Speaker 1: Welcome to the kick Your Expert led podcast, helping you
Speaker 1: explore and learn everything about getting pregnancy, birth, and becoming
Speaker 1: a parent.
Speaker 2: On the podcast and our online pregnancy program grow My Baby,
Speaker 2: we share my experience of helping more than four thousand babies.
Speaker 1: To be born, and our experience of running a women's
Speaker 1: health clinic and parenting for boys.
Speaker 2: We're here to help everyone to feel empowered in pregnancy
Speaker 2: and birth with real life, practical information.
Speaker 1: Welcome everyone. I'm Bridget Maloney.
Speaker 3: And I'm obstetrician doctor Patrick Maloney, and.
Speaker 1: Today we've got an episode that I can't believe we
Speaker 1: haven't done pad on CMV.
Speaker 3: Yeah, definitely time we talked about CMV.
Speaker 1: Yeah, we got a question ages ago about this, oh gosh,
Speaker 1: like years ago, and we did do a couple of
Speaker 1: social media posts on it. But I think there's enough
Speaker 1: information for us to do an episode, and it's such
Speaker 1: an important thing for people to know about.
Speaker 2: Yeah, I think in our in our sort of preparation
Speaker 2: for this episode, one of the most interesting stats is
Speaker 2: that people don't know about.
Speaker 1: Oh that's it. Yeah, so let's go talk about that,
Speaker 1: all right. It's cytomegalovirus if I pronounced that correctly.
Speaker 3: That is right, good, Yeah.
Speaker 1: What is it? Pat?
Speaker 2: So CMV is a virus. It's a common virus in
Speaker 2: our community. It's often spread around by well, it's spread
Speaker 2: it's spread through through close contact and it's often spread
Speaker 2: around by asymptomatic normal children through saliva and close touch
Speaker 2: and urine. And the problem with that is that that's
Speaker 2: what children do and there and that virus is easily
Speaker 2: spread around. Now, the relevance to us is that it
Speaker 2: is an important virus in pregnancy. It can cause significant
Speaker 2: problems for the developing baby. And it's not that rare.
Speaker 2: A little over a baby a day is born in
Speaker 2: Australia with a significant outcome from CMV.
Speaker 1: And we're going to talk about why that is a
Speaker 1: problem in a minute. But I just you've already raised
Speaker 1: so many points there. It's most virulent, isn't it in
Speaker 1: kids under the age of two.
Speaker 2: Yes, So it's bad to get it as a fetus,
Speaker 2: and it's bad to get it as a newborn. But
Speaker 2: and it can cause a significant sort of flu like
Speaker 2: illness in children. But it can also be spread around
Speaker 2: relatively well people in settings like child cares.
Speaker 1: And kindergartens and parents with toddlers that then happen to
Speaker 1: be pregnant.
Speaker 3: That's the problem.
Speaker 1: Yeah, yeah, So it's part of the herpes virus family.
Speaker 2: Yeah, big family of viruses with some similar characteristics.
Speaker 1: And we know that, you know, I have a little
Speaker 1: bit of herpies. Can I say that? You know I
Speaker 1: get my cold sauce every now and then, you know,
Speaker 1: it lies dormant in my system and then just reactivates.
Speaker 1: That's the same thing with CMV, isn't it.
Speaker 3: It can be. Yeah.
Speaker 2: So the classic cold saw picture where you get the
Speaker 2: saw on the corner of your mouth when you're tired,
Speaker 2: run down, burn the candle at both ends it comes
Speaker 2: out again. There is a sort of a version of
Speaker 2: that with CMV. See lots of by the time someone
Speaker 2: gets to the age of having a baby, about half
Speaker 2: the community have already had CMV, and they get some
Speaker 2: lifelong immunity to it, which is a little incomplete in
Speaker 2: that one there is a capacity to be reinfected, so
Speaker 2: you might not have complete immunity. And two there's a
Speaker 2: phenomenon of reactivation where the old CMV virus might have
Speaker 2: been alive in your body but dormant, and it reactivates
Speaker 2: in pregnancy because you're a bit immunosuppressed, possibly due to
Speaker 2: the demands on your body of being pregnant, So you
Speaker 2: might be a little bit in mino suppressed, a little
Speaker 2: bit sleep deprived.
