Infectious Diseases in an Age of Change The Impact of Human Ecology and Behavior on Disease Transmission (1995) / Chapter Skim
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Working Parents: The Impact of Day Care and Breast-Feeding on Cytomegalovirus Infections in Offspring
Working Parents: The Impact of Day Care and Breast-Feeding on Cytomegalovirus Infections in Offspring
Pages 15-30
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From page 15... ...
Under special circumstances fomites may also play a role, since CMV has been shown to retain infectivity for hours on plastic surfaces and has been isolated from randomly selected toys and surfaces in day-care centers (4, 5~. RestricSergio Stagno is the Katharine Reynolds Ireland Professor and chairman of the Department of Pediatrics and professor of microbiology, and Gretchen A
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From page 16... ...
.] tion enzyme analyses of CMV DNA have been used to demonstrate route of transmission of the virus in situations in which close contact occurs, such as breast-feeding, sexual activity, day care, and interaction between parents or caretakers and infected toddlers.
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From page 17... ...
As illustrated in Table 1, the acquisition of CMV by the infants of these seropositive women was significantly related to the duration of breast-feeding and the presence of detectable virus in the breast milk. In sharp contrast, no bottle-fed babies or infants born to women who shed CMV only in saliva or urine become infected.
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From page 18... ...
A few years ago we reported that, of a cohort of 154 predominantly Black infants of low socioeconomic background who were prospectively followed for a 2-yr period to establish the rate of postnatal CMV infection, only 8% had acquired the infection by age 6 ma (8~. The rate of seropositivity among mothers was 85%, yet only 8% of the infants had been breast-fed.
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From page 19... ...
After 1970, the resurgence of breast-feeding began at the upper socioeconomic levels, and it is spreading along the various strata in much the same manner as the abandonment of breast-feeding occurred. In 1980 the National Center for Health Statistics reported a significantly higher percentage of both Black and White women exclusively breast-feeding their infants than in 1969 (14~.
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From page 20... ...
The much lower prevalence of CMV infection that we and others have documented in the United States among women of the upper middle class when compared to women of low socioeconomic background living in the same geographic area is to some extent the result of this phenomenon. As fewer White, largely upper and middle class seropositive women elected to breast-feed their infants in the first half of this century, the perinatal transmission of CMV declined progressively.
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From page 21... ...
was among toddlers in their second year of life. Infants younger than 12 ma in group day care who excrete CMV are more likely to have acquired CMV congenitally or perinatally from maternal cervical secretions or breast milk.
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From page 22... ...
No data have indicated CMV transmission via respiratory droplets. The strongest evidence supporting child-to-child transmission was obtained by analysis of the restriction enzyme digestion patterns of CMV DNA of the isolates obtained from infected children attending day care.
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From page 23... ...
FIGURE 3 (A) Rate of seropositivity to CMV of two enrollment periods for women of low socioeconomic extraction.
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From page 24... ...
. RISK TO CARE GIVERS Several lines of evidence indicate that children excreting CMV often become the source of infection for serosusceptible parents and child-care personnel, particularly women of childbearing age.
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From page 25... ...
observed that of 18 seronegative mothers whose children shed CMV strains associated with day care, 6 seroconverted and excreted CMV strains identical to the strains shed by their children. On an average these mothers acquired the infection within 4.2 mo (range, 3-7 mo)
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From page 26... ...
Of particular concern is the risk to seronegative mothers who have children in group day care and who become pregnant. As part of our ongoing investigations of CMV infection in pregnancy, we have prospectively studied >2200 seronegative women from a high socioeconomic group during more than one pregnancy and have been able to establish the risk of seroconversion in successive pregnancies.
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From page 27... ...
In the more distant future, as more infants and young children acquire CMV in early life, the pool of seronegative individuals will decline progressively and the risk of primary infection for women of childbearing age will subside. The situation in the low socioeconomic sector is quite different.
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From page 28... ...
If primary cytomegalovirus infections occur during pregnancy it is logical to anticipate more cases of severe congenital infections. These studies were supported by General Clinical Research Center Grant RR0032, Program Project Grant HD10699, Children's Hospital Research Center Grant HD28831, and University of Alabama, Birmingham, Comprehensive Cancer Center Grant CA13148.
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From page 29... ...
(1990) Vital & Health Statistics of the National Center for Health Statistics 187, (Natl.
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