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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 child with immune suppression is at higher risk of getting infections. 

Children with immune suppression are usually followed by a specialist. There are different types of situations where your child is considered to have immune suppression:

  1. They have a medical condition that affects their immune system
  2. They have side effects from medications that cause a very low white blood cell count 
  3. They are taking medication that suppresses their immune system. Children may be taking these medicines as treatment for:
    • autoimmune or rheumatologic disease
    • inflammatory bowel disease
    • immune-mediated kidney or liver disease
    • organ transplant
    • bone marrow or stem cell transplant
4. They are having chemotherapy, or they had chemotherapy recently.

Here are some common questions and answers: 

COVID-19 and your child with immune suppression

Common immune suppressing medicines are: 
  • Actemra (Tocilizumab)
  • Anakinra (Kineret)
  • Arava (Leflunomide)
  • CellCept (MMF)
  • Cyclophosphamide
  • Cyclosporine
  • Enbrel or Erelzi (Etanercept) 
  • Entyvio (Vedolizumab)
  • Humira (Adalimumab)
  • Ilaris (Canakinumab)
  • Imuran (azathioprine)
  • Methotrexate
  • Myfortic (MPS)
  • Orencia (Abatacept)
  • Prednisone
  • Prograf or Advagraf (Tacrolimus)
  • Remicade or Renflexis (Infliximab)
  • Rituximab
  • Sirolimus
  • Stelara (Ustekinumab)
  • Xeljanz (Tofacitinib)
If your child takes immune suppressing medicine, please read the information below. If you have questions, phone your specialist care team.
In general, children are much less likely than adults to catch, spread, or have severe illness from COVID-19.

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

As we learn more about the COVID-19 virus, we see that there have been very few cases of severe illness in children with immune compromise.  There is no convincing evidence that the risk of COVID-19 is different for children with mild immune compromise from the risk with other common types of respiratory virus infections.

Understand the level of risk for your child. Your child’s specialist team will tell you about your child’s risk of getting an infection. Your child’s level of risk depends on their illness and its treatments, and other risk factors like pre-existing lung disease.

 
Your child’s level of risk may be:
 
  • Low risk: In general, your child’s level of immune compromise does not increase the risk of serious or rare infection.
  • Medium risk: Your child’s level of immune compromise increases their risk of infection. Your child may be at higher risk to get sick with an infection or stay sick for longer. Or, your child may get sick from an infection that does not affect healthy people.  This can happen when your child takes immune suppression medicines for a long time.
  • High risk: Your child has a high risk of getting sick with an infection.  This includes situations like starting some chemotherapy, treatment with high doses of steroid medications or children with very low white blood cell counts.
Children at medium and low risk should take the same precautions as other children to avoid infection with COVID-19. Children at high risk should discuss what additional precautions may be needed with their specialist.
Most COVID-19 infections happen when a person comes into contact with the droplets of an infected person. These droplets may contain infectious particles and can infect another person if the virus comes in contact with their eyes, nose or mouth. They may also fall on surfaces and then be transferred onto someone’s hand who then rubs their eyes, nose or mouth.

We think that people are most contagious when they have symptoms. People can get the COVID-19 virus when they:

  • Are in contact with an infected person, or,
  • Touch their face or mouth after touching a surface with virus on it. Any surface like a door handle or tabletop, can be contaminated by virus after an infected person has touched it or coughed/sneezed nearby.
Learn how it spreads at on our Common Questions page.
COVID-19 can cause many different symptoms that can range from mild to severe. The most common symptoms of COVID-19 are cough and fever, but there are many others. If your child is immune suppressed and they are experiencing a symptom that is new or different, please contact your child’s specialist team. 

Learn more about symptoms of COVID-19.
  • Phone your child’s specialist team. The team will tell you if your child needs a COVID-19 test. They may direct you to the nearest testing site or Emergency Department. The Emergency Department team will check your child’s breathing and may test your child for COVID-19 and other viruses. 
  • If your child is having difficulty breathing, or you cannot reach your child’s specialty team, call 9-1-1 or bring your child to the nearest Emergency Department. 
If you need to bring your child to an Emergency Department be sure to:

  • Clean your hands with alcohol-based hand rub (hand sanitizer) as soon as you enter.
  • Put on a mask yourself and your child (if they are older than 2 years of age) when you arrive, to protect others.
  • Tell the triage nurse that your child has symptoms that might be COVID-19 
  • Tell the triage nurse that your child has immune suppression
  • Tell the triage nurse the name and contact details of your child’s specialist 
Updates about COVID-19 and self-assessment tool are available in the B.C. COVI-19 app: https://bc.thrive.health/
If your child with immune suppression has new symptoms related to COVID 19, they should be tested. 

If your child does not have symptoms of COVID-19, they do NOT need to be tested.

Your child with immune suppression's medical care

‎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 becomes sick with COVID-19, your specialist may adjust your child’s medicines.
Call the clinic before coming to your appointment. Many clinics are offering virtual online appointments instead of in person. 
  • Children with new symptoms should get tested before coming to a routine appointment at the hospital or clinic.
  • If the appointment is not urgent, the clinic may move it to when your child feels better.
  • Many clinics are now able to offer virtual appointments over the telephone or video. 
  • The clinic may send you to your nearest Emergency Department, depending on your child’s symptoms. 

