Position Statement: Care for Children with CMV

Congenital cytomegalovirus (cCMV) is a common in-utero infection and a leading cause of childhood hearing loss. Through early childhood, CMV is nearly ubiquitous, as up to 70% of children between 1 and 3 years old may have CMV detected in urine or saliva. Most of these children are asymptomatic, even when shedding the virus.^1.  Healthcare workers, regardless of the type of patient contact, do not have an increased risk of developing CMV infection when compared with the general population.^2-6 The annual seroconversion rate for primary infection among healthcare providers was 2.3% compared with 2.1% among pregnant women in the community.^2,7 Adults are at a much higher risk of acquiring CMV from children living in the same household than from an occupational exposure.⁸

Members of the Joint OHA/OMA Communicable disease Surveillance Protocols Committee published a cytomegalovirus surveillance protocol for all Ontario Hospitals in 2017.⁸ They concluded that CMV is not an occupational health and safety risk even for pregnant women if routine practices are followed. Routine practices include careful hand hygiene after all patient and patient environment contact, and the wearing of gloves if healthcare workers expect to contact body secretions or mucous membranes. They also recommend avoiding kissing or cuddling infants and young children and to not share utensils, which risks bringing secretions from mucous membranes of the ears, eye, nose and mouth into close proximity of the worker.

The National Institute for Occupational Safety and Health of the Centers for Disease Control and Prevention (CDC) website published similar recommendations for Healthcare workers, childcare workers, and teachers, regarding CMV and other infectious agents.⁹ The CDC’s 2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings includes hand hygiene and personal protective equipment (gloves). Since not all children undergo CMV testing and most with CMV show no signs of this infection, workers and staff must follow these precautions for all children. These precautions should also apply to daycare workers or staff who work in schools and who are in contact with young children.

Similarly, the American Academy of Pediatrics (AAP), acknowledges that hand hygiene, particularly when changing diapers, is advised to decrease risk of transmission. Access to appropriate hand hygiene measures should be ensured in order to minimize occupational transmission. Standard precautions should be sufficient to interrupt transmission of CMV, even among immunocompromised individuals or non-immune pregnant childcare or healthcare workers. Female childcare workers should be aware of CMV and its potential risks.¹

Adopted 01/11/2019
Revised 12/9/2025

References:

1. 2021. “Cytomegalovirus Infection”, Red Book: 2021–2024 Report of the Committee on Infectious Diseases, Committee on Infectious Diseases, American Academy of Pediatrics, David W. Kimberlin, MD, FAAP, Elizabeth D. Barnett, MD, FAAP, Ruth Lynfield, MD, FAAP, Mark H. Sawyer, MD, FAAP
2. Hyde TB, Schmid DS, Cannon MJ. Cytomegalovirus seroconversion rates and risk factors: implications for congenital CMV. Rev Med Virol. Sep 2010;20(5):311-326.
3. Dworsky ME, Welch K, Cassady G, Stagno S. Occupational risk for primary cytomegalovirus infection among pediatric health-care workers. N Engl J Med. Oct 20 1983;309(16):950-953.
4. Balfour CL, Balfour HH, Jr. Cytomegalovirus is not an occupational risk for nurses in renal transplant and neonatal units. Results of a prospective surveillance study. JAMA. Oct 10 1986;256(14):1909-1914.
5. Brady MT. Cytomegalovirus infections: occupational risk for health professionals. Am J Infect Control. Oct 1986;14(5):197-203.
6. Balcarek KB, Bagley R, Cloud GA, Pass RF. Cytomegalovirus infection among employees of a children’s hospital. No evidence for increased risk associated with patient care. JAMA. Feb 9 1990;263(6):840-844.
7. Lamarre V, Gilbert NL, Rousseau C, Gyorkos TW, Fraser WD. Seroconversion for cytomegalovirus infection in a cohort of pregnant women in Quebec, 2010-2013. Epidemiol Infect. Jun 2016;144(8):1701-1709.
8. Association OHAatOM. Cytomeaglovirus: Surveillance Protocol for Ontario Hospitals. OHA/OMA Communicable Diseases Surveillance Protocols. May 2017 2017.
9. Infectious Agents. Reproductive Health and the Workplace 2016; https://www.cdc.gov/niosh/topics/repro/infectious.html. Accessed November 3, 2018, 2018.

Important Disclaimer Notice (Updated 7/31/14)

Position statements are approved by the American Academy of Otolaryngology—Head and Neck Surgery or Foundation (AAO-HNS/F) Boards of Directors and are typically generated from AAO-HNS/F committees. Once approved by the Academy or Foundation Board of Directors, they become official position statements and are added to the existing position statement library. In no sense do they represent a standard of care. The applicability of position statements, as guidance for a procedure, must be determined by the responsible physician in light of all the circumstances presented by the individual patient. Adherence to these clinical position statements will not ensure successful treatment in every situation. As with all AAO-HNS/F guidance, this position statement should not be deemed inclusive of all proper treatment decisions or methods of care, nor exclusive of other treatment decisions or methods of care reasonably directed to obtaining the same results. Position statements are not intended to and should not be treated as legal, medical, or business advice.