You Get CMV From Those You Love the Most

Imagine this: You are pregnant and your seemingly healthy toddler leans in for a sloppy, open-mouthed kiss on the lips…what would you do? You find this quite adorable and harmless, so you kiss them back! But what if you knew that in that adorable child’s saliva potentially lived a virus that could harm your unborn baby? 

For those just tuning in, cytomegalovirus (CMV) is one of 8 strains of herpesviruses that can infect humans, not to be confused with genital herpes. It is extremely common and the leading infectious cause of congenital disabilities in the United States and the world. 

Quick facts about the herpesvirus family: Once you have had them, they live in your body for life and periods of “reactivation” are standard (Colugnati, 2007). They are most often transmitted through direct contact with bodily fluids (Kaye, 2019).

How is CMV transmitted?

Source: (CDC, 2020) (Brown, 2019)

Which pregnant women are at the greatest risk of contracting CMV?:

  1. Pregnant women with young children in the home.
  • In developed countries like the United States, CMV is usually transmitted after “frequent and prolonged contact with children (less than three years of age)”(Manicklal, 2013). 
  • Young children who acquire CMV infection may shed the virus into their bodily fluids for a year or more (Cannon et al., 2011). 
  1. Pregnant with young children who attend daycare.
  • Those with children in daycare are at a higher risk of contracting CMV; the percentage of children ages 1 to 3 years old with the virus in their urine and saliva ranges between 30-40% in childcare centers, but can be as high as 70% (American Academy of Pediatrics, 2015).
  1. Pregnant women who work in early childcare.
  • 8% – 20% of childcare staff are infected with CMV each year (Adler, 2015). 

What are activities that can increase the risk of congenital CMV?

  • Kissing a child on the lips.
  • Sharing food, drinks, & utensils.
  • Putting a child’s pacifier in your mouth.
  • Handling toys that may have been in children’s mouths.
  • Wiping a child’s nose or mouth.
  • Changing a diaper.
  • Not washing your hands before putting hands to your mouth (i.e., for eating, smoking, nail-biting) (Brown, 2019).
  • Having unprotected sex, especially with a new partner (Cannon et al., 2011).

How Long Can CMV Live On Surfaces?

Brown, 2019

If I have already had CMV, is my unborn child immune to congenital CMV?

The short answer? No, but it is less likely. Here are the odds that a pregnant mother with an active CMV infection will pass it along to her baby, according to the CDC:

  • Primary infection (first time): 
    •  30 to 40% in the first and second trimesters
    •  40 to 70% in the third trimester
  • Non-primary infection (not the first time): 
    • Around 3% 
    • These are women whose strain of CMV has been reactivated or in women who are reinfected with a different CMV strain.

Source: (CDC, 2020)

Should I follow these guidelines if my child does not appear sick?

YES. The majority of healthy individuals who get CMV do NOT display ANY symptoms, including children who acquire CMV outside of the womb and pregnant women. Possible mild symptoms include fever, sore throat, fatigue, and swollen glands. Occasionally, CMV can cause mononucleosis (“mono”), which is usually caused by a different strain of herpesviruses, Epstein-Barr (CDC, 2020). 

I wish I knew

When I was pregnant with my second son, I already had a one-year-old named Sam. I had no idea that kissing him on the lips or sharing a drink or fork with him could put my unborn child at risk. I believe I was a good hand-washer, but had I known his saliva and urine potentially carried a dangerous virus, I would have been more thorough and consistent about handwashing. My second child, Logan, was born via c-section at 27 weeks, weighing only 1.2 pounds and very sick with congenital CMV. The only reason he was even born alive was that I had a minor fall that brought me into the doctor for monitoring. The fall did not hurt him, but it was clear that something was very wrong. I couldn’t believe it when I learned he had cytomegalovirus. I do not remember being sick. I do not remember Sam being sick. Logan never left the hospital, passing away at four months old. 

I chose to follow these prevention guidelines while pregnant with my third son, Julian. I thought not kissing Sam on the lips would be difficult, but it wasn’t. Sam adjusted quickly to being kissed on the forehead, and he felt no less loved or nurtured. It was not hard to make sure he had his own fork, spoon, and drinking glass. I was more vigilant about washing my hands. Julian was born full-term and healthy, for which I am so thankful. It is impossible to say whether or not Logan would also be here, happy and healthy, had I known these simple recommendations. Unfortunately, I will never know.


References
Adler S. P. Prevention of Maternal-Fetal Transmission of Cytomegalovirus. EBioMedicine. 2015, 2(9): 1027–1028. 
American Academy of Pediatrics. [Children in Out of Home Childcare.] In: Kimberlin DW, Brady MT, Jackson MA, Long SS, eds. Red Book: 2015 Report of the Committee on Infectious Diseases. 30th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2015: [144]. Retrieved from https://redbook.solutions.aap.org/DocumentLibrary/Red%20Book%202015%201.pdf
Brown, N. J. (2019). Occupational exposure to cytomegalovirus (CMV): Preventing exposure in child care and educational settings, including OSHA advisories. Ithaca, NY: Cornell University, ILR School, Workplace Health and Safety Program. 
Cannon MJ, Hyde TB, Schmid DS. Review of cytomegalovirus shedding in bodily fluids and relevance to congenital cytomegalovirus infection. Rev Med Virol. 2011; 21(4): 240-255. 
Centers for Disease Control and Prevention. (2020). Cytomegalovirus and Congenital CMV Infection. Retrieved from https://www.cdc.gov/cmv/index.html on 8/23/20.
Colugnati, F., Staras, S., Dollard, S., & Cannon, M. Incidence of Cytomegalovirus Infection Among the General Population and Pregnant Women in the United States. BMC Infect Dis. 2007, 7(71).
Kaye, K (2019). Overview of Herpesvirus Infections. Retrieved from: https://www.msdmanuals.com/professional/infectious-diseases/herpesviruses/overview-of-herpesvirus-infections on 8/23/20.
Manicklal, S. Emery, V., Lazzarotto, T., Boppana S., Gupta, R., The “Silent” Global Burden of Congenital Cytomegalovirus. Clinical Microbiology Reviews. 2013, 26(1): 86-102.
Vauloup-Fellous, C., Picone, O., Cordier, A. G., Parent-du-Châtelet, I., Senat, M. V., Frydman, R., & Grangeot-Keros, L. Does hygiene counseling have an impact on the rate of CMV primary infection during pregnancy? Results of a 3-year prospective study in a French hospital. Journal of clinical virology. 2009, 46 (4), 49–53.

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