Speaker 1: So farth Yeah, right, I want to add it's not
Speaker 1: relevant actually to CMV, but coswals come when I get
Speaker 1: a sun burnt on my lip too, If anyone also
Speaker 1: has that, then I want to hear from.
Speaker 3: You, because that's definitely a thing.
Speaker 1: Yeah, that's my issue. So I read a study that
Speaker 1: only one in six pregnant people have even ever heard
Speaker 1: of CMV.
Speaker 2: Yeah, and this is this is definitely somewhere where we
Speaker 2: can improve. I've got a theory on this. I think
Speaker 2: one of the reasons why we don't sort of talk
Speaker 2: to people about CMV as much as we should is
Speaker 2: there's a feeling amongst obstetricians, midwives, obstetric care give is
Speaker 2: that there's not tons that can be done about it.
Speaker 2: And firstly, that's not entirely true, because the there is
Speaker 2: some evidence that the preventative things that can stop be
Speaker 2: catching it do work or at least improve the odds
Speaker 2: in your favor. And the other thing is just because
Speaker 2: like for example, there isn't a vaccine, then that doesn't
Speaker 2: mean there's nothing we can do. We're don't throw our
Speaker 2: arms up and say well, we can't do anything about CMV.
Speaker 2: By contrast, if you look at rebella used to be
Speaker 2: a cause of serious infection in pregnancy people in our
Speaker 2: community this day with the natal rebella, blindness, deafness, intellectual disability,
Speaker 2: pretty much fixed by an effective vaccine that really works.
Speaker 3: So vaccinated as.
Speaker 2: A child potentially have a booster before we have a baby,
Speaker 2: you're not going to catch rebella in pregnancy. You'll be
Speaker 2: fine c MV. Unfortunately, we don't have the same we
Speaker 2: don't have the same weapons to fight it.
Speaker 1: And interestingly, I did see a graph that showed people's
Speaker 1: knowledge about the different diseases and things like rebella. Nearly
Speaker 1: one hundred percent of pregnant people know about the impact
Speaker 1: of rebella or why they should even be tested for rebella. Yes,
Speaker 1: but you know, I don't know this. It's interesting why
Speaker 1: I know you said that. It's because we feel like,
Speaker 1: as you know, you feel like as medical people that
Speaker 1: you can't do much about it. But one in six
Speaker 1: people not knowing about it. I find that really a
Speaker 1: shocking statu.
Speaker 3: Yeah, we should be doing better than that. And I think.
Speaker 2: It starts with the fact that it isn't actually one
Speaker 2: of the tests that's recommended in early pregnancy.
Speaker 3: And that's because you know, if.
Speaker 2: Someone's got CMV immunity or they don't, the advice we
Speaker 2: would give them would be the same. It's about preventing transmission.
Speaker 2: That there isn't something special we could do for the
Speaker 2: person who's non immune versus immune. Whereas the person who
Speaker 2: early pregnancy testing shown that they didn't have any rebella immunity,
Speaker 2: we could we give that person a booster before they're
Speaker 2: pregnant again and at least is risk that way. So
Speaker 2: it's it's it's sometimes it is tested for in early
Speaker 2: pregnancy opportunistically, but it's not actually an official recommendation in Australia.
Speaker 2: And I think that's where it's where it's where it
Speaker 2: starts that we don't talk about enough.
Speaker 1: Yeah right, I want to really highlight that CMV is
Speaker 1: the most common infectious cause of disabilities in newborn babies.
Speaker 2: Yeah yeah, yeah, so presumably it came to number one
Speaker 2: as rubella dropped away.
