Working in a childcare or school setting may involve frequent exposure to children infected with communicable diseases.

Certain communicable diseases can have serious consequences for pregnant women and their unborn children. It is helpful if women know their medical history (which of the diseases listed below they have had and what vaccines they have received) when they are hired to work in a childcare or school setting. The childcare or school employers should inform employees of the possible risks to pregnant women and encourage workers who may become pregnant to discuss their occupational risks with a healthcare provider. These women should also be informed about measures to prevent infection with diseases that could harm their fetuses.

Per the CDC: These and other infections can pass to the fetus during pregnancy, or cause more severe illness to a pregnant woman (or person)

• Cytomegalovirus (CMV)
• Fifth disease (Parvovirus B19)
• Hand, Foot, and Mouth (Enteroviral Infections)
• Hepatitis B
• Human Immunodeficiency Virus (HIV/AIDS)
• Rubella (German Measles)
• Varicella-Zoster (Chickenpox and Shingles)

Pregnant women exposed to these diseases should notify their healthcare providers immediately.

All persons who work in childcare or school settings should know if they have had chickenpox or rubella disease or these vaccines. If they are unsure, they should have blood tests to see if they are immune. If they are not immune (have never had the disease or vaccine), they should strongly consider being vaccinated for chickenpox and rubella before considering or attempting to become pregnant.

Fact sheets for each of the above diseases are not included in this section.

1. What is CMV?

Cytomegalovirus (CMV) is a virus that infects 50% to 85% of adults in the United States by 40 years of age. Once a person has been infected with CMV, the virus remains in the body for life, typically in an inactive (latent) form. This disease may occur again in persons with weakened immune systems.

2. What illness does it cause?

Most healthy persons who acquire CMV have no symptoms. Occasionally people will develop mononucleosis-like symptoms such as fever, sore throat, fatigue, and swollen glands.

3. Is this illness serious?

For most healthy adults, CMV is not a problem. About 1% to 4% of uninfected women develop first-time CMV infection during their pregnancy. Healthy pregnant women are not at special risk for disease from CMV infection. When infected with CMV, most women have no symptoms and very few have a disease resembling mononucleosis. However, about one-third of women who become infected with CMV for the first time during pregnancy pass the virus to their unborn babies.

Each year in the United States, about 1 in 750 children are born with or develop disabilities as a result of congenital (meaning from birth) CMV infection. Most babies with congenital CMV never have health problems. However, some may eventually develop hearing and vision loss; problems with bleeding, growth, liver, spleen, or lungs; and mental disability. Sometimes health problems do not occur until months or years after birth. Of those with symptoms at birth, 80% to 90% will have problems within the first few years of life. Of those infants with no symptoms at birth, 5% to 10% will later develop varying degrees of hearing and mental or coordination problems.

CMV infection can be serious in people with weakened immune systems, such as persons infected with Human Immunodeficiency Virus (HIV), organ/bone marrow transplant recipients, chemotherapy/radiation patients, and people on steroids. Such persons are at risk for infection of the lungs (pneumonia), part of the eye (retinitis), the liver (hepatitis), the brain and covering of the spinal cord (meningoencephalitis), and the intestines (colitis). Death can occur.

4. I’ve recently been exposed to someone with CMV. How will this exposure affect my pregnancy?

As previously stated, since 50% to 85% of women have already been infected and are immune, being exposed will have no effect on their pregnancy. When a woman who has never had CMV becomes infected during pregnancy, there is potential risk that the infant may have CMV related problems. The risk increases if infection occurs in the first half of pregnancy.

5. I have had a blood test for CMV. What do the results of the blood test show?

Blood tests for CMV may show that you:

• Have already had the disease and do not need to be concerned. It is uncommon for the virus to become active again in someone who has had a previous infection and for the virus to cause infection in the unborn child.
• Have not had the disease. You may want to consider reducing your contact with children, especially those under 2 ½ years of age.
• Are currently experiencing an infection. You should discuss this with your healthcare provider.

6. If I develop CMV, what do I need to do about my pregnancy?

If you were exposed to CMV or develop signs and symptoms, you should consult your healthcare provider for information about diagnosis, possible lab tests, and follow-up.

7. Is there any way I can keep from being infected with CMV?

There is no preventive vaccine. Most people with CMV have no symptoms, but they can spread the virus in their urine, saliva, blood, tears, semen, and breast milk. So, throughout the pregnancy, practice good personal hygiene to reduce the risk of exposure to CMV.

