Summary Maternofetal transmission of cytomegalovirus (CMV) is the most common infectious cause of congenital malformation in developed countries. Maternal infection often results from close contact with infected children, and this may occur in day care centres (DCCs). A systematic review of observational studies was conducted to examine the prevalence of CMV infection among children attending DCCs. Meta‐analysis using the random effect model was performed for studies including controls. Sources included PubMed, EMBASE (until August 2018), and references from identified publications. Inclusion criteria were studies reporting CMV infection prevalence among childcare children aged less than 7 years of age. Controls were children without childcare exposure. CMV infection was defined as viral excretion detected by culture, polymerase chain reaction, or CMV seropositivity. Twenty‐eight publications including 8347 participants met the eligibility criteria. The pooled prevalence of CMV infection among children in childcare from all studies was 32% (95% CI 23‐41). Within case‐controlled studies, prevalence among children attending DCCs was 34% (95% CI 25‐44), whereas prevalence among those without childcare exposure was 22% (95% CI 15‐30). Meta‐analysis showed a significant association between DCC attendance and CMV infection (odds ratio 2.69, 95% CI 1.68‐4.30; heterogeneity χ2/df = 8; I2 = 84%, P < 0.00001). Attendance at DCCs is significantly associated with increased risk of childhood CMV infection. Prevention strategies to reduce risk of CMV infection of pregnant women and children should involve review of DCC exposure and consideration of preventative hygiene strategies.

Primary cytomegalovirus (CMV) infection during pregnancy carries a high risk (~30%) of transplacental transmission to the developing fetus, which may result in congenital CMV and consequent disease in the newborn. An estimated 2000 Australian children are born with congenital CMV each year, with 25% developing life-long sequelae, including hearing loss and mental disability.1 Higher rates of CMV infection occur with increasing age (seroprevalence: 34.9% for <20 years of age, 72.4% for >50 years of age), household crowding and attendance at childcare. 2Children shed high levels of CMV in saliva and urine and frequently acquire CMV from other children.1,2 Exposure of childcare staff through changing nappies (diapers), feeding and contact with contaminated environmental surfaces potentially increases their risk of acquiring CMV. Data from France and other developed countries show higher rates of paediatric shedding in childcare (50% in childcare vs. 20% in controls in emergency department at age of 3 months to 6 years), measured using sensitive and specific assays such as salivary real-time polymerase chain reaction. 2 However, no published study has determined prevalence of CMV in childcare staff in Australia, and shedding of this virus from saliva or other sites has not been examined systematically.We examined CMV excretion among childcare staff from two childcare centres in Sydney using our published methods for viral sampling of nasal and clothing surfaces 3 under South Eastern Sydney Local Health District ethics approval no. 10332. We tested 114 clothing samples and 125 nasal samples collected from 20 childcare staff from two university childcare centres in Sydney over 5 weeks in 2011. 3 DNA was extracted and real-time polymerase chain reaction (assay limit of detection 10 copies) was performed using CMV major immediate early gene primers. Of 125 nasal swabs tested, 6 (5%) were positive for CMV DNA, giving rise to an overall CMV excretion rate of 30% (6/20) among childcare staff. However, of 114 clothing swabs tested, none were positive for CMV DNA, which suggests clothing was unlikely to be a vector of fomite transmission at these childcare centres, contrasting our previous findings for respiratory virus detection on clothes of childcare staff. 4The CMV detection rate among nasal secretions of childcare staff suggests there is a need for education regarding effective hygiene measures to prevent CMV transmission and acquisition, particularly for pregnant staff. Measures shown to reduce CMV infection include not sharing food, utensils, cups or washcloths with a child; regular handwashing; and not kissing a child on or near the mouth. 4 Until an effective therapy is available, educating childcare staff regarding these hygiene measures remains the best preventive strategy for congenital CMV infection and subsequently congenital CMV disease.

The chemical composition and properties of nickel-based superalloy Inconel 718 was investigated first. Turning Inconel 718 was simulated by Deform-3D software to figure out main affection factors, and optimal combination of cutting speed, feed rate and cutting depth was introduced. In addition, different cooling and Lubrication methods (heat transfer coefficient f of cooling and tool-chip friction factors) for cutting of Inconel 718 was studied, and a best cooling/lub mode was obtained.