cmv is the most common congenital infection in the united states , 
 affecting as many as 40 000 newborns each year . approximately , 10% of these infants are symptomatic at birth and most of these will suffer permanent 
 neurologic sequelae such as neurodevelopmental delays , motor 
 disabilities , deafness , and blindness [ 25 ] . although 
 most infants appear asymptomatic at birth , 10% to 15% of them 
 will develop progressive hearing loss . more children are 
 affected by congenital cmv - related disabilities than by other , 
 better - known childhood diseases , and syndromes , such as fetal 
 alcohol syndrome , down 's syndrome , and neural tube defects 
 [ 2 , 7 ] . most congenital cmv infections and related disabilities result 
 from primary ( ie , first - time ) infections in pregnant women 
 . many maternal cmv infections might be prevented by 
 simple hygienic precautions , such as frequent and thorough hand 
 washing [ 7 , 9 ] . despite this opportunity to prevent infection 
 in mothers and subsequent disability in their children , anecdotal 
 evidence suggests that the general public has little awareness or 
 knowledge of cmv . to further investigate this evidence , and to 
 improve the knowledge base for developing effective interventions , 
 we designed a survey to evaluate awareness and knowledge of cmv 
 among women . we conducted a survey of congenital cmv awareness at 7 different 
 geographic locations : atlanta , ga ; birmingham , al ; cleveland , oh ; 
 provo , ut ; richmond , va ; chicago , il ; and houston , tx . at the 
 first four sites , women were recruited from pediatric outpatient 
 clinic waiting rooms . in richmond , women were recruited from an 
 obstetrics / gynecology clinic . in chicago , women were recruited 
 from a university 's student union center . in houston , the women 
 who participated in the survey were medical students and support 
 staff in a hospital . at each site , we asked all women aged  
 18 years , who were literate in english or spanish , to complete the 
 short , self - administered written survey . women were told that the 
 survey would assess their knowledge of newborn infections but not 
 that it was designed specifically to assess knowledge of 
 congenital cmv . the survey assessed demographic information , 
 awareness of cmv , risk factors , modes of transmission , prevention 
 of cmv infection , and symptoms of cmv disease . the survey also 
 collected information about healthcare and prenatal visits , 
 parenting behaviors , and awareness of other birth defects and 
 childhood illnesses . when the women returned their completed 
 surveys , they were given a brochure about congenital cmv . the 
 study was approved by the human subjects review boards of the 
 institutions involved . we aimed to survey approximately 100 women at each of the study 
 sites ( table 1 ) . of the 643 women surveyed , 142 ( 22% ) 
 had heard of congenital cmv . among other birth defects and 
 childhood illnesses that were included in the survey , women 's 
 awareness of congenital cmv ranked last ( figure 1(a ) ) . in univariate analyses , awareness of cmv increased with higher 
 levels of education ( p - value for trend < .0001 ) , older age 
 ( p - value for trend = .02 ) , and varied by study site , with 
 awareness being highest in houston and birmingham and lowest in 
 chicago ( table 1 ) . in addition , women who were 
 currently or previously employed in healthcare professions were 
 more likely to have heard of cmv than those who had never worked 
 in the health field ( 56% versus 16% , or = 6.7 [ 4.310.6 ] ) . on the other hand , there was no significant 
 difference in awareness of cmv between women who were currently or 
 previously employed as a daycare worker . there was also no 
 significant difference in cmv awareness between women who had 
 never been pregnant and women who had been pregnant . there were no 
 significant differences in awareness of cmv by income or 
 race / ethnicity . after adjusting for other covariates in 
 multivariate analyses , awareness was still associated with higher 
 level of education and having been a healthcare professional , but 
 was no longer associated with older age ( table 2 ) . cmv knowledge among women who had heard of cmv among the 142 ( 22% ) women who had heard of cmv , there was a low 
 level of accurate knowledge about cmv . the majority of these 
 respondents could not correctly identify the symptoms associated 
 with congenital cmv disease ( table 3 ) . approximately , 
 one third ( 36% , 48/133 ) also indicated that congenital cmv could 
 cause congenital heart defect , a symptom not associated with 
 congenital cmv . although women who had heard of cmv appeared to lack knowledge 
 about cmv and its symptoms , most women indicated ( 78% , 109/140 ) 
 that a pregnant woman could pass cmv to her unborn baby . more than 
 half ( 57% , 78/138 ) indicated that the spread of cmv could be 
 reduced by frequent hand washing . however , nearly one quarter 
 ( 23% , 83/137 ) incorrectly believed that cmv could be prevented by 
 avoiding cleaning cat litter boxes . concerning source of 
 knowledge , 54% of women indicated that they had heard about 
 congenital cmv from a healthcare professional 
 ( table 4 ) . we aimed to survey approximately 100 women at each of the study 
 sites ( table 1 ) . of the 643 women surveyed , 142 ( 22% ) 
 had heard of congenital cmv . among other birth defects and 