• Wash your hands with soap and water after contact with diapers or saliva.
• DO NOT kiss children on the mouth or cheek. Instead, kiss them on the head or give them a hug.
• DO NOT share food, drinks, utensils (spoons or forks), or cups.
• Clean and sanitize items contaminated with saliva. Clean and disinfect items contaminated with urine.
• Female childcare or school workers who expect to become pregnant should consider being tested for antibodies to CMV. If antibody testing shows that the woman has not had CMV, contact with children less than age 2 1/2 (where the majority of virus circulates) should be reduced.

For more information, please contact your local health department.

Southern Nevada Health District (Clark County) 702-759-1300 (24 hours)

Northern Nevada Public Health  (Washoe County) 775-328-2447 (24 hours)

Carson City Health & Human Services (Carson City, Douglas, Lyon Counties) 775-887-2190 (24 hours)

Division of Public and Behavioral Health (All other Counties) 775-400-0333 (24 hours)

Email: dpbhepi@health.nv.gov

1. What is parvovirus B19?

Parvovirus B19 is a virus that commonly infects humans.

About 50% of all adults have been infected sometime during childhood or adolescence. Parvovirus B19 infects only humans. There are animal parvoviruses, but they do not infect humans. Therefore, a person cannot catch parvovirus B19 from a dog or cat.

2. What illnesses do parvovirus B19 infection cause?

The most common illness caused by parvovirus B19 infection is “fifth disease,” a mild rash illness that occurs most often in children. The ill child usually has an intense redness of the cheeks (a “slapped-cheek” appearance) and a lacy red rash on the trunk and limbs. Occasionally, the rash may itch. The child is usually not very ill. The rash resolves in 7 to 10 days. However, if the person is exposed to sunlight or heat, the rash may come back. Recovery from parvovirus infection produces lasting immunity and protection against future infection.

An adult who has not previously been infected with parvovirus B19 can be infected and have no symptoms or can become ill with a rash and joint pain and/or joint swelling. The joint symptoms usually go away in a week or two but may last several months.

3. Are these illnesses serious?

Fifth disease is usually a mild illness. It goes away without medical treatment among children and adults who are otherwise healthy. Joint pain and swelling in adults usually go away without long-term disability. During outbreaks of fifth disease, about 20% of adults and children are infected without getting any symptoms at all. However, the disease can be severe in children with sickle cell anemia, other blood disorders, or weakened immune systems and in pregnant women.

4. I have recently been exposed to someone with fifth disease. How will this exposure affect my pregnancy?

Typically, there are no serious complications for a pregnant woman or her baby following exposure to a person with fifth disease. About 50% of women are already immune to parvovirus B19, and these women and their babies are protected from infection and illness via natural immunity. If a woman is susceptible and gets infected with parvovirus B19, she usually experiences only a mild illness. Likewise, her unborn baby usually does not have any problems because of the parvovirus B19 infection.

Sometimes, however, parvovirus B19 infection will cause the unborn baby to have severe anemia and the woman may have a miscarriage. This occurs in less than 5% of all pregnant women who are infected with parvovirus B19 and occurs more commonly during the first half of pregnancy. There is no evidence that parvovirus B19 infection causes birth defects or intellectual disabilities.

5. What should I do about this exposure?

If you have been in contact with someone who has fifth disease or you have an illness that might be caused by parvovirus B19, you should discuss your situation with your healthcare provider. Your healthcare provider can do a blood test to see if you have become infected with parvovirus B19.

6. I have had a blood test for parvovirus B19. What do the results show?

A blood test for parvovirus B19 may show that you:

• Are immune to parvovirus B19 and have no sign of recent infection. This means have protection against parvovirus B19.
• Are not immune and have not yet been infected. You may wish to avoid further exposure during your pregnancy.
• Have had a recent infection. You should discuss this with your healthcare provider.

7. If I am infected, what do I need to do about my pregnancy?

Some healthcare providers treat a parvovirus B19 infection in a pregnant woman as a low-risk condition and continue to provide routine prenatal care. Other healthcare providers may increase the frequency of doctor visits and perform blood tests and ultrasound examinations to monitor the health of the unborn baby.

If the unborn baby appears to be ill, there are special diagnostic and treatment options available. Your obstetrician will discuss these options with you and their potential benefits and risks.