Speaker 1: Yeah, so CMV effects one in one hundred and fifty
Speaker 1: babies down syndrome one in six hundred and sixty, spina
Speaker 1: biffitter six point three in ten thousand, and toxoplasmosis is
Speaker 1: zero point zero one seven in one thousand. Yeah, so interesting,
Speaker 1: isn't it?
Speaker 2: That is interesting data because you know, it's certainly it's
Speaker 2: eurned its place in things we should be discussing. The
Speaker 2: we can get We can talk today easily about about,
Speaker 2: you know, how detection works and so forth. But you know,
Speaker 2: in our preparation for today, the thing I found most
Speaker 2: interesting was that there's quite good data behind the relatively
Speaker 2: simple things that you can do to prevent CMB transmission
Speaker 2: that actually shows that it really does prevent it.
Speaker 1: Yeah. All right, now we've talked about that. We want
Speaker 1: to raise awareness, but let's talk about why, Like why
Speaker 1: is CMV an issue?
Speaker 3: Why is it an issue in pregnancy?
Speaker 1: In pregnancy?
Speaker 2: Well, if the most significant CMV infection in pregnancy would
Speaker 2: be somebody with no previous immunity catching CMV while they're
Speaker 2: pregnant and then having that CMV virus cross the placenta
Speaker 2: into the developing baby, and that's a potentially very serious
Speaker 2: situation where the baby can develop a large number of
Speaker 2: significant abnormalities that could resate, resulting in long term health
Speaker 2: troubles for that baby, long term disability, or even still
Speaker 2: birth or nanatal death.
Speaker 1: I don't want to scare people, but maybe we could
Speaker 1: talk about some of those disabilities that are noted to
Speaker 1: be caused by CMB.
Speaker 2: Yeah, so, I guess in the most serious situation, you
Speaker 2: might get a CMV picture in the in the developing baby.
Speaker 2: That's a very serious and multi system. It can lead
Speaker 2: to a problem in babies called hydrops, which is where
Speaker 2: there's abnormal fluid develops right throughout the the baby's body
Speaker 2: cavities and that and that can be a cause of
Speaker 2: pregnancy loss or nanatal death. And then more subtly, but
Speaker 2: the CMV infection can affect various organs within the baby's body,
Speaker 2: causing you know, potentially very long term dysfunction of those organs.
Speaker 2: And among the more serious outcome scene are problems hearing,
Speaker 2: intellectual disability, learning difficulties, failed to thrive as newborn.
Speaker 1: Those sort of things, and eye diseases, yes, possibly, yeah,
Speaker 1: and it can be a cause of prematurity and growth restriction.
Speaker 2: Yeah, that's right. And these are some of the ways
Speaker 2: that it can be picked up. For example, sometimes it's
Speaker 2: quite obvious the woman has a really severe flu like illness,
Speaker 2: which is sometimes just mistaken for seasonal flu. And then
Speaker 2: but maybe she winds up sick enough for somebody to
Speaker 2: be looking into that she's tested for CMV and it's
Speaker 2: found that she's got a CMV infection at that time,
Speaker 2: and that she didn't used.
Speaker 3: To have any old immunity.
Speaker 2: And then this is somebody who who suddenly has developed
Speaker 2: antibodies for CMV which they didn't previously have, and that
Speaker 2: is and that proves that this is a new infection
Speaker 2: in this person, and that might lead to that being
Speaker 2: referred to a specialist center where with expertise in the
Speaker 2: management of infectious diseases in pregnancy, where her where her
Speaker 2: baby would be monitored for signs of CMV infection in
Speaker 2: the in the fetus, and that's done using ultrasound and
Speaker 2: occasional occasionally MRI and they and an amniosynthesis can be
Speaker 2: taken from the fluid around the baby to also look.
Speaker 3: For evidence of the virus in the water around the baby.
