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Cytomegalovirus (CMV) is readily transmitted from children in daycare to their mothers and to staff. CMV is a highly infectious, although mild or symptom-free illness in children and adults, but can cause severe birth defects among pregnant women contracting a first infection. Transmission occurs through bodily fluids, particularly saliva and urine. At large daycare centers about half of all children have active CMV infections and are shedding virus into urine and saliva. Active transmission ceases around age three. Conversely, 40% to 60% of daycare workers are antibody negative for CMV. Thirty percent of mothers of children infected in daycare also become infected. Because of the threat to fetuses, childbearing women should be tested for CMV antibodies. Antibody-negative women should avoid contact with children's saliva and should wash after diaper changing. Pregnant antibody-negative workers should be reassigned to older children. No women should be tested during pregnancy because a positive result does not discriminate between first infections and harmless repeat infections.

The Caribbean subregion was one of the first areas to successfully integrate measles and rubella surveillance, and it can serve as an example to other subregions on how to achieve similar success. The integrated surveillance system, established through strong political commitment by Caribbean countries, is coordinated by the Caribbean Epidemiology Centre (CAREC). The system, which became operational in January 2000, is designed to detect and investigate patients with fever and rash illness, and also test a blood specimen from each case investigated. During over 9 years of operation, 3733 cases were reported and investigated. Laboratory tests identified 2 imported cases of measles, 27 cases of rubella, 309 cases of dengue, and 260 cases of human herpesvirus 6 (HHV-6) infection. The lessons learned from the success of this integrated system indicate that the following factors are critical: strong political commitment, strong technical oversight from all levels within the health-care system, the use of proven tools or systems and technology for data collection and analysis, integration with other surveillance activities, continuing training, and continuing review and evaluation. [ABSTRACT FROM AUTHOR]

The Caribbean subregion was the first area of the world to eliminate measles. From 1991 through 2010, the 21 countries of the subregion were remarkably successful in maintaining their measles-free status despite importations of the virus from areas where it continues to circulate. This task has been accomplished by ensuring that each country in the subregion maintains measles vaccine coverage of ≥95%. The absence of measles is the result of a collaboration between the various national authorities and the Pan American Health Organization in ensuring vaccination campaigns to deliver the second dose of a measles-containing vaccine, estimating and validating vaccine coverage for both the first and second doses of measles vaccine for all local populations; developing detailed plans of action to improve coverage in those populations where coverage is <95%; providing technical assistance for the implementation of the plan; and performing follow-up to confirm that all aspects of the plans were in fact implemented and that the target vaccination level was achieved. These efforts have been extremely successful in maintaining high vaccine coverage and, therefore, in keeping the virus from circulating on those occasions when it has been reintroduced into the subregion. Although sophisticated statistical methods have been used to identify weaknesses in national vaccine programs, the program is basically quite simple and can be systematically implemented in any country that has the desire to eliminate measles from its population. [ABSTRACT FROM AUTHOR]

A national surveillance program for congenital cytomegalovirus (CMV) disease was initiated in 1990. In 4 years 285 cases were reported without seasonal patterns. Mean birth statistics were as follows: gestational age, 36 weeks; weight, 2,224 g; length, 45 cm; and head circumference, 30 cm. Of the infants 68% had CNS involvement, which was significantly (P < .005) associated with a direct bilirubin level of ⩾3 mg/dL, petechiae, an alanine aminotransferase level of > 100 U/L, a platelet count of ⩽75,000/mm3, hepatomegaly, and splenomegaly (P < .05). Maternal demographics revealed that the mean age was 23 years (range, 13–38 years), 59% were white, 33% were black, 47% had low incomes (receiving Medicaid), and 45% were primiparous. Compared with 1990 birth statistics in the United States, mothers of infants with congenital CMV disease were younger, and a greater percentage of these mothers were black. Two distinct maternal groups were identified on the basis of age, socioeconomic status, and parity. This finding may reflect different modes of transmission and suggest target populations for future CMV vaccine initiatives. [ABSTRACT FROM PUBLISHER]