title: Are female daycare workers at greater risk of cytomegalovirus infection? A secondary data analysis of CMV seroprevalence between 2010 and 2013 in Hamburg, Germany.
abstract: BACKGROUND
  Close contact with asymptomatic children younger than three years is a risk factor for a primary cytomegalovirus (CMV) infection. In pregnant women, such primary infection increases the risk of CMV-induced feto- or embryopathy. Daycare providers have therefore implemented working restrictions for pregnant daycare workers (DCWs) in accordance with legislation and guidelines for maternity protection. However, little is known about the infection risk for DCWs. We therefore compared the prevalence of CMV antibodies of pregnant DCWs to that of female blood donors (BDs).
  
  
  METHODS
  In a secondary data analysis, the prevalence of anti-CMV IgG among pregnant DCWs (N=509) in daycare centers (DCCs) was compared to the prevalence of female first-time BDs (N=14,358) from the greater region of Hamburg, Germany. Data collection took place between 2010 and 2013. The influence of other risk factors such as age, pregnancies and place of residence was evaluated using logistic regression models.
  
  
  RESULTS
  The prevalence of CMV antibodies in pregnant DCWs was higher than in female BDs (54.6 vs 41.5%; OR 1.6; 95%CI 1.3-1.9). The subgroup of BDs who had given birth to at least one child and who lived in the city of Hamburg (N=2,591) had a prevalence of CMV antibodies similar to the prevalence in pregnant DCWs (53.9 vs 54.6%; OR 0.9; 95%CI 0.8-1.2). Age, pregnancy history and living in the center of Hamburg were risk factors for CMV infections.
  
  
  CONCLUSIONS
  The comparison of pregnant DCWs to the best-matching subgroup of female first-time BDs with past pregnancies and living in the city of Hamburg does not indicate an elevated risk of CMV infection among DCWs. However, as two secondary data sets from convenience samples were used, a more detailed investigation of the risk factors other than place of residence, age and maternity was not possible. Therefore, the CMV infection risk in DCWs should be further studied by taking into consideration the potential preventive effect of hygiene measures.
authors.affiliation: Institute for Statutory Accident Insurance and Prevention in the Health and Welfare Services, Hamburg, Germany.
authors.forename: Johanna
authors.initials: J
authors.lastname: Stranzinger
authors.affiliation: University Medical Center Hamburg-Eppendorf, Institute for Health Services Research in Dermatology and Nursing, Hamburg, Germany.
authors.forename: Agnessa
authors.initials: A
authors.lastname: Kozak
authors.affiliation: University Medical Center Hamburg-Eppendorf, Institute for Health Services Research in Dermatology and Nursing, Hamburg, Germany.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Schilgen
authors.affiliation: Department for Occupational Health Service of the Administration of Hamburg, Hamburg, Germany.
authors.forename: Diana
authors.initials: D
authors.lastname: Paris
authors.affiliation: Central Institute for Transfusion Medicine, Hamburg, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Nießen
authors.affiliation: Central Institute for Transfusion Medicine, Hamburg, Germany.
authors.forename: Lutz
authors.initials: L
authors.lastname: Schmidt
authors.affiliation: State Institute for Food Safety, Health and Environment, Hamburg, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Wille
authors.affiliation: Saw Swee Hock School of Public Health, National University of Singapore, Singapore.
authors.forename: Norbert L
authors.initials: NL
authors.lastname: Wagner
authors.affiliation: Institute for Statutory Accident Insurance and Prevention in the Health and Welfare Services, Hamburg, Germany; University Medical Center Hamburg-Eppendorf, Institute for Health Services Research in Dermatology and Nursing, Hamburg, Germany.
authors.forename: Albert
authors.initials: A
authors.lastname: Nienhaus
keywords: CMV infection; daycare providers; daycare workers (DCWs); female blood donors; nursery educators