8. Is there a way I can keep from being infected with parvovirus B19 during my pregnancy?

There is no vaccine or medicine that can prevent a parvovirus B19/ Fifth disease infection. Frequent hand washing is recommended as a practical and effective method to reduce the spread of parvovirus. Excluding persons with fifth disease from work, childcare centers, schools, or other settings is not likely to prevent the spread of parvovirus B19, since ill persons are only contagious before they develop the characteristic rash.

The Centers for Disease Control and Prevention (CDC) do not recommend that pregnant women routinely be excluded from a workplace where a fifth disease outbreak occurs. The CDC considers this to be a personal decision for the woman after discussion with her family, healthcare provider, and employer.

For more information, please contact your local health department.

Southern Nevada Health District (Clark County) 702-759-1300 (24 hours)

Northern Nevada Public Health  (Washoe County) 775-328-2447 (24 hours)

Carson City Health & Human Services (Carson City, Douglas, Lyon Counties) 775-887-2190 (24 hours)

Division of Public and Behavioral Health (All other Counties) 775-400-0333 (24 hours)

Email: dpbhepi@health.nv.gov

1. What viruses are in the enterovirus group?

The enterovirus groups consist of 24 group-A coxsackieviruses, 6 group-B coxsackieviruses, 34 echoviruses, and 5 enteroviruses. Infection with an enterovirus results in immunity to that specific virus, but not to other viruses of the enterovirus group.

2. What illness does it cause?

Hand, foot, and mouth disease (HFMD) is a common illness of infants and young children. Symptoms include low-grade fever that may last 1 to 2 days, runny nose and/or sore throat. Blister-like rash occurs in the mouth, on the sides of the tongue, inside the cheeks, and on the gums. These sores may last 7 to 10 days. Blister-like rash may occur on the palms and fingers of the hands and on the soles of the feet. The disease is usually self-limited, but in rare cases has been fatal in infants.

3. Is HFMD illness serious?

HFMD illness is usually not serious. HFMD caused by coxsackievirus A16 infection is a mild disease and nearly all patients recover without medical treatment in 7 to 10 days. Complications are uncommon. Rarely, the patient with coxsackievirus A16 infection may also develop “aseptic” or viral meningitis, in which the person has fever, headache, stiff neck, or back pain, and may need to be hospitalized for a few days. Another cause of HFMD, enterovirus 71 (EV71) may also cause viral meningitis and, rarely, more serious diseases, such as encephalitis, or a poliomyelitis-like paralysis. EV71 encephalitis may be fatal. Newborns without maternal antibody who acquire this infection are at risk for serious disease with a high mortality rate.

4. I have recently been exposed to someone with enteroviruses. How will this exposure affect my pregnancy?

Enteroviruses, including those causing HFMD, are very common. Therefore, pregnant women are frequently exposed to them, especially during summer and fall months. Most enteroviral infections during pregnancy cause mild or no illness in the mother. Currently there is no clear evidence that maternal enteroviral infection causes adverse outcomes of pregnancy such as abortion, stillbirth, or congenital defects; however, mothers infected shortly before delivery may pass the virus to the newborn. Babies born to mothers who have symptoms of enteroviral illness around the time of delivery are more likely to be infected. Most newborns infected with an enterovirus have mild illness. There have been rare cases, where a newborn developed an infection of many organs, including the liver and heart, and die from the infection. The risk of this severe illness in newborns is higher during the first two weeks of life.

5. If I develop HFMD, what do I need to do about my pregnancy?

If you were exposed to HFMD, consult your healthcare provider for information about diagnosis, possible lab tests, and follow-up.

6. Is there any way I can keep from being infected with HFMD?

There is no preventive vaccine. Most people with HFMD have no or few symptoms, but they can spread the viruses in secretions from the nose or mouth and in stool. Specific prevention for HFMD or other non-polio enterovirus infections is not available, but the risk of infection can be lowered by good hygienic practices.

7. So throughout the pregnancy, practice good personal hygiene to reduce the risk of exposure to enteroviruses:

• Wash your hands with soap and water after contact with diapers and secretions from the nose or mouth.
• DO NOT kiss children on the mouth.
• DO NOT share food, drinks, or utensils (spoons or forks), or cups.
• Clean and sanitize items contaminated with secretions from the nose or mouth. Clean and disinfect items contaminated with stool.