 childhood illnesses that were included in the survey , women 's 
 awareness of congenital cmv ranked last ( figure 1(a ) ) . in univariate analyses , awareness of cmv increased with higher 
 levels of education ( p - value for trend < .0001 ) , older age 
 ( p - value for trend = .02 ) , and varied by study site , with 
 awareness being highest in houston and birmingham and lowest in 
 chicago ( table 1 ) . in addition , women who were 
 currently or previously employed in healthcare professions were 
 more likely to have heard of cmv than those who had never worked 
 in the health field ( 56% versus 16% , or = 6.7 [ 4.310.6 ] ) . on the other hand , there was no significant 
 difference in awareness of cmv between women who were currently or 
 previously employed as a daycare worker . there was also no 
 significant difference in cmv awareness between women who had 
 never been pregnant and women who had been pregnant . there were no 
 significant differences in awareness of cmv by income or 
 race / ethnicity . after adjusting for other covariates in 
 multivariate analyses , awareness was still associated with higher 
 level of education and having been a healthcare professional , but 
 was no longer associated with older age ( table 2 ) . cmv knowledge among women who had heard of cmv among the 142 ( 22% ) women who had heard of cmv , there was a low 
 level of accurate knowledge about cmv . the majority of these 
 respondents could not correctly identify the symptoms associated 
 with congenital cmv disease ( table 3 ) . approximately , 
 one third ( 36% , 48/133 ) also indicated that congenital cmv could 
 cause congenital heart defect , a symptom not associated with 
 congenital cmv . although women who had heard of cmv appeared to lack knowledge 
 about cmv and its symptoms , most women indicated ( 78% , 109/140 ) 
 that a pregnant woman could pass cmv to her unborn baby . more than 
 half ( 57% , 78/138 ) indicated that the spread of cmv could be 
 reduced by frequent hand washing . however , nearly one quarter 
 ( 23% , 83/137 ) incorrectly believed that cmv could be prevented by 
 avoiding cleaning cat litter boxes . concerning source of 
 knowledge , 54% of women indicated that they had heard about 
 congenital cmv from a healthcare professional 
 ( table 4 ) . to our knowledge , this was the first survey to examine women 's 
 knowledge of congenital cmv . of the women surveyed , only 22% 
 had heard of congenital cmv and very few had specific knowledge 
 about clinical symptoms , modes of transmission , or prevention . there was a tremendous gap between cmv knowledge and congenital 
 cmv disease burden ( figure 1)women 's awareness of 
 cmv ranked last among other birth defects and common childhood 
 illnesses despite cmv being one of the most common and most 
 serious causes of birth defects and disabilities . in order to bridge this gap our survey indicated that healthcare professionals 
 play the most important role in informing women about cmv 
 ( table 4 ) . yet , only a little over half of women who 
 were working or had worked in the healthcare field were aware of 
 congenital cmv . women did not specify what type of healthcare work 
 they had done , and many might have done work that required no 
 cmv - related knowledge or training . nevertheless , the lack of 
 awareness among healthcare professionals shows that there is 
 considerable room for improvement . the curricula of medical , 
 nursing , and midwifery schools should emphasize the importance of 
 educating pregnant women about congenital cmv prevention through 
 improved hand hygiene , as recommended by the american college of 
 obstetrics and gynecology ( acog ) . surveys should be 
 conducted of healthcare providers ' knowledge and practices 
 relating to congenital cmv , including how well 
 providers adhere to these acog recommendations . the survey revealed that women who were currently working or had 
 worked in daycare centers were no more aware of congenital cmv 
 than those who had never worked in a daycare setting . prevalence 
 of cmv in daycare centers is relatively high due to horizontal 
 spread , and women who work with children in this setting 
 have a higher risk of acquiring cmv infection . day care workers 
 should be informed of the risk of acquiring cmv infection and 
 possible effects on the unborn child , as well as strategies for 
 reducing risk of infection . many women also indicated that they were informed about cmv 
 through school or class . information about cmv should be included 
 in secondary - school health curricula and in childbirth courses for 
 expecting parents . although educational messages need to target 
 all women , a special effort should be made to reach women of lower 
 educational levels , since their awareness was the lowest . it is important that books and magazines  another key source of 
 cmv information identified by our survey  contain better cmv 
 information than is currently available . many pregnancy books 
 contain little information on cmv , and sometimes their information 
 is inaccurate . for example , although studies show relatively high 
 rates of transmission from young children to parents , 
 one popular pregnancy book states that  pregnant women 
 with toddlers of their own need not worry about catching cmv ; the 
 possibility is extremely remote . such inaccuracies might be 
