Every fall, programs for children in groups face possible outbreaks of flu. Flu can be life-threatening. ECELS recommends that all early education and child care programs actively use measures to prevent this disease.

The best way to stop the spread of seasonal flu is to get flu vaccine as soon as it is available. Whether you get the shot or the nasal spray depends on your age, health condition and preference. The 2013 vaccines have either 3 or 4 strains of influenza virus material. If it is available, get the one with 4 strains. Both of the vaccines prepare your body to resist influenza.

Too many people believe myths about flu vaccine and about influenza. The vaccine does not give you influenza. It stimulates the immune system to recognize influenza viruses. While you might get a sore spot on your arm or feel a bit under the weather for a day or so, getting infected with disease-producing influenza is much worse. Influenza disease can make healthy people sick enough to miss months of work or school or worse. Sadly, each year thousands die from influenza. Flu vaccine could have prevented many of these severe illnesses and deaths.

Child care facilities should start promoting influenza vaccination in September and continue until everyone has received the vaccine or spring comes. With very few exceptions, everyone over 6 months of age should get annual flu vaccine.

In the fall, reinforce the value of practicing good hand hygiene and using an elbow or shoulder to catch a sneeze or cough. Flu viruses spread easily in group care settings. Adults and children in group care take the virus home and spread it in the community. Consider the risk that people who do not get flu vaccine pose to others while respecting their right to make individual decisions.

Act now for the 2013-14 influenza season.

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Since 1986, conference workshops, professional journal articles, manuals, national standards, and sample forms have described the risk to an unborn child if a pregnant mother is exposed to certain infections that commonly spread in groups of young children. Employers of female early education staff of child-bearing age should educate their staff members about this risk. They should urge them to discuss with their health care providers how to reduce their risk.

Cytomegalovirus (CMV) is one of the infections that pose a risk to an unborn child. CMV is a common infection among young children, usually without symptoms. Between 30% and 70% of children less than 3 years of age in child care excrete the virus in their urine, saliva and blood at any one time. Excretion of the virus may occur intermittently for years after the first infection. Women who work in child care may or may not be immune to the strains of CMV infecting children in their care. If a woman has her first CMV infection while pregnant, or has a CMV infection with a different strain than the one she had previously, her unborn child is more likely to be infected.

In utero (congenital) CMV infection occurs in only 1% of live births. However, CMV is the most common viral infection of babies before they are born and the most common cause of sensorineural hearing loss. About 10% of the CMV-infected babies have some symptoms or signs at birth. Those who do may have devastating multi-organ damage. These include poor growth, liver damage, brain damage, hearing loss, blindness, underdeveloped brains and developmental delay. About half of infants who have some symptoms of CMV at birth develop hearing loss from damaged nerves that are needed to carry sound sensations to the brain from the ear. About 15% of those who are infected but have no symptoms of CMV infection at birth develop this type of hearing loss as they grow older. In many children, the degree of hearing loss is progressive.

Nurses who conscientiously practice recommended hand hygiene don't get CMV infections from their CMV infected patients at a higher rate than other women. Teachers/caregivers of groups of young children could similarly reduce their risk by practicing hand hygiene after every contact with urine, saliva or blood. However, achieving this level of hand hygiene is challenging in group care. Teachers/caregivers have contact with more than one drooling child at a time, and frequently touch saliva coated toys or other surfaces. They change diapers or soiled underwear for children in their group multiple times a day.
At the least, women who teach groups of young children need to know how to reduce the risk if they might become or are pregnant. When properly informed, they can consider three options: 1) be very careful about practicing hand hygiene, 2) decide to provide care for preschool or older children instead of infants and toddlers when pregnancy is possible, or 3) choose to work in settings where they have less risk of contact with body secretions of young children.

Employers should explain CMV and other common occupational health risks verbally pre-employment. The information should be in an employee handbook given to each staff member, and discussed at a staff meeting at least once a year. It is best practice to use a Staff Health Assessment form that lists the common occupational risks. The list may prompt the health care provider who completes the form to assess and discuss these risks. Many health care professionals are unaware of the tasks performed by women whose work involves close contact with groups of young children. A list of these occupational risks is in Caring for Our Children, Managing Infectious Diseases in Child Care and Schools, and in Model Child Care Health Policies. Each of these publications has a sample Staff Health Assessment Form too.

Teach early education staff members about each of their occupational risks. Then have them sign a statement acknowledging the teaching received, that they understand and know how to reduce each risk, and that with this knowledge, they accept the risks.


Child care providers have a responsibility to advise their paid and volunteer female staff members about occupational health risks. One of these risks is the likely exposure to infections that can damage a fetus if the worker becomes pregnant. These infections include rubella, measles, mumps, chicken pox, hepatitis B, cytomegalovirus (CMV), herpes, parvovirus and HIV.

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