Speaker 1: Can I ask you know you mentioned that the that
Speaker 1: sometimes the woman will feel unwell and that will be
Speaker 1: thought of it that it's just the cold or a flu.
Speaker 1: Would from a patient's perspective, would it be best for
Speaker 1: them to go I would like to be tested for CMV.
Speaker 2: I think that's quite reasonable, especially for someone with a
Speaker 2: significant flu like illness where they were they had a
Speaker 2: vaccine for seasonal flu, which I think would mean it
Speaker 2: was less likely to be seasonal flu. Then a CMV
Speaker 2: test would be quite reasonable. And the other one would
Speaker 2: be a situation where it had features that were more
Speaker 2: in keeping with CMV rather than seasonal flu. For example,
Speaker 2: significant what we call limphat anopathy, big lymph nodes in
Speaker 2: the neck, core, the armpits, or the groin, And you're thinking,
Speaker 2: hang on a minute, this is a bit not very
Speaker 2: much like seasonal flu.
Speaker 3: Could this be CMV.
Speaker 2: When you're go and have those first trimester bloods, when
Speaker 2: you're first pregnant, you have HIV and hepatitis and hemoclover
Speaker 2: and all that are the blood from those that first
Speaker 2: set of bloods, they keep that in the laboratory for
Speaker 2: a year so that if you later developed something that
Speaker 2: might be CMV and they say, yep, you've got some
Speaker 2: CMV antibodies, they can then go back to the stored
Speaker 2: blood from the start of the pregnancy and see whether
Speaker 2: you had antibodies then.
Speaker 1: But would CMV be looked for back then?
Speaker 3: No, but the blood still there, and they just test again.
Speaker 1: Oh they can, Okay, they keep the actual blood.
Speaker 2: Yeah yeah, you big of these storage units, yeah, be big, right,
Speaker 2: And so they keep it. They keep it all for
Speaker 2: a year, so you can go back then and say,
Speaker 2: just find the tube of blood from seven months ago, please, wow,
Speaker 2: and then they'll test that for CMV. And I guess
Speaker 2: the most I guess the most concerning would be that
Speaker 2: there were zero antibodies back then and fresh antibodies now.
Speaker 1: Yeah.
Speaker 3: Yeah, proves that the infections new.
Speaker 1: And that's also called a primary infection. If anyone then
Speaker 1: goes and reads up, yeah, that's.
Speaker 2: That's what's called a primary infection. And then there's also
Speaker 2: secondary infections where you've always had CMV and you've got
Speaker 2: it again. And then there's a reactivation where you've got
Speaker 2: it years ago and it was never quite killed off
Speaker 2: inside your body and it comes back.
Speaker 1: And you're more interested in the primary infection because the
Speaker 1: transmission rate is higher, isn't it.
Speaker 2: The transmission from mother to baby is highest. Yes, that's right,
Speaker 2: but more people have secondary or reactivations, so.
Speaker 3: We're interested in both.
Speaker 1: Yeah, and I want to go back just in case
Speaker 1: anyone's panicking right now, when we said that one in
Speaker 1: one hundred and fifty babies are found with CMV. There's
Speaker 1: some that are infected yep, and there are some that
Speaker 1: are affected exactly.
Speaker 2: So lots of those babies are fine and have no
Speaker 2: problems then and no problems later. Yeah, But the most
Speaker 2: severe scenario is a baby that becomes quite sick inside.
Speaker 2: So when we talk about it as a cause of prematurity,
Speaker 2: some of that prematurity will be caused by us. We'll
Speaker 2: be watching a baby with CMV and thinking this baby
Speaker 2: is not going to make it to full term unless
Speaker 2: we interfere.
Speaker 1: Now, yeah, the old better out than in scenario.
Speaker 3: Sometimes that applies.
Speaker 1: Yeah, Now the baby can also get CMV during delivery
Speaker 1: and post natally through breast milk, is that right?