 reduced by consulting physicians who are experts on congenital cmv 
 infection , or by including information from other reliable 
 sources , such as acog   or the centers for disease control 
 and prevention ( cdc ) . the cmv prevention guidelines that pregnant women should receive 
 from healthcare providers , books , magazines , websites , and other 
 media should be straightforward and have a special focus on 
 improved hand hygiene ( figure 2 ) . examples of 
 these guidelines can be found at websites such as 
 http://www.cdc.gov/cmv and 
 http://www.bcm.edu/pedi/infect/cmv . risk of cmv infection is likely to be reduced by adherence to 
 these guidelines , and pregnant women have proven 
 receptive to other behavior changes that protect their babies 
 [ 9 , 1319 ] . in our survey , for example , nearly 
 all women reported that during their latest pregnancy , they took 
 prenatal vitamins on a regular basis ( 90% ) and did not drink 
 alcohol ( 94% ) . further research is needed to assess which 
 prevention messages work best for cmv and which educational 
 interventions are most effective . the questionnaire 
 was not pretested to eliminate ambiguous questions , and some of 
 the respondents did not follow directions when answering 
 questions . another limitation was that the survey was a 
 convenience sample that may not represent all women in the us . for example , the lower awareness in chicago was 
 probably due to the women being young , college students , whereas 
 the higher awareness in houston was probably due to the women 
 being medical students and hospital support staff . nevertheless , 
 the seven different geographical locations included a diverse 
 population of women , so the results should be reasonably 
 applicable to women of childbearing age . another study limitation 
 was that guessing may have played a role in answering specific 
 knowledge questions about cmv . for example , many women incorrectly 
 answered that cmv can cause congenital heart defects . the majority of 
 the surveys were administered in a clinic setting , and women 
 attending a healthcare clinic may be more likely to be aware of 
 health issues than other women . raising awareness among women and their healthcare providers will 
 be an important first step for preventing congenital cmv . such 
 awareness can lead to improvement in hygiene behaviors among 
 pregnant women , immediately impacting the congenital cmv disease 
 burden . furthermore , as women and their healthcare providers 
 become educated about congenital cmv , they will better appreciate 
 the potential for interventions such as prenatal screening and 
 diagnosis , newborn screening , and antiviral 
  or hyperimmuneglobulin treatments , and they 
 will see the urgent need for the development of an effective cmv vaccine . ( a ) awareness of congenital cmv and other birth defects and childhood illnesses . ( b ) estimates of the annual burden of prominent childhood diseases 
 and syndromes in the us ( from ) . assumes 4 million live 
 births per year and 20 million children < 5 years of age . childhood deaths were defined as those occurring < 1 year after 
 birth except for haemophilus influenzae type b ( hib ) 
 ( < 5 years ) and hiv / aids ( < 13 years ) . all estimates should be 
 considered useful for rough comparisons only since surveillance 
 methodology and diagnostic accuracy varied over different studies . cmv : cytomegalovirus ; toxo : toxoplasmosis ; crs : congenital rubella 
 syndrome ; gbs : group b strep ; fas : fetal alcohol syndrome ; sids : 
 sudden infant death syndrome ; n / a : not applicable because 
 long - term sequelae are not normally associated with the condition ; 
 i d : insufficient data . hygienic practices to reduce risk of cmv infection for 
 women who are pregnant or planning to become pregnant . when 
 interacting with young children , women should assume the children 
 are excreting cmv in their urine and saliva ( from ) . some categories were collapsed in the multivariate 
 analysis because of small numbers in the categories . percentage of women responding to questions regarding 
 which of the following clinical manifestations were caused by 
 congenital cmv in newborns . note that these figures are among the 
 22% of the women who have heard of cmv . note that multiple 
 answers were accepted so the percentages add to more than 
 100% .
background . congenital cytomegalovirus ( cmv ) 
 infection   is a leading cause of   disabilities in children ,   yet the general public appears to have little awareness of cmv . methods . 
 women were   surveyed about newborn infections at 7 
  different geographic locations . 
 results . of the 643 women surveyed , 142 ( 22% ) had heard of congenital cmv . 
 awareness increased with   increasing levels of education ( p < .0001 ) . 
 women who   had worked as a healthcare professional had a higher 
  prevalence of awareness of cmv than   had other women ( 56% versus 16% , p < .0001 ) . women who were aware of cmv 
 were most likely to have heard about it from a healthcare 
  provider ( 54% ) ,   but most could not correctly identify modes of 
  cmv transmission or prevention . among common causes of birth defects and 
  childhood illnesses , 
 women 's awareness of cmv ranked last . 
 conclusion .   despite its large public health burden 
 , few women had heard of congenital cmv , and even fewer were aware of prevention strategies .