6 - The social ecology of infectious disease transmission in day-care centers

Abstract

Cytomegalovirus (CMV) is extremely well adapted to persist in, and be spread among, its human hosts. The proportion of the population that acquires CMV in childhood is very dependent on child-rearing practices, particularly breastfeeding and group care of children. Since disease due to congenital CMV infection results mainly from infections in susceptible women during pregnancy, it could be speculated that this public health problem is largely the result of changes in social behavior (bottle-feeding and child-rearing practices) that occurred in the twentieth century in the US and other developed countries. Although current widespread use of day-care centers probably increases the occurrence of congenital CMV infection, it might be expected that over time the increasing infection rate among preschool children may eventually lead to a higher proportion of the population acquiring CMV prior to reproductive age, and therefore fewer problems with sequelae of congenital CMV infection. Although vaccines for prevention of congenital CMV infection are in development, for the time being the only measures available for prevention of maternal and congenital CMV infection are traditional public health approaches. The Centers for Disease Control and Prevention recommend that day-care workers and pregnant women be informed about the risk of acquiring CMV infection from a young child; procedures to prevent contact with body fluids are recommended for prevention.