Robert F Pass

There are many examples of outbreaks of infectious diseases that are linked to child day care. This is not surprising. Provision of day care to preschool age children creates a convergence of several factors that promote transmission of infection. The fact that group care of young children increases the likelihood that they will acquire infections due to common viruses and bacteria that cause acute illnesses, and bring these infections home to their family members is both intuitive and well documented (Pickering and Cordell, 2003).

Cytomegalovirus (CMV) is different from the infectious agents that are frequent causes of acute illnesses. It is common to think of viral infections as self-limited events during which virus is shed for days or perhaps a few weeks, corresponding to the time when symptoms are present and when virus can be transmitted to others. The effector mechanisms of the host innate or adaptive immune systems result in clearance of the virus and resolution of illness. Infection results in immunologic memory that will provide some degree of protection against future encounters with the same agent. Cytomegalovirus infection rarely causes any signs of illness in healthy adults or children. However, CMV is shed in multiple body fluids for months to years in spite of the host immune responses. Cytomegalovirus is not cleared even when viral shedding is no longer detectable; like other members of the herpesvirus family, CMV becomes latent and can reactivate with intermittent productive infection with virus in blood cells or secretions. Further distinguishing CMV from many other viruses is the fact that vertical transmission (transmission from mother to offspring) plays a very important role in both the epidemiology and medical significance of CMV.

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