/spleen • Abnormal liver function tests
Actions to take • Reassure mother: CMV is not easy to catch and maternal infection does not always cause disabilities 10%) • If mum is showing the listed symptoms, and other causes are ruled out, you could refer to maternity unit for assessment • Serological screening for CMV should be offered in severely SGA (small for gestational age) foetuses • If supported by your Trust, serological screening for CMV should be carried out on request
What to do if infection is suspected – signs in fetus Symptoms in fetus may be visible on scans : • Intrauterine growth restriction • Microcephaly (small head) • Intracranial calcifications However, if CMV infection has been confirmed in the mother, a normal scan does not guarantee the baby won’t be affected
Learning Objective 2: Know what you can do to limit the impact 2.3 Understand what would happen if a new-born baby was diagnosed with CMV
What to do if infection is suspected – signs in newborns • Lots of very small (1-2mm) red or purple spots (called petechiae) • Larger (2-8mm) red or purple dome shaped spots • Low birth weight • Anaemia • A head significantly smaller than other babies (microcephaly) • Enlarged liver and spleen (hepatosplenomegaly) • Yellow skin (jaundice • Pneumonia (rarely) However, most babies will have no obvious signs at all
Actions to take • Samples MUST be obtained within the first 21 days of life to confirm a CMV diagnosis • Testing can done through urine or saliva: check pathways in your area • Treatment with anti-virals can prevent hearing loss getting worse • Early diagnosis ensures babies are monitored for problems
Further support and resources from CMV Action • We supply our comprehensive information free of charge to professionals as well as families • Information about the latest CMV research and guidelines on our website www.cmvaction.org.uk • Our CMV e-learning module is on RCM’s ilearn • Poster of symptoms and actions to pin on the clinic wall • Phone and email support for families from our support volunteers
Thank you for taking time to learn more about CMV. Do come and see us on stand 8 or find further information at www.cmvaction.org.uk Sharon Wood, Project Manager, CMV Action sharonwood@cmvaction.org.uk
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