Prevention tips for immunocompromised patients

Nelson Santos
Mar 18, 2020
6 min read

Implementing measures to help prevent the spread or transmission of infectious diseases is essential for patients undergoing immunomodulatory treatment. This type of treatment includes immunomodulatory drugs and high doses of systemic corticosteroids (greater than 20mg daily). It is not necessary to comply with all of the following measures perfectly, but it would be of great benefit to take them into account in order to prevent the development of other diseases and/or complications:

Lifestyle

1. Do not share personal products. These include: toothbrushes, towels for drying the body, clothes, shoes, shaving razors, make-up, etc.

2. It is preferable to use an electric razor for hair removal. If you still want to use razors, it is recommended that you use disposable razors and never reuse them. Be sure to shave in the direction of hair growth, not against it.

3. It is not recommended to remove body hair by waxing, tweezing or threading. Hair removal from the follicle is a trauma or irritation that can trigger immune-mediated inflammatory reactions on the skin. These are perceived as acne-like lesions, redness, irritation and may contain pus.

4. If you have air conditioners in your home, it is important to clean the filters routinely.

5. Wear gloves, mask and goggles if gardening.

6. Limit your exposure to sunlight and always use sunscreen when doing so.

7. Do not get wet in the rain. This can cause colds that can easily become more complicated. You could keep an umbrella in your home, backpack, purse or car to use when you need it.

8. Avoid visiting crowded places and being around people with an infectious disease that can be airborne (common cold, viruses, etc.).

9. Wear gloves when cleaning your home and wash your hands thoroughly when you are done. Especially, if you perform tasks related to pet care, such as cleaning up pet feces.

10. Do not walk barefoot outside your home. Do not walk barefoot on dirt, sand, or even around common recreational areas: swimming pools, public showers, saunas, locker rooms, public restrooms, etc.

11. Do not wear closed shoes that have gotten wet without drying them thoroughly first. If it has fungus, throw it away.

12. Limit or eliminate salon manicures and/or pedicures. It is preferable to do them at home, using YOUR personal tools.

13. Avoid visiting caves, especially if they are dark and deep.

14. Limit or completely eliminate visits to swimming pools, beaches and/or rivers.

15. DO NOT bathe in the beach, river, swimming pool, jacuzzis or hot tubs if you have any injury or skin irritation.

16. Do not use tanning booths or tanning beds.

17. Dry your whole body thoroughly after bathing to avoid conditions that may encourage fungal growth on the skin. Avoid getting dressed when your skin is still wet.

18. Brush your teeth at least twice a day. It is especially important to do this before going to bed, flossing and using mouthwash. This avoids developing any infections or cavities that require invasive procedures.

19. Keep your home clean, especially bathrooms and kitchens. Regularly disinfect surfaces and wash towels.

20. Frequently wash bed sheets and linens.

21. Do not drink tap water.

22. Consult with your physician before undergoing any invasive cosmetic, therapeutic or surgical procedure. These include: microblading, microneedling, false eyelashes, skin peels, acupuncture, tattoos, piercings, surgeries, etc.

23. Use mosquito and insect repellents for outdoor activities.

24. Wear protective clothing when exposed to sunlight or when doing rural activities.

25. Do not use "neti pots" or "douches" with tap water. Properly sterilized water should be used instead.

26. Do not place flowers or natural plants in your room or near your bed as they may be inhabited by small insects.

Food

1. AVOID raw meats coming in contact with fruits and vegetables. For example, never chop vegetables on a chopper after having used it to cut meats. It is preferable to have two different choppers or to chop vegetables first, clean the chopper and then proceed with meats.

2. If you notice that fungus has grown on any food such as bread or cheese, DO NOT EAT IT. It is very important that you DO NOT EAT IT even after you have removed the part where the fungus has grown.

3. Wash hands thoroughly, especially before eating.

4. Use gloves when handling or cooking raw meats.

5. Wash fruits and vegetables thoroughly before consumption. It is even important to wash those fruits whose peels are not consumed, such as bananas or avocados.

6. Store food properly. Always keep refrigerated those that require it. Do not allow raw meats to come in contact with fruits or vegetables.

7. Limit or eliminate consumption of raw meats, including sushi.

Pets

If you already have pets, it is important that they are properly evaluated and cared for by a veterinarian. Make sure they are well cared for and are not carrying pathogens or parasites that could put your health at risk.

