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Children with immune compromise

Find guidance for families of immunocompromised children during the COVID-19 pandemic.
Last updated: August 2, 2022

Key points:

  1. Most children with immune compromise will have a medium or low risk level for COVID-19.
  2. Your child's specialist team will tell you about your child's risk level.
  3. If you or your child has COVID-19 symptoms, get tested.

Some diseases and treatments affect children's immune systems. Children with weaker immune systems have immune compromise. They are more likely to get sick with different types of infection. 

So far, very few children with immune compromise have had severe COVID-19 illness. In general, children are much less likely than adults to have severe COVID-19 illness. For children with mild to moderate immune compromise, the chance of severe COVID-19 illness is the same as other common viruses.

Parents and children with immune compromise should take steps to protect themselves from COVID-19, like washing hands regularly, practicing physical distancing and wearing a mask in public. Extra steps like keeping children at home are no longer recommended in most cases. This may be different for children with severe immune compromise. Some examples of severe immune compromise are children who:

  • had a recent organ transplant
  • are on intensive chemotherapy
  • receiving high doses of steroids
  • have severe immune deficiency diseases.

Children with immune compromise

Immune compromise means that your child's immune system is weakened by medications or a medical condition. A weakened immune system may not be able to protect as well from infection.

A child with immune compromise has a higher chance of getting sick and of more serious illness.

Children with immune compromise are usually followed by a specialist team. There are different situations where your child is considered immune compromised:
  • They have been diagnosed with a primary immunodeficiency. These are genetic conditions affecting the immune system, like severe combined immunodeficiency.
  • They have side effects from medications that cause a very low white blood cell count.
  • They are taking medication that suppresses their immune system. Children may be taking these medicines as treatment for:
    • autoimmune or rheumatologic disease, such as lupus or juvenile idiopathic arthritis
    • inflammatory bowel disease, such as Crohn's disease or ulcerative colitis
    • immune-mediated kidney or liver disease
    • organ transplant, such as liver transplant, kidney transplant or heart transplant
    • bone marrow or stem cell transplant
  • They are being treated for cancer and are having chemotherapy. Or, they had chemotherapy recently.

COVID-19 Vaccination for Children with Immune Compromise

Vaccination is available for children 6 months and older.

Learn more about vaccination and children.

Find information on planning for vaccination for people who are transplant recipients, have cancer, taking medication that suppresses their immune system and other conditions at Vaccine Considerations.

Your child's specialist team will tell you about your child's likelihood of:

  • getting COVID-19
  • getting severe COVID-19 illness
  • having complications from COVID-19

Your child's risk level will depend on their condition, its treatments and other factors. Your child's risk level may be:

Low: In general, your child's level of immune compromise does not increase their likelihood of serious or rare infection. 

Medium: Your child's level of immune compromise increases their likelihood of infection. Your child may have a higher chance of getting sick with an infection or staying sick for longer. Or your child may get sick from an infection that does not affect other people. This can happen when your child takes immune compromising medicines.

High: Your child has a high chance of getting sick with an infection. This includes situations like:

  • starting chemotherapy,
  • treatment with high doses of steroid medications,
  • certain forms of primary immunodeficiency, or
  • children with very low white blood cell counts

Call your child's specialist team or health-care provider to find out if their risk level is low, medium or high.

First Nations families who don't have a family doctor, or don't have access to one, can contact the virtual Doctor of the Day service at 1-855-344-3800.

Your child's specialist team will explain if your child has a higher risk level, and whether they need to stay home.

Children with immune compromise already take precautions to prevent infection. Most children with immune compromise will have a low or medium risk level. They should take the same precautions for COVID-19 as the general population. 

For children with a high risk level.

Your child should generally stay at home and keep apart from other people as much as possible. Discuss precautions with your child's specialist to find the best plan for your child. 

If possible, avoid public transit, ferries and airports. If you live in a rural or remote community, contact your local health centre for transportation information.

Your child's specialist team can write letters to school and work to support your household staying home.

Follow the advice on the BCCDC page for preventing COVID-19. This advice is even more important when a household member has immune compromise. This means that every person in your home should follow those guidelines. You and your family should wear a mask when you are in public.

Like all British Columbians, your family and your child should avoid:

  • People who have a cough, cold or flu symptoms
  • People who have been in contact with someone in the last 14 days who may have had COVID-19  
  • People that travelled outside of the Province in the last 14 days

Prevention and protection resources from First Nations Health Authority can be found here

COVID-19 can cause many different symptoms. Children with immune compromise can have minimal symptoms. If your child has new symptoms that could be COVID-19, you should get your child tested. 

Visit the BCCDC testing and symptom pages to learn more.

You can also call your child's specialist team for advice on COVID-19 testing.

If your child is having difficulty breathing, call 9-1-1 or bring them to the nearest emergency department.

If you need to bring your child to an emergency department be sure to:

  • Clean your hands with hand sanitizer as soon as you enter.
  • Put a medical mask on yourself and your child (if they are older than 2 years of age) when you arrive. Masks will be provided by the health-care facility.
  • Tell the triage nurse that your child has symptoms that might be COVID-19
  • Tell the triage nurse that your child has immune compromise
  • Tell the triage nurse the name and contact details of your child's specialist.

Do not stop or change your child's medicines, unless your child's specialist team tells you to. Always talk to the specialist team before making any changes to your child's treatment.

It is dangerous to stop your child's medicines without talking to your child's specialist team. Stopping these medicines:

  • Can make your child's health condition worse, and
  • Will not stop your child from getting COVID-19

If your child gets COVID-19, their specialist team may adjust their medicines. 

Unless your specialist team says otherwise, still attend your child's scheduled appointments. Some appointments are being done by phone or video during the pandemic.

All hospitals, labs and doctors' offices have procedures to keep patients safe

If your child has COVID-19 symptoms, phone their specialist team before you come in. Your appointment may get postponed or held by phone or video.

When you come to your child's appointment:

  1. Come right at the time you are scheduled.
  2. Put a medical mask on yourself and your child (if they are older than 2 years of age) when you arrive. Masks will be provided by the health-care facility.
  3. When you arrive for the test, check in. Then, wait in an area where there are fewer people. Return when it is time for your child's test.
  4. Clean your hands before and after you visit the clinic, hospital, or lab.
  5. Follow guidance about the number of people who can attend an appointment. Some clinics may only allow one caregiver to attend in-person.

For children with a low and medium risk level, follow public health recommendations. School is important for social and emotional development. Schools also provide space for exercise and connecting with friends. Schools have COVID-19 prevention measures like hand washing and physical distancing in place. Learn more about school and childcare measures here.

Children at high risk level are generally recommended not to attend school. In some cases their specialist may suggest otherwise. For children with a high risk level who still attend school, contact your child's specialist. They may have more recommendations than what is shown here.

Follow public health recommendations for taking part in sports. If your child has a higher chance of getting sick, please discuss with your child's specialist team. 

SOURCE: Children with immune compromise ( )
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