The risk of getting COVID-19 in hospitals in Canada is still low. 

Examples of how we keep patients safe:
  • Wearing masks, eye protection, gloves and gowns when needed
  • Performing hand hygiene 
  • Doing extra cleaning and disinfection 
  • Limiting the number of people that attend appointments or visit patients, and
  • Doing some visits by telephone or video call.  
Yes, come to your child’s scheduled test appointment, unless your specialist team has told you otherwise.

If your child has symptoms that may be related to COVID-19, phone your specialist team before you come for the test. You will need to notify the lab before you arrive.

When you come to your child’s appointment:
  • Check the time and come right at the time you are scheduled.
  • 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. 
  • Clean your hands before and after you visit the hospital or lab.

‎At BC Children’s Hospital, health care teams diagnose, isolate and treat infectious diseases.


To protect patients, families and staff from COVID-19, hospitals are decreasing the number of people on-site, and are limiting the number of people that can visit patients or come to appointments. You may notice more people wearing masks and other personal protective equipment. This is for everyone’s protection.

Keep your child with immune system suppression safe

Children with immune compromise already take precautions to prevent infection.  Most children with immune suppression will be considered medium or low risk, and should take the same precautions for COVID-19 as the general population. The specialist team will explain if your child should be considered at high-risk, and whether protective self-isolation is needed. 

Continue physical distancing and hand cleaning practices. It is still very important to:
  • Stay 2 meters away from people that are not in your household 
  • Wash  hands often with soap and water for at least 20 seconds
  • If a sink is not available, alcohol-based hand rubs (ABHR) can be used to clean hands as long as they are not visibly soiled
  • Avoid touching your face
  • Regularly clean and disinfect frequently touched surfaces
  • Do not share food, drinks, utensils, etc.
Learn more about protective measures against COVID-19 on the BCCDC Common questions page.

If you or your child has symptoms, get tested. If someone in your household has new symptoms, they should be tested for COVID-19. The sick person should isolate (stay apart) from other household members, if possible. They should isolate until they get a negative COVID-19 test result.

COVID-19 can cause many different symptoms, not just cough and fever. Learn about possible COVID-19 symptoms on the BCCDC Symptoms page.

For children at high-risk who still require protective self-isolation. Stay at home and keep apart from other people as much as possible. 
  • Precautions will be discussed by your specialist on a case by case basis to see what the best safety plan is for your child.
  • Your child’s specialist team can write letters to school and employers, in support of your household members staying home.  

‎School and contact with other children is critical for healthy social and emotional development, physical exercise and connecting with friends. Prevention measures are now being used to do this safely, including hand washing, no face touching and physical distancing.


At the present time here in BC, all parents and children are advised to take precautions to avoid infection with COVID 19.  Extra precautions to keep children at home and away from all others (protective self-isolation) are no longer recommended in most cases.  

This may be different for children with severe immune compromise who are considered at high-risk of infection, such as those who have had a recent organ transplant, who are on intensive chemotherapy, those receiving high doses of steroids, those with severe immune deficiency diseases.  For children at high-risk who still require protective self-isolation. Stay at home and keep apart from other people as much as possible. 
  • Precautions will be discussed by your specialist on a case by case basis to see what the best safety plan is for your child.
  • Your child’s specialist team can write letters to school and employers, in support of your household members staying home.  

To avoid COVID-19, it is safest to travel in a private vehicle. Public health experts say that people with immune suppression and caregivers should avoid public transit or transport hubs like buses, SkyTrain, airports and ferries. However, this is not always possible.

If you cannot take a private vehicle:
  • Avoid traveling during busy times
  • Stay at least 2 meters from other travellers
  • Stay away from travellers that cough or look unwell
  • Clean your hands often with soap and water, or alcohol-based hand rub
  • Avoid touching your face.
B.C. residents should stay at home, unless travel is necessary. Any person who has travelled outside B.C. may need to self-isolate for 14 days when they return. This includes people that have travelled to the United States or some Canadian provinces with higher rates of COVID infection. 

Get up to date travel information on the Canadian government travel website.  

If you or your child must travel, make sure you have enough extra medicine for at least 2 weeks after you plan to return home.  You may not be able to return home as planned, so you should have extra medications in case your return is delayed. You will need to self-isolate when you return home. 
The traveller should self-isolate for 14 days. If the traveller stays healthy for 14 days, you can resume contact. 

If you cannot avoid contact, the traveler should:

  • Stay away from people at greater risk, like your child
  • Clean their hands often with soap and water, or alcohol-based hand rub
  • Wear a mask when they are in shared areas of your home.
  • If the traveller starts to develop any symptoms, they should get checked and tested right away.


‎We know now that COVID-19 causes many different symptoms, not just cough and fever. If someone in your household has new symptoms, they should get tested right away for COVID-19.  Let your specialist team know right away if this happens. 


The sick person should isolate themselves from other household members, if possible. They should stay apart until they get a negative COVID-19 test result. Consult with your specialist team to see if any other safety measures are needed.

For information about how to self-isolate and reduce the risk of infecting others, see the BCCDC guidelines

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

Learn how to self-isolate, and reduce the risk of infecting others, from the BCCDC guidelines.



Addtional rseources:

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