Immunosuppression: Protecting your child from infection when the immune system is lowered

What is immunosuppression?

Infections in children are common. They can contract infections both inside and outside the home. When a child gets an infection, the immune system usually works to fight it off. Some medicines or diseases can weaken the immune system (immunosuppression). When the immune system is weak, a child is more vulnerable to infection. They will also have a difficult time recovering.

If your child is on a medicine that lowers her immune system, it is important to protect against infection as much as possible. You may not be able to prevent your child from getting an infection. However, following these steps may reduce the risk.

Practice and promote good hand washing

Recent studies have found that hand washing is the most important step in preventing the spread of infections. Hand washing is especially important after:

• using the toilet
• changing diapers
• handling garbage
  
• using a cleaning cloth or soiled dishcloth
• handling raw food (meat, eggs)
• touching a pet
• blowing or touching the nose
• contact with other body fluids such as vomit or blood

As soon as someone enters your home, ask them to immediately wash their hands or use a hand sanitizer. Anyone who has diarrhea should thoroughly wash their hands with soap and water. Always wash your hands before:

• touching your child
• preparing food
• eating

Keep your home clean

• Dust and vacuum your house weekly.
• Wash your child's bed linens, bathroom towels, and pajamas at least once a week.
• Wash all dishes and utensils in hot water or in the dishwasher.
• Wash surfaces in common areas such as the bathroom, kitchen, and living room with a disinfectant. Pay particular attention to surfaces that are touched frequently such as handles on doors, the refrigerator, the oven, cupboards, sink taps, toilet handles and seat, telephones, and computers. Clean these surfaces regularly.
• Clean toys before your child touches them.
• Do not use humidifiers unless you clean them daily.

Limit contact with those who have an infection

The following suggestions are for children with severe immunosuppression. These are not required for all children receiving immunosuppressive treatment. Talk to your child's health care team and ask if you need to take these precautions:

• Keep your child away from crowds. Try to avoid stores, markets, parties, etc.
• Keep your child out of daycare and group play activities during the treatment period.
• Avoid communal play areas such as play parks, sandboxes, and public swimming pools.
• Limit sharing of household items such as toys, towels, drinking glasses, and eating utensils.
• All visitors should be screened for illness. They should not visit if they are sick or have recently been directly exposed to someone who is sick. In the event that this cannot be avoided, the sick family member should wash their hands thoroughly before coming in direct contact with your child.
• If you must be in a public place, use a plastic cover on the stroller and choose times when there is less likely to be crowds. An older child may wear a mask.
• When at a clinic, doctor's office or medical lab, advise them of your child's lowered immune system and request to be put in a room right away or ask for an appointment at the beginning or end of the day. Avoid waiting rooms as much as possible.

Ensure family members are immunized

Immunizations reduce the risk of many serious infections. Family members you live with should update their immunizations. This includes having annual flu vaccines. Immunizations make it less likely they will get sick and expose your child to one of these serious infections.

In general, it is safe for family members to be vaccinated during your child's treatment period. However, be cautious with two vaccines:

• Chickenpox (varicella): About 5% of people who receive this vaccine develop a rash. If this happens, your child should avoid contact with this person. Also contact your child's doctor because your child may need treatment to prevent infection.
• Rotavirus: It is possible that people who receive this vaccine may have live virus in their feces. If a family member receives the rotavirus vaccine, wash hands thoroughly and often.

Try to have your child's vaccinations updated four to six weeks before starting treatment. It is safe for your child to have 'inactivated' vaccines while immunosuppressed. However, they may not work well. The vaccine may need to be repeated at a later date. Talk to your child's health care team before your child has any vaccinations.

For more information, see Immunizations for Children and Teens with Suppressed Immune Systems.

Avoid contact with pets

Do not allow your child to touch your pet. Pets carry bacteria, viruses and fungus that may harm your child. Keep your child away from surfaces where pets may have been such as the floor or furniture. If it is difficult to keep your child away from pets, you may choose to remove pets from your home during the treatment period. To prevent illness due to animal contact, the Centers for Disease Control (CDC) and Prevention recommends the following for all people, especially those at greatest risk of getting sick from pets:

• Always wash your hands thoroughly with soap and running water after contact with animals and their feces.
• Avoid rough play with cats and dogs to prevent scratches and bites.
• If you are at higher risk of getting sick from animals, you should avoid contact with reptiles, baby chicks, ducklings, puppies and kittens less than 6 months old, and pets with diarrhea. You should also be extra cautious around young calves and other farm animals.

Do not smoke around your child

Second-hand smoke increases the frequency and severity of colds, coughs, ear infections, sinus infections, croup, wheezing, and asthma.

Prepare and store food safely

When preparing food for your child:

• always wash your hands before and after preparing food or handling raw meats
• wash all fruits and vegetables before eating
• keep all meat, poultry, and fish separate from cooked food and at the bottom of the refrigerator. Thaw frozen meat in the refrigerator (not on the counter) away from other foods. Use a plastic cutting board. Clean cutting boards and utensils immediately after use. Have a separate cutting board for meat only. Cook meat thoroughly. Avoid deli meats.
• keep dairy products such as milk, cheese, and yogurt in the fridge. All dairy products must be pasteurized.

Your child should not eat food:

• left at room temperature for more than two hours, which should be refrigerated.
• containing raw eggs.
• that has expired.

What do I do if my child gets an infection?

If your child has any of the following, contact your paediatrician or family doctor within 24 hours. Go to the local emergency department or walk-in clinic if your doctor is unavailable.

• Fever. An oral temperature of 38.3°C or a temperature of 38°C that lasts for one hour or more. It also includes temperature under the arm of 37.8°C or a temperature of 37.5°C that last for one hour or more. It is not recommended to use a thermometer that is placed in the ear.
• Cough, runny nose, breathing problems
• Nausea, vomiting or loss of appetite
• Diarrhea (loose, watery, foul smelling bowel movements)
• Foul smelling urine, pain when voiding (peeing), frequent voiding
• Thrush (white specks in the mouth or on the diaper area)
• Rash
• Increased sleepiness

What do I do if my child comes into contact with someone who has chickenpox?

Your child may need to take the treatment called Varicella Zoster Immune Globulin (VZIG). VZIG has a large number of antibodies to help prevent chickenpox. It is given by injection (a needle). A health care professional must give your child VZIG within 96 hours (four days) of the exposure to chickenpox. If your child comes into contact with chickenpox, call your health care team to discuss whether your child needs VZIG. This is particularly important if your child has been in contact with the infected person (family member, classmate or playmate) for 1 hour or more indoors. Very close contact outdoors (e.g., playing with another child in a sandbox) can also place your child at risk. If your child gets chickenpox, they may need to take a medicine that makes it less serious.