Speaker 2: Yeah, So that's a significant situation as well. So we
Speaker 2: want to know about mums that are sick with CMV
Speaker 2: even if there's no even if there's no immediately obvious
Speaker 2: evidence of fetal infection.
Speaker 1: You've talked about how we can test for it during pregnancy,
Speaker 1: but if it's suspected after birth, what sort of tests
Speaker 1: would a parent expect for their baby to have.
Speaker 2: So after birth, when we've got the baby right there
Speaker 2: in front of us, we can try and sample and
Speaker 2: culture multiple body fluids, urine, a saliva, pooh, and get
Speaker 2: swabs and viral cultures off the baby to try and
Speaker 2: make a quick diagnosis of whether the baby appears to
Speaker 2: have CMV at birth, because there is a role for
Speaker 2: anti viral medication, but you need to give it quickly,
Speaker 2: So we'd.
Speaker 1: Want to get a diagnosis right at the start, and
Speaker 1: that baby then would be referred to a pediatrician or yeah,
Speaker 1: that's in the hands of a pet isn't it.
Speaker 2: Yes, So the pediatricians would then be looking at that
Speaker 2: baby for any signs of an acute illness. So the
Speaker 2: baby got sick as a newborn, and then long term,
Speaker 2: if CMV was proven for the development of any you know,
Speaker 2: neuro developmental things, vision, hearing, and so forth, it must.
Speaker 1: Be so hard because you know, jaundice is one symptom
Speaker 1: as well, but jaundice can be caused by so many
Speaker 1: different things like it do people say, oh, well, how
Speaker 1: about SAMV? Like, is that what you hear?
Speaker 3: That's right?
Speaker 2: So we rely on these neonatal pediatricians.
Speaker 3: They're pretty clever.
Speaker 2: Men and women, and they and we and we rely
Speaker 2: on them to take a broad look at a newborn.
Speaker 2: And the new one can't tell you what's wrong. It
Speaker 2: must be a really hard job. So they do take
Speaker 2: a really broad look. And sometimes we would say, well, well,
Speaker 2: here's a baby with some significant jaundice, and yet there
Speaker 2: were no real obstetric risk factors for that obstetric for
Speaker 2: that jaundice, like a mismatch between blood groups or anything
Speaker 2: like that, or significant prematurity. Why is this baby joundice?
Speaker 2: And the clever pedatrician will often say, well, let's let's
Speaker 2: rule out infection. So they test the baby for something
Speaker 2: called a torch screen, which is any evidence of infections
Speaker 2: that could be making a baby.
Speaker 1: See right, What about the placenta do they do? The
Speaker 1: peds also say hey, can we hey obstetrician, what do
Speaker 1: you do with the placenta? Can we test it?
Speaker 3: Yeah? They do.
Speaker 2: Yeah, so you can swap the placenter for any signs
Speaker 2: of infection and then for other problems, you can analyze
Speaker 2: the placenta microscopically for any for signs of problems that
Speaker 2: might have led to an unexpected pregnancy outcome.
Speaker 1: All right, so you mentioned that the baby needs you know,
Speaker 1: it's best if they get their antiviral treatments within twenty
Speaker 1: one days. That's that's a pretty tight frame, isn't it.
Speaker 3: Yeah.
Speaker 2: I think I think that's the important thing we need
Speaker 2: to have about CMV is an index of suspicion.
Speaker 3: Could this be cmp and.
Speaker 2: The opportunities for early treatment might be lost by that
Speaker 2: just not being thought of. But if we're on the
Speaker 2: ball about CMV, then then you know there's a there's
Speaker 2: a clear protocol of of how to a manager suspected
Speaker 2: their natal infection.
Speaker 1: I imagine that in one in six people knowing about CMV
Speaker 1: listening to this podcast will be kind of shocking and
Speaker 1: it will be kind of terrifying.