For more information, please contact your local health department.

Southern Nevada Health District (Clark County) 702-759-1300 (24 hours)

Northern Nevada Public Health  (Washoe County) 775-328-2447 (24 hours)

Carson City Health & Human Services (Carson City, Douglas, Lyon Counties) 775-887-2190 (24 hours)

Division of Public and Behavioral Health (All other Counties) 775-400-0333 (24 hours)

Email: dpbhepi@health.nv.gov

1. What is hepatitis B and what illness does this cause?

Hepatitis B is a viral illness. The hepatitis B virus infects the liver and can cause serious disease. Persons who are newly infected with hepatitis B virus (acute infection) may develop symptoms such as loss of appetite, tiredness, stomach pain, nausea, vomiting, dark (tea or cola-colored) urine, light-colored stools, and sometimes rash or joint pain. Jaundice (yellowing of eyes or skin) may also be present. Some people have no symptoms at all and may not know they have been infected. If the virus is present for more than six months, the person is considered to have a chronic (lifelong) infection. Persons infected with the hepatitis B virus, can spread the virus to other people. All pregnant women should be tested for hepatitis B virus early in their pregnancy, and testing should be done with each new pregnancy.

2. Is hepatitis B serious?

Most people who have an acute infection recover without problems.  A small number (6% to 10%) of infected people will develop chronic infection. Most people who are chronically (lifelong) infected have no symptoms and feel healthy but there are people who develop non-specific symptoms at times when the virus is reproducing causing liver problems. People with lifelong hepatitis B infection can develop cirrhosis of the liver, liver cancer, and/or liver failure, which can lead to death.

3. If I have been exposed to someone infected with the hepatitis B virus, what should I do?

An exposure is defined as contact with blood or other body fluids of an infected person. Contact includes touching the blood or body fluids when you have open cuts or wounds (that are less than 24 hours old), splashing blood or bloody body fluids into the eyes or mouth, being stuck with a needle or other sharp object that has blood on it, or having sex or sharing needles with someone with the hepatitis B virus. A baby can get hepatitis B from its infected mother during childbirth. It is not spread through food or water or by casual contact (e.g., shaking hands or kissing the face of a person who is infected with hepatitis B).

Anyone who has an exposure to a person infected with hepatitis B virus should have blood tests done as soon as possible to determine whether treatment is needed.

At the time of exposure, persons who have never had the disease or vaccine (susceptible to the virus) should receive a dose of hepatitis B immune globulin (HBIG) and the first dose of hepatitis B vaccine. Doses two and three of the vaccine series should be completed per the recommended vaccine schedule that your healthcare provider will explain to you. In some cases, people who have already been vaccinated may be tested and/or revaccinated.

4. How will this exposure affect my pregnancy?

If you have hepatitis B virus in your blood, you can pass hepatitis B to your baby during the birthing process. If the mother develops acute hepatitis in the third trimester of pregnancy or the immediate postpartum period, the risk of infection for the newborn baby may be 60% to 70%. It is very important that the baby receive treatment right after birth to get as much protection as possible. About 90% of infected infants will develop chronic infection. They may have the virus for the rest of their lives and be a source to spread the disease. There may be long term effects from acquiring hepatitis B as a newborn.

5. Can anything be done to protect my baby?

If the blood test is positive for hepatitis B virus, the baby should receive the first dose of hepatitis B vaccine along with a shot of HBIG within the first 12 hours of life. The vaccine series should be completed on time. Check with your healthcare provider for the schedule for dose 2 and dose 3 of the vaccine. Once the baby has turned 1 year of age, the baby should have a blood test to make sure infection did not occur and that the vaccine is protecting the baby.

6. I have had a blood test for hepatitis B. What do the results of the blood test show?

The blood test for hepatitis B may show that you:

• Are immune (had hepatitis B disease or vaccine in the past) and have no sign of recent infection. You are protected and do not need to worry about hepatitis B.
• Are not immune and have not yet been infected. You should receive the hepatitis B vaccine series if you are at risk of blood exposures at your job or through risk behaviors in your personal life. Talk to your healthcare provider about this.
• Have had a recent infection. Discuss the situation with your healthcare provider.
• Have chronic infection. Talk to your healthcare provider about regular medical evaluation and monitoring.

