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