These slides showing the prevalence of CMV in the child care setting are very eye-opening. Hopefully child care policy makers will educate their workers about their occupational hazard for CMV.

Dr. Adler will want to answer that from his perspective, but as a CMV mom who works a bit with the media, this is the list I've come up with to answer women who say, "IF CMV WAS A PROBLEM, WOULDN’T MY DOCTOR TELL ME?"

5 Possible Reasons Women Are Unware of CMV

1) Low media coverage. In the HealthNewsReview.org article, "Why does CMV get so much less news coverage than Zika — despite causing far more birth defects?" the author states, “Researchers we spoke with identified the same factors – fear and the epidemic/endemic nature of the diseases – as driving the media disparity” (Shipman, 2018).

2)"The virtual absence of a prevention message has been due, in part, to the low profile of congenital CMV. Infection is usually asymptomatic in both mother and infant, and when symptoms do occur, they are non-specific, so most CMV infections go undiagnosed” (Cannon and Davis, 2005).

3) Doctors don’t want to frighten, worry or “burden” patients.
New York Times: "Some experts argue that because there is no vaccine or proven treatment, there is no point in worrying expecting women about the virus...Guidelines from ACOG suggest that pregnant women will find CMV prevention 'impractical and burdensome,' especially if they are told not to kiss their toddlers on the mouth — a possible route of transmission.” (Saint Louis, 2016).

4) CMV prevention education is not part of a doctor’s “standard of care.”

5) Although U.S. workers have the right to “receive information and training about hazards” (Occupational Safety and Health Act of 1970), there are no federal laws governing CMV education policies for child care workers. The Department of Labor states, "Education and training requirements vary by setting, state, and employer."

Thank you for your talk and life of leading work in infectious disease. Do you suggest that randomized controlled trials for prevention of CMV in seronegative mothers be repeated or that your trials be deemed sufficient, along with personal reasoning?