Speaker 2: Yeah, that's that's sort of the risk, isn't it, Because
Speaker 2: information is good, but it also worries people potentially. So
Speaker 2: I'm encouraging people, if they're hearing about CMB for the
Speaker 2: first time and have never heard of it, to talk
Speaker 2: to their cares and say what can I do to
Speaker 2: prevent this? Is there any value in me being tested.
Speaker 2: I had a shock and flu like illness a month
Speaker 2: ago which is passed. Is there any chance that was CMV?
Speaker 2: And encouraged discussion of it.
Speaker 1: Hopefully our next portion of the podcast, we're really going
Speaker 1: to hone in on how to prevent getting CMV. So
Speaker 1: everyone take a big breath, because that's.
Speaker 2: That I think is the most is the best way
Speaker 2: to respond. If this is causing people anxiety, we'll say, right,
Speaker 2: what can what can we do? What's been shown to
Speaker 2: help reduce transmission?
Speaker 1: Let's do that, all right, what has been shown to
Speaker 1: help stop transmission? Yeah, you asked your own question.
Speaker 2: Then look, I think you might get it off your
Speaker 2: own children who are older and two or three year old,
Speaker 2: say in daycare or kindergarten or something. And you won't
Speaker 2: get it from just giving that child a hug or
Speaker 2: just usual parenting care, but you could get it from
Speaker 2: sharing saliva.
Speaker 3: So there are a couple.
Speaker 2: Of things that parents do that maybe we shouldn't if
Speaker 2: we knew about CMV. And one is that if a
Speaker 2: todler drops their dummy on the ground, I've done this,
Speaker 2: I've done this, We pick it up up and there's
Speaker 2: no tap or anything around. So we put in our
Speaker 2: own mouth to wash the dirt off, and then we
Speaker 2: put back in the baby's mouth, and that's probably a
Speaker 2: high risk activity for CMV transmission.
Speaker 3: And then you know, the other thing that it's.
Speaker 2: Nice to do when you've got when you've got really
Speaker 2: little ones, is you want to kiss them all the time.
Speaker 2: But it's presumably a lot safer to kiss a baby
Speaker 2: anywhere but on the mouth, and that's something that people
Speaker 2: could consider. And the other thing is contact with urine,
Speaker 2: so the virus is spread heavily in urine. There's a
Speaker 2: lot of virus in the urine. So when you have
Speaker 2: to clean up we your baby or somebody else's that,
Speaker 2: you know, proper hand wash afterwards.
Speaker 1: I want to further explore where we might share saliva
Speaker 1: with our children. I remember being on holidays and one
Speaker 1: of the kids has forgotten toothbrush, and I've loaned my toothbrush,
Speaker 1: which in hindsight is disgusting.
Speaker 2: But also that's why I'm hesitating, because it all sounds
Speaker 2: a bit gross, But when it's your baby, doesn't feel gross.
Speaker 3: Kissing a little.
Speaker 2: Baby on the male You think it's other people baby
Speaker 2: on the mouth, but you Mike's your own baby in
Speaker 2: the mouth and there.
Speaker 1: They might kiss you like you know, the the open
Speaker 1: mouth kiss of a six month old is hilarious.
Speaker 2: Hilarious, And but they've definitely got saliva aging out there.
Speaker 2: And then and then you know, things like contact with urine.
Speaker 2: You would wash your hands if you if you had
Speaker 2: just cleaned up somebody else's urine, but we had, but
Speaker 2: with our own children in our own household, we're probably
Speaker 2: a bit slack.
Speaker 1: Yeah, so it's back to That's one thing COVID did
Speaker 1: teach us his proper hand washing routine, which is good.
Speaker 1: I'm stuck on the saliva sorry. But toddlers their slobbery people,
Speaker 1: so they sobber over everything, So you know, you've got
Speaker 1: to make sure you're cleaning their toys properly. Sometimes you
Speaker 1: want to feed your baby off your own utensils, you know,
Speaker 1: put a mouthful in their mouth and then back in yours.
Speaker 3: Or do what I used to do and take food
Speaker 3: from their.
