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Children with immune suppression

This information from BC Children's Hospital is for children with immune suppression (also called immunosuppression, or immunocompromised). Immune suppression means that the immune system does not work properly.
A person with immune suppression is more likely to get infections. 

Your child is living with immune suppression if:

  1. Their medical condition affects their immune system, or causes a very low white blood cell count 
  2. They take immune suppressing medicines. People often take these medicines for: 
    • autoimmune or rheumatologic disease
    • inflammatory bowel disease
    • immune-mediated kidney or liver disease
    • organ transplant
    • bone marrow or stem cell transplant.
  3. They are having chemotherapy, or they had chemotherapy recently.
Here are some common questions and answers: 

Common immune suppressing medicines are: 
  • Prednisone
  • Methotrexate
  • Arava (Leflunomide)
  • Imuran (azathioprine)
  • CellCept (MMF)
  • Myfortic (MPS) 
  • Rituximab
  • Cyclophosphamide
  • Cyclosporine
  • Prograf orAdvagraf (Tacrolimus)
  • Sirolimus
  • Humira (Adalimumab)
  • Enbrel or Erelzi (Etanercept) Anakinra (Kineret)
  • Orencia (Abatacept)
  • Remicade or Renflexis (Infliximab),
  • Actemra (Tocilizumab)
  • Ilaris (Canakinumab)
  • Xeljanz (Tofacitinib)
  • Entyvio (Vedolizumab) )
  • Stelara (Ustekinumab )
If your child takes immune suppressing medicine, please read the information below. If you have questions, contact your specialist care team.
Healthy children are less likely than adults to get very sick with COVID-19.  However, we do not yet know how COVID-19 will affect children with immune suppression. Children with immune suppression are more likely than other children to get very sick from viral infections. 

We predict that children with immune suppression will be more likely to get very sick with COVID-19 infections. Your child’s risk will depend on how well their immune system works. Ask your child’s specialist care team about your child’s risk. Currently, there is no approved medicine to treat or prevent COVID-19.

‎Most COVID-19 infections happen when a person is in contact with an infected person. Contact means touching, or being within 2 metres of the person. 

We think that people are most contagious when they have symptoms. 
People can catch the COVID-19 virus:
  • When they are near an infected person 
  • When they touch a surface that an infected person has touched, like a door handle or table top.

The best way to protect your child is for every family member to practice regular hand washing, respiratory hygiene (cough into elbow) and avoid touching their face. 

People at higher risk from infection should practice protective self-separation. This means staying separate from other people as much as possible.   
Your child should:
  • Avoid people who have a cough, cold or flu symptoms
  • Avoid people who have been in contact with someone who may have had COVID-19 in the last 14 days 
  • Avoid people who have traveled outside the country in the last 14 days
  • Avoid crowds and places that many people pass through
  • Avoid groups of children or people
  • Indoors, and in closed spaces, stay at least 2 metres from other people
Check the BCCDC website regularly for up-to-date guidelines to reduce infection risk.
It is more common these days to see people wearing masks, even if they are not sick. Wearing a mask is important if you are sick, so that you limit the spread of viral illness to others.  At this time, people that are not sick do not need masks.

Remember: The best ways to protect your child are frequent hand washing and protective self-isolation.
Do not stop or change your medicines, unless your child’s specialist team tells you to. Always talk to your child’s specialist team before making changes.

It is dangerous to stop your child’s immune suppressing medicines without talking to your child’s specialist team. Stopping these medicines:
  • Can make your child’s health condition worse
  • Will not stop your child from getting COVID-19
If your child becomes infected with COVID-19, your specialist may adjust your medicines depending on the severity of illness.
The symptoms of COVID-19 in any child or adult, with or without immune suppression include:
  • Fever; AND
  • Respiratory symptoms: Cough, difficulty breathing or shortness of breath
These symptoms are similar to many other types of respiratory virus infections like the flu (influenza). They do not mean your child has COVID-19.  Only children who are being admitted to the hospital are being tested at this time.

Please refer to the BCCDC website for an up-to-date description of symptoms from COVID-19. 
Most children with immune suppression have a plan from their specialist team. This plan tells you what to do and who to call if your child is sick with a fever and other symptoms. 

