CMV A Bigger Threat Much Closer to Home Sharon Wood, Project - - PowerPoint PPT Presentation

Sharon Wood, Project Manager, CMV Action MMB Midwifery Exchange Wednesday, 1st February, 2017

CMV – A Bigger Threat Much Closer to Home

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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 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

• f CMV

CMV – A Bigger Threat Much Closer to Home

Learning Objectives

1.1 What CMV is and the symptoms it can cause 1.2 How CMV is spread 1.3 How risks of CMV infection in pregnancy can be reduced 2.1 Give advice on reducing risks 2.2 Know what to do if infection in pregnancy is suspected 2.3 Understand what would happen if a new-born baby was diagnosed with CMV

• 1. Understand how CMV

can affect babies

• 2. Know what you can

do to limit the impact

First, a short quiz ……

What is this?is this?

Q1: What is CMV? Congenital CMV is a common virus that can damage unborn babies

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CMV is the leading preventable cause of hearing loss

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• Some babies are
• bviously ill at birth

(~15% of those affected by CMV)

• Most will not show
• bvious symptoms yet

account for two thirds of disease burden e.g. through hearing loss that develops in the months and years after birth

CMV affects more babies every year in the UK than other infections

Sources: Dollard 2007, Griffiths 1991, NHS Choices, Public Health Laboratory Service Working Party 1990, Chapman 1993, Gay 1994, Public Health England 2014

~900

A E G D F C B

~500 ~250 <30 ~20 2 or 3 ‘extremely small’

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CMV

Parvo- virus Listeriosis Toxo- plasmosis Rubella Chicken pox Listeriosis Toxo- plasmosis

Approx number of babies affected per year by pregnancy infections

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

• r work with young children are at greater risk

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There are simple ways a pregnant woman can reduce the risk of infection to her unborn child

Experts recommend simple hygiene precautions to reduce risks

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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:

2.1 Give advice on reducing risks

Know what you can

do to limit the impact

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

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Prevention Advice

Don’t Share

Avoid putting things in your mouth that have just been in a child’s mouth, e.g. food, cups, utensils, dummies Avoid getting saliva in your mouth when kissing a child by trying to give more kisses on the head instead of the lips

Wash with Care

Wash hands when “things get messy” e.g. after feeding a child, wiping a child’s nose/mouth or changing a nappy Wash any items that may have been in contact with bodily fluids

Practical tips on prevention advice

• There is a risk that CMV is seen as ‘one more thing to

worry about’ or that women feel overwhelmed by all the different prevention advice they receive

• 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

Evidence from focus groups gives some practical tips

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

• 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

Further support and resources from CMV Action

Thank you for taking time to learn more about CMV. Do come and see us on stand 8

• r find further information at www.cmvaction.org.uk

Sharon Wood, Project Manager, CMV Action sharonwood@cmvaction.org.uk