7. Is there a way I can keep from being infected with hepatitis B during my pregnancy?

Yes, get vaccinated. It is safe to get hepatitis B vaccine while you are pregnant.

In the meantime:

• Wear gloves when handling blood and body fluids.
• Clean and disinfect contaminated objects or surfaces and wear gloves. (See pages IV-4 and IV-5.)
• Wash hands after removing gloves.
• DO NOT share personal care items, such as toothbrushes, razors, or nail clippers.
• If your sexual partner is infected with hepatitis B virus, use latex condoms during intercourse.
• DO NOT share needles to inject drugs or to perform tattoos or body piercings.

For more information, please contact your local health department.

Southern Nevada Health District (Clark County) 702-759-1300 (24 hours)

Northern Nevada Public Health  (Washoe County) 775-328-2447 (24 hours)

Carson City Health & Human Services (Carson City, Douglas, Lyon Counties) 775-887-2190 (24 hours)

Division of Public and Behavioral Health (All other Counties) 775-400-0333 (24 hours)

Email:  dpbhepi@health.nv.gov

1. What is HIV?

Human immunodeficiency virus (HIV) is a virus that attacks the body’s immune system allowing other infections to occur. Advanced HIV infection is called Acquired Immunodeficiency Syndrome (AIDS).

HIV can be spread when the body fluids (blood, semen, vaginal fluids, and breast milk) of an infected person enter your body. In adults, the virus is most often spread through sexual contact or by sharing needles. Most children who are infected get the virus from their infected mothers during pregnancy, at the time of birth, or through breastfeeding. With the current screening guidelines, spread through blood transfusion is rare.

2. I have recently been exposed to someone with HIV. What should I do?

An exposure is defined as direct contact with the blood or body fluids of an infected person. Contact includes touching the blood or body fluids when you have open cuts or wounds (that are less than 24 hours old), splashes of blood or body fluids into the eyes or mouth, being stuck with a needle or other sharp object that has blood on it or having unprotected sex or sharing needles with someone with HIV. A baby can get HIV from its infected mother during childbirth and from drinking breast milk from an infected mother.

Everyone who has an exposure to a person infected with HIV should have a blood test to determine whether or not they have been infected with the virus. The test should be repeated 3 months after exposure to completely rule out infection.

3. How will this exposure affect my pregnancy?

All pregnant women should be tested for HIV early in their pregnancy. If a woman is infected with HIV during her pregnancy, there is a chance that she could give the infection to her baby. About 25% of babies of infected mothers who do not receive antiretroviral treatment become infected, whereas, about 2% become infected when the mother receives antiretroviral treatment. The infant can become infected anytime during pregnancy, but infection usually happens just before or during delivery. Women who are infected with HIV should not breastfeed their babies, as HIV can be transmitted via breast milk.

HIV infection can be diagnosed in most infants by 1 month of age, and in all infants by 6 months using special viral diagnostic tests. These tests look for the HIV virus produced by the body instead of antibodies to the virus; most adults are diagnosed using an antibody test. Because newborns have some of their mother’s antibodies to HIV in their blood for a time, the special tests need to be used.

4. How can I tell if I’m infected with HIV?

The only way to determine whether you are infected is to be tested for HIV infection. You cannot rely on symptoms to know whether or not you are infected with HIV. Most people who are infected with HIV do not have any symptoms for many years.

5. What are the HIV/AIDS symptoms?

The symptoms listed below are not specific for HIV and may have other causes. Most persons with HIV have no symptoms for several years. The only way to determine whether you are infected is to be tested for HIV infection.

Early symptoms (weeks to months after exposure):

• Flu-like illness
• Swollen lymph nodes
• Rash

Late symptoms (years after exposure):

• Persistent fevers
• Night sweats
• Prolonged diarrhea
• Unexplained weight loss
• Purple bumps on skin or inside the mouth and nose
• Chronic fatigue
• Swollen lymph nodes
• Recurrent respiratory infections

6. I have had a blood test for HIV. What do the results of my blood test mean?

There are several steps to test for HIV. They are all done on the same sample. First an enzyme immune assay (EIA) is performed. If negative, the person has no HIV antibodies. If the EIA is positive, a Western blot test is done to confirm the result. The person is considered HIV infected if the Western blot is positive. Early in the infection it is possible to have a positive EIA and a negative Western blot test, so some people may need to have further testing or retesting in a month’s time.

