Prevention of child-to-mother transmission of cytomegalovirus by changing behaviors: a randomized controlled trial.

BACKGROUND: To determine whether a behavioral prevention approach reduces child-to-parent transmission of cytomegalovirus. METHODS: Subjects were seronegative mothers whose child was less than 36 months of age and was shedding cytomegalovirus. Nonpregnant women were randomly assigned to three groups. Mothers in the education group (E) were given instructions about protective behaviors (frequent hand washing, wearing latex gloves) and risky behaviors to avoid (intimate contact with the child). Disposable diapers, liquid soap and latex gloves were provided. During biweekly home visits glove and soap use were monitored for an indirect objective measure of adherence to the protective behaviors. Throughout the study mothers self-reported the frequency they engaged in protective and risky behaviors. In addition to the procedures for Group E the adherence and education group (A) also received social reinforcement for adherence and problem solving for any perceived problems with the behavioral recommendations. The control group (C) received no intervention. A fourth group of pregnant women received an intervention equivalent to that of the education group. RESULTS: Eight of 17 women in Group C and 4 of 11 women in Group E seroconverted. For both E and Group C the average time from enrollment to infection was 4 months (range, 2 to 7 months). Two of 8 women in Group A seroconverted (1 at 3 months and 1 at 8 months). None of 14 pregnant women observed for an average of 8.4 months during pregnancy seroconverted. CONCLUSIONS: These results suggest that intervention for pregnant women is effective because pregnant women will perceive a higher risk and be more motivated to adhere to recommendations than nonpregnant women.

Risk of human parvovirus B19 infections among school and hospital employees during endemic periods.

Because human parvovirus B19 (B19) infections are common in children, and maternal infection of pregnant women may cause fetal death, risk factors for B19 infections for hospital and school employees were identified during an endemic period. By serologic testing, 2730 employees of 135 schools in three school systems and 751 employees of a hospital were monitored. Of these, 60% were initially seropositive. After adjusting for age, race, and gender, risk factors for seropositivity were contact with children 5-18 years old at home (odds ratio [OR] = 1.2), at work (OR = 1.2), and employment in elementary schools in school system 2 (OR = 1.4). Over 42 months, 1 of 198 susceptible hospital employees seroconverted versus 62 of 927 school employees. Four factors associated with seroconversion were employment at elementary schools in system 2, contact with children 5-11 years old at home or with children 5-18 years old at work, and age < 30 years. Those in daily contact with school-age children had a fivefold increased annual occupational risk for B19 infection.