Safe living strategies for the immunocompromised child Flashcards
Children and youth considered significantly immunocompromised? (medical conditions not meds)
- A hematopoietic stem cell transplant (within 2 years of transplantation or still taking immunosuppressive drugs)
- A solid-organ transplant
- Any current or recently treated malignancy
- Aplastic anemia
- Asplenia, with specific risk being encapsulated organisms such as Streptococcus pneumoniae, Neisseria meningitidis or Haemophilus influenzae type b (Hib)
- HIV infection (specifically with a CD4+ count of <200/mm3 in children 5 years or older or a CD4+ count of <15% in infants and children younger than 5 years)
- Severe combined congenital immunodeficiency disease (SCID)
Medications that would cause child to be considered immunocompromised?
- High-dose corticosteroids (specifically >2 mg/kg of body weight or ≥20 mg per day of prednisone or equivalent in individuals weighing >10 kg), when administered for ≥2 weeks
- Cancer chemotherapeutic agents (e.g., cyclophosphamide)
- Antimetabolites (e.g., azathioprine)
- Transplant-related immunosuppressive drugs (e.g., cyclosporine, tacrolimus, sirolimus, mycophenolate mofetil)
- Biologics (e.g., etanercept, adalimumab, infliximab, rituximab, alemtuzumab)
Broadly, how to build a protective environment for immunocompromised individuals?
- Immunization
- Hand hygeine
Specifics re: immunization to build a protective environment? Immunizations of particular importance for care providers and especially families of patients?
- Should receive all routine vaccines that are not contraindicated by their condition (e.g. live)
- Caregivers & health care providers should make sure their own immunizations are complete and up-to-date
- Especially MMRV, annual influenza
What must health care facilities do to build a protective environment?
Must have infection prevention and control policies and procedures in place to mitigate risk of infection transmission to anyone, regardless of immune status
Important considerations for hand hygiene to minimize risk of infection in community settings?
-All day-to-day activities \+ -Before eating or preparing food -After urinating or defecating -After touching body fluids or excretions or items that might have had contact with human or animal feces (e.g., clothing, bedding, toilets) -After touching plants or soil -After collecting or depositing garbage -After being in any environment outside the home or visiting a public place -After touching animals
What respiratory viruses are associated with greatest risk for severe illness?
- RSV
- Influenza
- Adenovirus
Preventative measures to reduce risk for respiratory infections? Avoid risk of exposure to fungal pathogens?
- All immunocompromised persons and their contacts should exercise proper respiratory etiquette and meticulous hand hygiene
- Avoid contact with individuals known to have a respiratory illness, especially when they are symptomatic.
- Notify the child or youth’s treating physician at the first signs of respiratory illness during influenza season – may need prophylaxis or treatment
- Inform the child or youth’s medical team when there is influenza illness within the household.
- Minimize exposure to crowded environments, such as shopping malls, during influenza/respiratory virus season.
- Avoid primary or secondary exposure to tobacco smoke.
Avoid risk of exposure to fungal pathogens by:
- Minimizing exposures to construction, excavation and renovations sites, where fungal spores (e.g., Aspergillus) can thrive,
- Minimizing inhalation of fungal spores from plants and animals (i.e. in farms, barns or pigeon coops, or from mulching, turning compost piles or cave exploration),
- Not smoking marijuana.
Some organisms that are transmitted in contaminated water?
- Cryptosporidium
- Giardia
- some enteric gram-negative bacteria
What is cryptosporidium? How is it passed? What does it cause?
- a waterborne parasite
- passed in stool of infected persons or animals
- common cause of symptomatic waterborne disease in North America and significantly increases risk of prolonged diarrhea in immunocompromised individuals
Preventative measures to reduce risk of contracting a waterborne illness?
- Not drinking tap water in Canada when ‘boil water’ advisories are in effect.
- Drinking only bottled or boiled water when travelling to regions with suboptimal sanitation.
- Not drinking well water unless the source is properly screened and monitored by health authorities.
- Not drinking water directly from rivers, streams, lakes and ponds.
- Not using hot tubs, which have been associated with infections such as Pseudomonas folliculitis, Legionella pneumophila infections, and mycobacterial infections.
- Cleaning abrasions with water from a safe source
- Avoid swimming in water that may be contaminated. Waterborne pathogens can enter through skin abrasions, or the respiratory tract if aspirated.
Preventative measures for foodborne illnesses?
- General principles of safe food sourcing and handling apply universally
- All milk, fruit and vegetable juices should be pasteurized.
- Avoid cheeses produced from raw or unpasteurized milk, especially soft and semi-soft varieties (e.g., Brie, Camembert, and blue-veined cheeses).
- Avoid raw meats, seafood and eggs.
- Lettuce and all other raw vegetables should be washed thoroughly, even when they are labelled as prewashed.
- Avoid cross-contamination when preparing foods. Keep cooked and raw foods separate and use different cutting boards or surfaces for raw and cooked foods
Virtually all pets can transmit ______ to immunocompromised individuals.
Zoonoses (animalborne infections)
Animal-associated pathogens of particular concern to immunocompromised children and youth, as they are more vulnerable and can get very ill? Which ones are asplenic individuals at specific risk for?
- Bartonella spp.
- Bordetella bronchiseptica
- Campylobacter spp
- Capnocytophaga canimorsus
- Chlamydia psittaci
- Cryptosporidium spp.
- Giardia lamblia
- Mycobacterium marinum
- Pasteurella multocida
- Rhodococcus equi
- Salmonella spp.
- Toxoplasma gondii
- zoophilic dermatophytes
-Asplenic: Capnocytophaga and Salmonella
Precautionary measures to reduce risk of contracting an animalborne infection?
- Wait to acquire a new pet until a child or youth is less immune suppressed, if practical, and consult about risks with a subspecialist in this area.
- A prospective pet should be thoroughly evaluated by a veterinarian before being placed with an immunocompromised child or youth, and an ill pet should be seen by a veterinarian immediately.
- Consider the type of pet and specific risks for infection:
- -Reptiles (snakes, iguanas, lizards and turtles) and frogs carry high risk for Salmonella, and should be avoided.
- -Chicks and ducklings can also transmit Salmonella infections.
- -Rodents, but especially the common house mouse, can transmit lymphocytic choriomeningitis virus.
- -Young cats can transmit Bartonella henselae infections (cat-scratch disease).
- -Cats can transmit Toxoplasma gondii.
- -Puppies, kittens and chicks can transmit Campylobacter infections.
- -Fish tanks may be associated with waterborne pathogens e.g., Mycobacterium marinum.
- Avoid contact with ill animals, especially when they have mouth lesions.
- Avoid cleaning birdcages, bird feeders or litter boxes, and any contact with animal feces. When this is not possible, wear disposable gloves and a standard surgical mask and be sure to wash hands thoroughly after removing gloves.
- Avoid contact with or cleaning aquariums. When this is not possible, wear disposable gloves and be sure to wash hands after removing gloves
- Some general principles apply universally:
- Wash hands with soap and water after contact with any animal or pet, and especially after visits to a petting zoo or farm.
- Avoid contact with stray animals.
- Raccoons are a source of Bayliascaris procyonis (raccoon roundworm). Places where racoons visit should be inspected for stool and regularly cleaned.