7. Is there a way I can keep from being infected with HIV during my pregnancy?

• Use latex condoms during sex. Limit the number of partners.
• Wear gloves when handling blood and body fluids.
• Clean and disinfect contaminated objects or surfaces and wear gloves. (See pages IV-4 and IV-5.)
• Wash hands after removing gloves.
• DO NOT share personal care items, such as toothbrushes, razors, or nail clippers.
• DO NOT share needles to inject drugs or to perform tattoos or body piercings.

For more information, please contact your local health department.

Southern Nevada Health District (Clark County) 702-759-1300 (24 hours)

Northern Nevada Public Health  (Washoe County) 775-328-2447 (24 hours)

Carson City Health & Human Services (Carson City, Douglas, Lyon Counties) 775-887-2190 (24 hours)

Division of Public and Behavioral Health (All other Counties) 775-400-0333 (24 hours)

Email: dpbhepi@health.nv.gov

1. What is rubella?

Rubella (German measles) is usually a mild viral infection.

Symptoms include generalized skin rash, tiredness, headache, fever, and swollen glands in the area behind the ears and the neck (lymphadenopathy). It is estimated that 25% to 50% of persons infected with rubella may not have any symptoms.

2. What illness does rubella infection cause? Is this illness serious?

Rubella is usually a mild illness. There may be severe illness in adults who have not had the disease in the past or have not had the vaccine. Joint stiffness and/or joint pain may occur in up to 70% of adult women infected with rubella. Some of the other problems that may occur include a bleeding problem called thrombocytopenia and an infection of the brain (encephalitis). If a woman gets rubella during her pregnancy, congenital rubella syndrome (CRS) may occur and result in miscarriage, stillbirth, and severe birth defects. A baby with CRS may have blindness, heart defects, deafness, and mental retardation.

3. I have been exposed to someone with rubella. How will this exposure affect my pregnancy?

It is recommended that all women be tested for rubella early in their pregnancy. An estimated 90% of young adults in the U.S. are immune to rubella (most likely through vaccination). If you are immune (vaccinated) and have been exposed, there is no concern. However, about 25% of babies whose mothers get rubella during the first three months of her pregnancy are likely to develop a fetal infection and are likely to have congenital rubella syndrome (CRS) as described above. After the 20th week of pregnancy if a woman develops rubella, most likely there will not be any problems for either the mother or the unborn baby.

4. What should I do about this exposure?

If you know that you are immune to rubella (have had a blood test to show that you have antibodies to rubella via vaccine or past illness), you do not need to be concerned about the exposure. If you are not immune to rubella and have been exposed to someone with rubella or have developed a rash illness that might be rubella, you should call your healthcare provider. They will do a blood test to see if you have become infected with the virus.

5. I have had a blood test for rubella. What do the results of the blood test show?

The blood test for rubella may show that you:

• Are immune (had rubella disease or vaccine in the past) and have no sign of recent infection. You are protected from rubella.
• Are not immune and have not yet been infected. You may wish to avoid anyone with rubella during your pregnancy
• Have or had a recent infection. You should discuss what the risks are based on your stage of pregnancy with your healthcare provider.

6. If I’m infected or have been exposed, what do I need to do about my pregnancy?

Talk to your healthcare provider. Recommendations will depend on the stage of your pregnancy.

7. Is there a way I can keep from being infected with rubella during my pregnancy?

If you are not pregnant and not immune, all adults working with children should know their vaccine history or immune status. If you are not immune, you should be vaccinated with MMR (measles, mumps, and rubella) vaccine.

When you are given the vaccine, you should avoid becoming pregnant for at least one month after immunization. Rubella vaccine should not be given to pregnant women.

If you are pregnant, you should receive MMR vaccine after your baby is delivered.

For more information, please contact your local health department.

Southern Nevada Health District (Clark County) 702-759-1300 (24 hours)

Northern Nevada Public Health  (Washoe County) 775-328-2447 (24 hours)

Carson City Health & Human Services (Carson City, Douglas, Lyon Counties) 775-887-2190 (24 hours)

Division of Public and Behavioral Health (All other Counties) 775-400-0333 (24 hours)

Email: dpbhepi@health.nv.gov

Many studies have shown the benefits of breastfeeding.

This section is not intended to discourage breastfeeding or bottle feeding of breast milk in childcare or school settings. These guidelines are provided to prevent transmission of infectious organisms that may be contained in breast milk.

