Cytomegalovirus is something I learnt about at uni as a student midwife but only as part of 'TORCH' screening.
TORCH is a blood test for unwell newborns that screens for: toxoplasmosis, rubella, cytomegalovirus, herpes simplex, and HIV.
What I don't remember learning is that cytomegalovirus (CMV) is the most common out of these conditions and there are some things you can do to prevent transmission.
It's not well publicised, yet it's a virus that causes more death and disability in babies than Downs syndrome, toxoplasmosis or listeriosis (though we did offer information to pregnant women on these when I was training...I wonder why CMV information hadn't caught on at that time?).
In this post, I'll give you a quick run down of what cytomegalovirus is and what we need to do about it. No panic, just some healthy, basic bits of information.
I also love geeking out on biology stuff, I bet some of you will be the same.
CMV is actually a herpes virus, known as 'HHV-5' and like many viruses gets into human cells during 'endocytosis' which is when cells let important substances through their cell walls.
CMV hitches a lift in on these substances and then as viruses do, takes over the cell and uses its machinery to make new copies of the DNA.
You can see the CMV virus here with its characteristic 'owl eye' enlarged nucleus. This sample is from a lung.
Most people infected with CMV will never even realise they have it.
Symptoms, when they appear, include a high temperature, sore throat, swollen glands, muscle and joint pain and loss of appetite.
CMV is passed on through body fluids such as saliva, breast milk, urine, blood, and so on, meaning you can get it from sex, kissing, sharing eating utensils and parenting toddlers.
As you can imagine, nurseries and other childcare type environments where toys are shared and nappies are changed are places in which the virus can be passed on.
It's a really common infection, it's thought that 70-80% of adults in the UK have it. Mostly this doesn't cause any problems or symptoms.
In pregnant women though, the biggest risk is 'congenital CMV' which is when a baby is born with the virus. The virus spreads through a mother's bloodstream to infect the placenta and the baby.
Having said that most babies, especially when they're term, will have no issues even when they're infected.
But out of every 200 babies born with congenital CMV, 13% will have problems at birth and/or life long conditions such as:
- Rash (purple spots)
- Low Birth Weight
- Microcephaly (smaller head size)
- Visual impairment, blindness
- Learning difficulties
- Hearing loss
Any kind of illness in a newborn is very upsetting and interferes with this important family period. Life long conditions are devastating and obviously, we all want to reduce the likelihood of babies having such damage.
There are antiviral drugs that can be given if babies are identified as having congenital CMV. This is important as progressive hearing loss and brain damage can continue after birth.
The advice to pregnant women at the moment is to avoid sharing food, cups, cutlery or anything else that's saliva contaminated. This includes avoiding toddler drool and not putting a baby's dummy into your mouth.
Good hand hygiene and hand washing between changing nappies and feeding children is also a good idea.
One of the harder bits of advice is to try and avoid saliva while kissing babies. We don't want to overload women who come to antenatal appointments and are already confronted with a huge amount of information, some of which hard to process.
'Don't kiss your baby' might be an alarming thing to hear!
There's a sensible article here from the Royal College of Midwives that suggests women should be offered information on good hand hygiene and avoiding saliva as healthy precautions for all kinds of infections. This should reduce the incidence of coughs, flu and pneumonia too.
There is a vaccine being developed, which could be used for pregnant women who have never had the virus or to prevent 're-activation' in those who have had it.
Now I'd love to hear from you! Leave me a comment telling me:
- When did CMV first get onto your radar?
- Do you have any good, simple ways of explaining CMV?
I hope you're having a good week, whatever life is throwing at you right now. It throws with good aim sometimes, doesn't it?!
As a midwife or someone interested in midwifery, you're likely meeting life head on in ways that are more intense than for most people.
I know you have huge responsibilities, but please remember to slow down once in a while. Turning off and unplugging for a few minutes can work for people as well as laptops, I've found this week.
P.S. The tickets for the 'Breaking the Cycle: Bullying in Midwifery conference are finally on sale! If this is an issue that's impacted you, you might want to see if our blend of creativity, courage and expertise from our really amazing speakers is something you'd benefit from.