What is altered immunity?
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The immune system helps to protect the body from infections and cancers.
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The immune system is very complex and requires many parts to work well together. When one piece of the puzzle is missing, some parts of the immune system may work and others might not function adequately.
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Causes of an abnormal immune system include
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HIV
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Genetic condition—B- or T-cell deficiencies (present at birth)
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Steroids or other medications, such as cancer treatment, that suppress the immune system
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Chronic illness—nephrotic syndrome, diabetes, metabolic diseases
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Spleen problem—missing or not working properly (eg, spleen removed after trauma or sickle cell disease)
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Cancer treatment—a low white blood cell count
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Transplantation—organ or bone marrow
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How common is it?
No one knows for sure how many children have suppressed immune systems. It is becoming more common as more children receive transplants and survive serious problems with their immune systems like HIV. Some children have temporary alterations in their immune system from medications and the immune system returns to normal when the medication is stopped.
What are some characteristics of children with altered immunity?
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There are a few common characteristics for children with immune problems. Some of the infections that tend to be the biggest problems are infections such as pneumonia, chickenpox, measles, and herpes cold sores.
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Measles and chickenpox vaccines have drastically reduced the number of cases of those diseases.
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However, there are still cases of chickenpox that occur (breakthrough cases) and they can be missed because they are so mild. Most of the time, this is not a problem for children with healthy immune systems, but it can be a problem for children with an altered or a weakened immune system.
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It is important that all children who come into contact with an immune-suppressed child be vaccinated against measles and chickenpox.
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Children with altered immunity should avoid direct exposure to the lesions of a child or caregiver with an active cold sore.
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Fever is a serious sign in children with immune problems and should be evaluated immediately. Most parents/guardians recognize this and will seek treatment for their child promptly.
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Because there are so many reasons a child could have an immune system problem, it is possible that the child could enter child care or school with the diagnosis or develop it while enrolled. The immune problem can occur for a short time, such as with children on steroids for a few weeks, or it can occur for a long time, such as with children with transplants.
What adaptations may be needed?
Medications
Some children will have enough of a problem responding to even weakened viruses that they cannot safely receive live-virus vaccines. Such children will have medical records that document their medical exemption from live-virus vaccines that excuse them from regulatory requirements for these specific vaccines (ie, varicella, measles). They will only receive vaccines that do not contain live material.
Physical environment
Adaptations for immune suppression depend on the specific disease. It is important to have a complete and up-to-date Care Plan that is reviewed with the child’s parents/guardians.
What should be considered an emergency?
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Fever is usually an emergency for a child with a suppressed immune system.
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It is critical that emergency medical services/911 first responders know that the child has an immune problem.
What types of training or polices are advised?
Staff should recognize the need for prompt action for fever.
Source: Managing Chronic Health Needs in Child Care and Schools: A Quick Reference Guide.
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