1. General information

Breast milk is a bodily fluid. The transmission of HIV from mother to infant through breastfeeding is well documented. Women who have HIV infection are advised not to breastfeed their infants. Breastfeeding is not contraindicated for infants born to mothers who are infected with hepatitis B virus or mothers who are infected with hepatitis C virus.

2. Prevention of exposures

• Place expressed milk in a clean and sanitary bottle; bottles made of plastics containing BPA or phthalates should be avoided.
• Store each child’s expressed breast milk in a bottle or container designated only for that child. Each bottle should be clearly labeled with the child’s first and last name as well as the date.
• Pumped milk should be either immediately stored in the refrigerator (if planned to be used in the next 3-5 days) or frozen for longer storage (3-6 months). Upon arrival at a day care center, ensure the milk is dated and immediately refrigerated.
• Warm each child’s bottle of breast milk in its own separate labeled container using a bottle warmer or under warm running water so that the temperature does not exceed 98.6° F.
• Each mother’s expressed milk should only be used for her own infant; therefore, confirm each child’s identity before feeding to prevent potential exposure to another mother’s breast milk.
• Do not save any unused or leftover milk.
• Expressed human milk that is in an unsanitary bottle, is curdled, smells rotten, and/or has been improperly stored should not be used; it should be discarded, and the mother educated as to proper safe handling and storage of expressed breast milk – http://www.cdc.gov/breastfeeding/recommendations/handling_breastmilk.htm

3. Staff prevention

• Wear gloves during the feeding if open cuts, sores, or cracked skin are present on your hands or breasts.
• If breast milk is spilled on the skin wash the area with soap and warm water as soon as possible. Once breast milk has been digested and spit up, there should not be any live virus in it because of the enzymes in the child’s digestive system.
• Do not rinse bottles that contained breast milk to prevent splashing of breast milk into your eyes. Parents or caregivers should clean and sterilize the bottles/containers at home.
• Clean up spilled breast milk. Wear gloves to clean the area, and then sanitize the area.

4. Follow-up of exposures

If a child has been mistakenly fed another child’s bottle of expressed breast milk, the possible exposure to HIV or other infectious diseases should be treated just as if an accidental exposure to other body fluids had occurred.

CDC GUIDANCE: http://www.cdc.gov/breastfeeding/recommendations/other_mothers_milk.htm

• Inform the parents of the child who was given the wrong bottle that:
  • Their child was accidentally given another child’s bottle of expressed breast milk.
  • Inform them that the risk of transmission of HIV is very small.
  • Encourage the parents to notify their child’s healthcare provider and ask about whether their child needs to have an HIV test.
  • Provide the family with detailed information regarding the expressed milk (e.g., when was it expressed, how was it stored, how much did they child consume, and any additional information that has been obtained).
• Inform the mother who expressed the breast milk that the bottles were switched and ask:
  • When was the breast milk expressed and how it was handled prior to being brought to the childcare center?
  • If she has been tested previously for HIV, and if so, would she be willing to share the results with parents of the child given the incorrect milk?
  • If not tested previously for HIV, would she be willing to be tested for HIV and share the results with the other parents?
• The risk of an infant becoming infected with HIV after one feeding of breast milk from an HIV positive mother is thought to be extremely low. Factors relating to the risk of spread are unknown but may include:

– repeated or prolonged exposure to breast milk containing the virus

– amount of HIV in the breast milk

– infant exposure to blood while breast feeding (e.g., blood from a mother’s cracked nipples)

– the presence of mouth sores in the infant

– transmission of HIV from a single breast milk exposure has never been documented.

These conditions are less likely to occur in the childcare setting. Additionally, chemical properties in breast milk act together with time and cold temperatures to destroy HIV that may be present in expressed breast milk.

The risk to staff exposed to HIV from breast milk is very low because the risk of spread from skin/mucous membrane exposures is extremely low.

• The following constitutes an exposure if breast milk gets:

– Spilled onto cuts, breaks in the skin, or sores less than 24 hours old.

– Splashed into the eyes or mouth.

Modified from What to do if an Infant or Child is Mistakenly Fed Another Woman’s Expressed Breast Milk, Centers for Disease Control and Prevention, 2009.

For more information, please contact your local health department.