Speaker 1: Play Yeah, you're a shocker at doing that. That is
Speaker 1: so bad.
Speaker 3: Used to go what are you doing? Yeah, yeah, that
Speaker 3: would have been like, no, they just left it them
Speaker 3: and you're like, we'll come to.
Speaker 1: What I'm back now, slob it all over it.
Speaker 2: Yeah, so this is I'm serious, like like we should
Speaker 2: be we should be rethinking these behaviors, and I guess
Speaker 2: things that we can do to reduce cm FEAT transmission
Speaker 2: might be our best defense in the absence of a vaccine.
Speaker 1: I want to read where this all sort of you know,
Speaker 1: came back to me and I thought, oh, well, we
Speaker 1: better get to it. I want to read this from
Speaker 1: a It's a written question this, this person said. I
Speaker 1: just wanted to know whether you could do a podcast
Speaker 1: or congenital CMB getting tested for expose when pregnant or before?
Speaker 1: Context is I am a physio, I worked with children
Speaker 1: with congenital CMV, and my boss checked that at the
Speaker 1: time I wasn't pregnant or planning to be. I'm no
Speaker 1: longer seeing this child and I will check with my GP.
Speaker 1: But maybe interesting if others have also asked about it,
Speaker 1: I've got to say, no one has ever asked about it.
Speaker 1: That's the only question we've ever got on CMB.
Speaker 2: Yeah, yep, which is interesting in itself, But in that
Speaker 2: setting of healthcare or childcare, you know, there's a this
Speaker 2: is not standard practice, but there's a potential argument that
Speaker 2: somebody with no CMV protection at all, no evidence of
Speaker 2: prior infection, no antibodies. Maybe within the childcare environment, the
Speaker 2: room with the babies where they are cleaning up a
Speaker 2: vomit pool and we all the time might not be
Speaker 2: the perfect job for that person. Certainly that person should
Speaker 2: be practicing a very active personal protection and hand washing.
Speaker 1: Yeah, and maybe you know, if there's some flexibility about
Speaker 1: where they work from the childcare, maybe they could go
Speaker 1: to the older kids rooms.
Speaker 3: Exactly jobs, but maybe the older kids rooms.
Speaker 1: Yeah, because I did read that risks of getting of
Speaker 1: kids getting CMV is two to threefold in childcare.
Speaker 3: We know that about. That's just the nature of the
Speaker 3: of the environment, isn't it. Yeah.
Speaker 1: It is tricky though, because, like you know, often the
Speaker 1: age gap between kids in families too is two years
Speaker 1: two and a half years. That's the prime infection time
Speaker 1: for that toddler as well. So you know, we say
Speaker 1: that people should be careful in childcare, but I suppose
Speaker 1: anybody with the toddler it's the same absolutely. Yeah. All right,
Speaker 1: So let's say somebody has a known CMV infection, should
Speaker 1: they have any precaution about getting pregnant?
Speaker 2: Well, no, it's not a reason not to become pregnant.
Speaker 2: This is somebody who's had it in the past before
Speaker 2: they were pregnant.
Speaker 1: Are there any sort of special recommendations for somebody that's
Speaker 1: planning to get pregnant but maybe have just had a
Speaker 1: primary CMV infection? God, if you know that they've had
Speaker 1: a CMV infection, I suppose that's that's.
Speaker 2: The problem, right Is that is that, apart from a
Speaker 2: pregnant person, if all woman's had a severe flu like illness,
Speaker 2: even with some lymph glands up and stuff, it's fairly
Speaker 2: unlikely to have been identified formally as a CMV infection.