Follow the plan from your child’s specialist team. This plan usually tells you to contact your child’s specialist team. The team will review your child’s symptoms. They will tell you if your child needs more assessment or testing. 

  • If your specialist team is worried about a serious respiratory virus like influenza or COVID-19, they will direct you to the nearest Emergency Doom for assessment. 
  • The Emergency Room team will check your child’s breathing, and may test them for COVID-19 and other respiratory viruses.
If your child is getting worse, or if you cannot get in contact with your specialty team to discuss your case, bring your child to the Emergency Room. 

If you go to an Emergency Room:
  • Wash your hands with hand sanitizer as soon as you enter.
  • Put on masks when you arrive (to protect others).
  • Tell the triage nurse that your child has immune suppression, and give the name of your child’s specialist.
Only children who have symptoms that may be related to COVID-19 (fever and respiratory symptoms) may need to be tested. If your child does not have symptoms, they do NOT need to be tested.
Check the BCCDC website regularly to learn who should be tested
The risk of acquiring COVID-19 in hospitals in Canada is still very low. We are working hard to protect all patients. We use gowns and masks when needed, do extra cleaning, and decrease the number of people that come into the hospital. We are doing some visits by telephone.

Come to your appointment, unless your specialist team calls you to cancel. The hospital is working to limit the risk of infection for people at the hospital. We are limiting the number of people that can visit patients or attend appointments. 

Learn about these precautions on the BC Children's Hospital website. 
If your child has fever or respiratory symptoms, check with the clinic before coming to your appointment. 
  • If the appointment is not urgent,  the clinic may move it to when your child feels better
  • You may also be advised to seek medical attention at an Emergency Room, depending on your child’s symptoms.

Your child’s specialist team may adjust regular tests or laboratory monitoring. They will contact you with any changes. Unless your child’s specialist team tells you otherwise, attend scheduled tests. 

When you attend your child’s test:
  • Schedule the appointment in advance to decrease waiting room time.
  • After you register for the test, wait outside of the testing area, where there are fewer people. Return when it is time for your child’s test. Wash your hands regularly. Wash your hands before and after the hospital visit.
  • If you think your child has symptoms of COVID-19, ask your specialist team for advice. You will need to warn the lab before you come.
The clinical staff and providers at BC Children’s are trained on the identification, isolation and treatment of infectious diseases.

If you do not have cold or flu-like symptoms, you will receive the care you need without change. If your child is an inpatient at BCCH, and you have a fever or cough, please do not visit. 

To protect our patients, families and staff from a possible exposure to COVID-19, we currently allow only two primary caregivers to visit a patient.  We do not allow siblings to visit. Please tell your family and other contacts to follow these guidelines.
The safest way to avoid COVID-19 infection while travelling within Canada is by a private vehicle. Public health experts say that you should avoid public transit or transport hubs like buses, SkyTrain, airports and ferries. However, this is not always possible.

Avoid traveling during busy times
Stay at least 2 meters from other travellers
Stay away from  travellers that cough or look unwell
Wash and sanitize your hands frequently
Avoid touching your face.

Travel outside of Canada (including the United States) is not recommended for any Canadian resident. Any person who has travelled internationally must self-isolate for 14 days upon return.  

You can find up to date information on the Canadian government travel website.  

If you or your child must travel, keep extra medicine: 
  • If your child must travel, make sure you have an extra two week supply of medicine with you. Your child will need this if they need to quarantine.
It is best to avoid contact with individuals who returned from an area where they could have been exposed to COVID-19. If the individual remains healthy after 14 days, you can resume contact.
  • The traveller should isolate themselves from family members that are at increased risk.
  • If you cannot avoid contact, the traveller should isolate themselves as much as possible. They should wash and sanitize their hands often.

Your child should avoid all non-essential group activities. Children with immune suppression should avoid places with many people. This is especially true if there is COVID-19 spreading in your community. We do not know how long COVID-19 will circulate in communities. ‎

Anyone who has COVID-19 infection or has been in contact with an infected person should self-isolate.

Check the BCCDC guidelines to learn how to self-isolate, and to reduce the risk of infection if you have a respiratory virus.

Addtional rseources:

SOURCE: Children with immune suppression ( )
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