Southern Nevada Health District (Clark County) 702-759-1300 (24 hours)

Northern Nevada Public Health  (Washoe County) 775-328-2447 (24 hours)

Carson City Health & Human Services (Carson City, Douglas, Lyon Counties) 775-887-2190 (24 hours)

Division of Public and Behavioral Health (All other Counties) 775-400-0333 (24 hours)

Email: dpbhepi@health.nv.gov

1. What is varicella-zoster?

Varicella-zoster is a herpes virus that causes chickenpox, a common childhood illness.

It is highly contagious, but rarely serious for most children. However, if an adult develops chickenpox the illness may be more severe. After a person has had chickenpox, the varicella zoster virus can remain inactive in the body for many years. Herpes zoster (shingles) occurs when the virus becomes active again.

2. What illnesses does varicella-zoster cause?

Chickenpox first occurs as a blister-like skin rash and fever. The sores commonly occur in batches with different stages (bumps, blisters, and sores) present at the same time. Typically, the blisters scab over in 5 days. Children with weakened immune systems may have blisters occurring for a prolonged time period. Adults can develop severe pneumonia and other serious complications.

Shingles occurs when the virus, which has been inactive for some time, becomes active again. Severe pain and numbness along nerve pathways, commonly on the trunk or on the face, are present. Clusters of blisters appear 1 to 3 days later. The blisters are usually on one side of the body and closer together than in chickenpox. Shingles does not spread as shingles from one person to another. If people who have never had chickenpox have contact with the fluid from the shingles blisters, they can develop chickenpox.

3. Are chickenpox and shingles serious illnesses?

The symptoms may be more severe in newborns, persons with weakened immune systems, and adults. Serious problems can occur and may include pneumonia (bacterial and viral), brain infection (encephalitis), and kidney problems.

4. I have recently been exposed to someone with chickenpox. How will this exposure affect my pregnancy?

If you have already had chickenpox, there is no risk. Most adults in the U.S. (90% to 95%) have had chickenpox and are immune.

If you have never had chickenpox and you get chickenpox during the:

• First half (about 20 weeks) of your pregnancy, there is a very slight risk (0.4% to 2%) for birth defects or miscarriage.
• Second half of your pregnancy, the baby may have infection without having any symptoms and then get shingles (zoster) later in life.
• Five days before to 2 days after the delivery, it is likely the baby will get chickenpox. A preventive treatment is available for these babies; it is called Varicella-Zoster immune globulin (VZIG).

5. What should I do about this exposure?

If you have been in contact with someone with chickenpox or shingles or if you have a rash-associated illness that might be chickenpox or shingles, discuss your situation with your healthcare provider. Blood tests may be done to see if you have become infected with the virus or have had the disease in the past. If you are pregnant and not immune and have been exposed to chickenpox or shingles, call your healthcare provider immediately. You must seek care from a healthcare provider within 72 hours of exposure to benefit from VZIG.

6. I have had a blood test for chickenpox. What do the results of the blood test show?

The blood test for VZV may show that you:

• Are immune (have already had varicella disease or varicella vaccine) and have no sign of recent infection. You have nothing further to be concerned about.
• Are not immune and have not yet been infected. You may wish to avoid anyone with chickenpox during your pregnancy.
• Have or recently had an infection. You should discuss what the risks are for your stage of pregnancy with your healthcare provider.

7. If I develop chickenpox or shingles, what do I need to do about my pregnancy?

Talk to your healthcare provider. Recommendations will be made based on the stage of your pregnancy. No cases of fetal infection or damage have been reported for women who develop shingles during pregnancy.

8. Is there a way I can keep from being infected with chickenpox?

If you are not pregnant and not immune, all adults working with children should know their vaccine history or immune status. If you are not immune, you should be vaccinated. You will receive two doses of varicella (chickenpox) vaccine one month apart.

You should avoid becoming pregnant for at least one month after the last vaccination. Varicella vaccine should not be given to pregnant women.

If you are pregnant, have your healthcare provider give you the varicella vaccine after your baby is delivered.

For more information, please contact your local health department.

Southern Nevada Health District (Clark County) 702-759-1300 (24 hours)

Northern Nevada Public Health  (Washoe County) 775-328-2447 (24 hours)

Carson City Health & Human Services (Carson City, Douglas, Lyon Counties) 775-887-2190 (24 hours)

Division of Public and Behavioral Health (All other Counties) 775-400-0333 (24 hours)

Email: dpbhepi@health.nv.gov