Immunodeficiency and Infection: Who Is at Risk?

I’ve Been Told My Child Is Immunocompromised – What Does That Mean?

Certain conditions may cause a child to become immunocompromised. Some children are born with abnormal immune systems and have genetic conditions called primary immunodeficiency disorders like chronic granulomatous disease (CGD) or severe combined immunodeficiency (SCID). Other children develop underlying diseases like cancer and autoimmune, or auto-inflammatory, diseases like juvenile rheumatoid arthritis, lupus, or inflammatory bowel disease and are receiving medications that negatively affect how their immune systems work to fight infections. Finally, some children receive therapies like solid organ and bone marrow transplantation or medications that decrease the efficacy of the immune system’s response to infection.

Some examples of medications that suppress the immune system include:

• Steroids: prednisone
• Calcineurin inhibitors: tacrolimus, cyclosporine
• mTOR inhibitors: sirolimus, everolimus
• Biologic response modifiers: infliximab (Remicade®), Adalimumab (Humira®), Abatacept (Orencia®), Etanercept (Enbrel®), Rituximab (Rituxan®)
• Other medications: methotrexate, mycophenolate mofetil (MMF), leflunomide, azathioprine, mercaptopurine (6MP)
• Chemotherapy or radiation

Does Being Immunocompromised Mean My Child Is at More Risk for Infections?

Unfortunately, yes - the immunocompromised child is at greater risk for infection than a child with an immune system that works normally. Our immune system protects us against infections and is our body’s defense against germs that surround us every day. Children who have weakened immune systems do not have the ability to respond normally to an infection and are at higher risk for common infections of childhood, as well as uncommon infections caused by bacteria, viruses, fungi, and parasites.

Infections in immunocompromised children may also be more severe since the weak immune system cannot effectively clear the infection. Fever (temperature greater than or equal to 101°F or two temperatures greater than or equal to 100.4°F taken one hour apart) may be the only symptom, since usual signs of infection may be absent in immunocompromised children.

Factors that increase the risk for infection in immunocompromised children include:

• Low numbers of white blood cells, including specific white blood cells like neutrophils and lymphocytes
• Inflammation of the gastrointestinal tract
• Having a central venous catheter in place

Preventing Infections in an Immunocompromised Child

Some infections can be passed from person to person, while others may occur after exposure to contaminated foods or water, or from exposures in the environment and home. Efforts to prevent infection in your child are very important.

Some general prevention measures include:

• One of the most important ways to prevent spread of many bacteria and viruses between people is to practice and teach children good hand-washing using soap and water or alcohol-based hand sanitizers.
• Taking meticulous care of central venous catheters and performing daily routine oral care are important ways to prevent bacterial infections.
• Avoid contact with people who are sick, including those who have fevers, cough, runny nose, vomiting, diarrhea, or rashes.
• If your child is very immunocompromised, their doctor may recommend they wear a surgical mask when outside the home to avoid contact with bacteria, viruses, or fungi that are in the environment.
• Limiting contact with animals – including scratches, bites, and licks - even from household pets and avoiding bringing new or exotic animals into the home.
• Immunization of household contacts is important to reduce potential exposure to vaccine-preventable infections in immunocompromised children. Some immunocompromised children should also receive In general, it is recommended that most immunocompromised patients older than six months of age receive their inactivated flu vaccine, yearly. Talk to your doctor about what vaccines your immunocompromised child should receive.

How Does Nationwide Children’s Hospital Care for Immunocompromised Children?

The Host Defense Program was created to provide comprehensive infectious disease prevention and treatment to immunocompromised children. Host Defense doctors have specialized expertise in the management of infectious diseases and work alongside specialty doctors in cancer, transplantation, rheumatology, immunology, and gastroenterology to deliver individualized care to immunocompromised children. Host Defense researchers work to improve the understanding of how germs and the immune system interact in order to develop new therapies and strengthen medical care. Through collaborative research, Host Defense team members strive to accelerate scientific knowledge and deliver new, innovative therapies to reduce infection-related complications and death and to optimize outcomes in immunocompromised children.