Speaker 2: So you're not really you don't really get an opportunity
Speaker 2: to give that person advice, conservative or otherwise because she's
Speaker 2: it's not known that that's what it was. Let's say,
Speaker 2: for example, it is known. So this is a person
Speaker 2: who's perhaps trying for a pregnancy or in her child
Speaker 2: bearing years or what have you, and some smart doctor
Speaker 2: has identified that illness as a CMV infection, then there
Speaker 2: there is some wisdom in that person. And waiting perhaps
Speaker 2: up to a year before becoming pregnant and blood tests
Speaker 2: can be helpful, you can watch the development of that
Speaker 2: person's antibodies, watch the immune response developed from a preliminary
Speaker 2: immune response into a mature one, and there are some
Speaker 2: clever tests that you can do to establish that the
Speaker 2: more dangerous pace of the infection is over and then
Speaker 2: and then go for the pregnancy after that. Yeah, well,
Speaker 2: but the problem is identifying that person in the first place.
Speaker 1: This seems to me that as a public health issue,
Speaker 1: we haven't focused enough on it. You know, if it
Speaker 1: is one in one hundred and fifty kids are born
Speaker 1: with CMV, whether they're infected or affected by it, why
Speaker 1: isn't that up the chain?
Speaker 3: I think it comes.
Speaker 2: It's an excellent question, and I'm sure some of it
Speaker 2: is we just we just aren't doing enough about CMV.
Speaker 2: But the other problem is that to justify a public
Speaker 2: health message, it needs to meet some criteria, and one
Speaker 2: of the criteria, unfortunately, is that there needs to be
Speaker 2: roughly something that can be done about it. If we
Speaker 2: make a big public health message out of a problem
Speaker 2: that doesn't have a way of detecting it or an
Speaker 2: obvious solution, then are we just creating anxiety without actually
Speaker 2: helping anybody with the ultimate health outcome.
Speaker 1: We could certainly throw a bit more money towards developing
Speaker 1: a vaccine. I know there's a few in trial, but like.
Speaker 2: I'm sure speed that up, yes, could? I think speeding
Speaker 2: that up would make an enormous difference. If we could
Speaker 2: treat it like rebella, that would be awesome. And then
Speaker 2: the other thing we could we should probably be doing,
Speaker 2: is definitely doing, is increasing people's knowledge of its existence
Speaker 2: and of the relatively simple and straightforward things that can
Speaker 2: be done in your home and in a childcare setting
Speaker 2: and in a kindergarten and in a pediatric sward to
Speaker 2: reduce transmission.
Speaker 1: All right, I think perhaps we'll call this the kick
Speaker 1: Public Health Annoyance Announcement.
Speaker 3: There's a thing called CMV, Yes, and.
Speaker 1: We want you to know about it.
Speaker 3: Yes.
Speaker 1: We hope we've helped you know more about it and
Speaker 1: what you can do to prevent it and not get
Speaker 1: it in the first place.
Speaker 2: Yes, And then we should return to this in a
Speaker 2: future a podcast. It would be fascinating to speak to someone,
Speaker 2: for example, who's maybe have been affected by by n
Speaker 2: natal CMV. And and also if there's if there's developments.
Speaker 1: Yeah, yeah, we'll come straight back and tell you if
Speaker 1: we've got a vaccine that is approved from one of
Speaker 1: the many trials that apparently are happening.
Speaker 2: Yeah, I think that might be a little way off,
Speaker 2: but but the you know, one day, we'll look back
Speaker 2: this at this as an issue that's been essentially solved.
Speaker 1: Yeah. Excellent. Al Right, everybody, thank you so much for listening.
Speaker 1: We really appreciate all the love that you give us
Speaker 1: on our reviews and in our dms. To know that
Speaker 1: we're helping is something that keeps us motivated and back
Speaker 1: at the mic. So keep them coming and other than that,
Speaker 1: we'll see you next week.
Speaker 3: Thanks for listening, everybody, Thanks for listening.
Speaker 1: Bye. Hey. Even though doctor Pat is well a doctor
Speaker 1: and we get lots of other doctors and other experts
Speaker 1: on our podcast, I just need to remind you that
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Speaker 1: is general in nature and may not apply to your
Speaker 1: specific situation. Please always consult with your own healthcare provider
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