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Associate Professor of Sociology, University of Virginia 

A Deadly Daycare Risk

Bryce J. Christensen and Robert W. Patterson

Epidemiologists have long recognized that children in daycare face a higher risk of contracting diseases than do children cared for at home. However, a new study reminds doctors that the children most at risk for contracting one of the deadliest daycare diseases are infants who have never seen the inside of a daycare facility. For these at-risk infants are babies born to women who have contracted a dangerous virus by working in daycare centers or by placing older siblings in such care.

The dangerous virus under scrutiny in the new study is Cytomegalovirus (CMV), and the researchers examining this virus are health scholars at UCLA and the Los Angeles County Department of Public Health. Though they acknowledge that CMV is “poorly known by the U.S. public-health community,” the researchers believe that CMV deserves serious attention because of “its negative impact on child development and pregnancy outcomes.” Specifying just how negative that impact can be, the researchers note that congenital infection with CMV may entail “consequences ranging from asymptomatic infection to lifelong disability to severe disease resulting in fetal or neonatal death.” Indeed, after parsing data extracted from death certificates from the National Center for Health Statistics, the researchers identify 777 congenital CMV-related deaths occurring between 1990 and 2006. The overwhelming majority (557 or 71.7 percent) of these deaths are of infants less than one year old.

Day-care centers can cause such tragic outcomes when they create an environment in which women contract the virus, which is then “vertically transmitted from a mother with primary or secondary infection to her unborn child.” Isolating “prolonged exposure to young children” as one of the “most important risk factors for primary CMV infection during pregnancy,” the researchers regard that risk as inevitable “since CMV-infected children will secrete virus in the saliva and urine for an average of 24 months.” Given that daycare centers bring together many such children, the researchers have reason to highlight the particularly elevated danger not only “women with children in day care” but also for “women of childbearing ages working in day-care facilities.”

In concluding comments, the researchers suggest that perhaps “CMV vaccine development is under-funded.” Though this may be true, health officials seeking a reliable strategy for protecting mothers and unborn children from deadly CMV infection will look for ways to lower these risks by moving children out of institutional daycare and back into maternal care in the home.

(Benjamin N. Bristow et al., “Congenital Cytomegalovirus Mortality in the United States, 1990–2006,” PLoS Neglected Tropical Diseases 5.4 [April 26, 2011]: e1140.)