Day care workers appear to be at a greater risk than hospital and other health care providers, and this may be due in part to the increased emphasis on personal hygiene in the health care setting.Recommendations for individuals providing care for infants and children:

Employees should be educated concerning CMV, its transmission, and hygienic practices, such as handwashing, which minimize the risk of infection. Susceptible nonpregnant women working with infants and children should not routinely be transferred to other work situations. Pregnant women working with infants and children should be informed of the risk of acquiring CMV infection and the possible effects on the unborn child. Routine laboratory testing for CMV antibody in female workers is not specifically recommended due to its high occurrence, but can be performed to determine their immune status. Epidemiology
Worldwide, approximately 1 in 100 to 500 babies are born with congenital CMV. Approximately 1 in 3000 will show symptoms and 1 in 7000 will die. Congenital HCMV infection occurs when the mother has a primary infection (or reactivation) during pregnancy. Due to the lower seroprevalence of HCMV in industrialized countries and higher socioeconomic groups, congenital infections are actually less common in poorer communities, where more women of child-bearing age are already seropositive. In industrialized countries up to 8% of HCMV seronegative mothers contract primary HCMV infection during pregnancy, of which roughly 50% will transmit to the fetus. Between 10 and 15% of infected fetuses are then born with symptoms, which may include pneumonia, gastrointestinal, retinal and neurological disease.
Haemobilia is a medical condition of bleeding into the biliary tree. Haemobilia occurs when there is a fistula between a vessel of the splanchnic circulation and the intrahepatic or extrahepatic biliary system. It can present as acute upper gastrointestinal (UGI) bleeding. It should be considered in upper abdominal pain presenting with UGI bleeding especially when there is a history of liver injury or instrumentation.First recorded in 1654 by Francis Glisson, a Cambridge professor. Presentation
Quinckes triad of upper abdominal pain, upper gastrointestinal haemorrhage and jaundice is classical but only present in 22% cases.It can be immediately life-threatening in major bleeding. However, in minor haemobilia, patient is haemodynamically stable despite significant blood loss being apparent. Causes
The causes of haemobilia include trauma (which can be accidental or iatrogenic due to procedures such as cholecystectomy), instrumentation (especially after ERCP), gallstone, inflammatory conditions ranging from ascariasis to PAN, vascular malformation, tumors, coagulopathy, and liver biopsy. Diagnosis
Combination of EGD, CT scan and angiography depending on clinical situation, bearing in mind that haemobilia may present many days after injury. Cholangiography is performed if there is a percutaneous access or if ERCP is undertaken. Management
Most bleeding from instrumentation are minor and would settle spontaneously.When indicated, management is directed towards stopping bleeding and relieving obstruction if present, which is achieved either by surgical ligation of hepatic artery or by endovascular embolisation. Endovasculartrans-arterial embolisation (TAE) is preferred initially because of high success rate and less complication. TAE involves the selective catheterization of a hepatic artery followed by embolic occlusion.