Sexual practices

Practicing pleasurable sexuality with low risk of exposure to sexually transmitted infe very important for everyone. The three main goals for the prevention of sexually transmitted infections are:

1. Correct and consistent use of condoms during oral, vaginal and anal sex.

2. Correct and consistent use of condoms for other sexual activities involving transmission of body fluids and fecal material, including oral sex.

3. Engaging in sexual activities that do not involve the transmission of bodily fluids or direct skin contact (such as mutual masturbation).

4. It is very important that people who are under immunomodulatory treatment DO NOT become pregnant without first consulting their physician.

Another equally important measure is routine medical evaluation, at least once a year. You can ask your primary care physician or gynecologist for labs for sexually transmitted infections or visit an STD clinic, commonly known in Puerto Rico as "Centro de Prevención y Tratamiento de Enfermedades Transmisibles" or CPTET. In the US, you can also visit Planned Parenthood.

Vaccines

Talk to your doctor about which vaccines you can and cannot get. There are different types of vaccines, but all can be classified either "live" or "inactivated". Live vaccines are contraindicated in immunosuppressed patients. In contrast, "inactivated" vaccines are safe. Please consult with your doctor as this table is non-comprehensive.

Learn to recognize symptoms of infection

The most important side effect of immunomodulatory therapy is the increased risk of infection or transmission of infectious diseases. For this reason, it is important to learn to recognize the symptoms that produce infectious diseases in order to seek medical assistance in case they begin to appear. Some of the symptoms suggestive of infection are:

Fever (temperature higher than 38.0°C or 100.4°F)
Chills, sweating and/or neck stiffness
Headache
Severe sore throat
Ear or sinus pain
Cough, nasal congestion and/or shortness of breath
Increased sputum or change in color of sputum
Pain to urinate
Canker sores or non-healing wounds
Skin wound that has become red, hot, lumpy or swollen. May be oozing pus or have an unpleasant odor
Eye discharge
Gritty sensation in the eyes accompanied by reddening of the eyes
Diarrhea
Vomiting

Signs of a urinary tract infection:

Blood in urine
Pain or burning when urinating
Need to urinate frequently or immediately
Fever
Stomach pain or pelvic pain
Discharge from the urethra or vagina

The appearance of any of these symptoms could indicate a fungal infection. These conditions can be treated with non-medical remedies, but others require medical treatment by a dermatologist:

White or black layers on the skin. They can occur anywhere, but appear most often on
the shoulders and back. They are usually more noticeable after sunbathing and tanning.
Yellowish or black discoloration of the nails accompanied by weakness and easy breakage. They can occur in any nail, but tend to be more frequent in the feet.
Itching, stinging and burning of the skin of the feet. It may also cause scaling. The most common condition associated with these symptoms is "athlete's foot".
Formation of a rounded area with regular edges on the scalp where no hair grows.

Travel

1. Disinfect the aircraft tray table. You could use hand sanitizer or disinfectant wipes.

2. Do not drink coffee or tea on airplanes. Only drink bottled or canned beverages.

3. Do not use airplane pillows.

4. Do not drink tap water in foreign countries.

5. Use a lot of insect repellent in foreign countries.

Prevention of skin and breast cancer

1.Evaluate your skin every few months to observe the appearance of moles with irregular borders or different colors. Make an appointment with a dermatologist if you find any.

2. If you have breasts, perform a monthly self-examination. You can do this in the shower, lying on your back or in front of a mirror. Feel your breasts firmly for any lumps, warmth or discomfort.Squeeze your nipples to check for any unusual discharge. Visit the National Breast Cancer Foundation for more information.

Lifestyle

1. Do not share personal products. These include: toothbrushes, towels for drying the body, clothes, shoes, shaving razors, make-up, etc.

2. It is preferable to use an electric razor for hair removal. If you still want to use razors, it is recommended that you use disposable razors and never reuse them. Be sure to shave in the direction of hair growth, not against it.

3. It is not recommended to remove body hair by waxing, tweezing or threading. Hair removal from the follicle is a trauma or irritation that can trigger immune-mediated inflammatory reactions on the skin. These are perceived as acne-like lesions, redness, irritation and may contain pus.

4. If you have air conditioners in your home, it is important to clean the filters routinely.

5. Wear gloves, mask and goggles if gardening.

6. Limit your exposure to sunlight and always use sunscreen when doing so.

7. Do not get wet in the rain. This can cause colds that can easily become more complicated. You could keep an umbrella in your home, backpack, purse or car to use when you need it.

8. Avoid visiting crowded places and being around people with an infectious disease that can be airborne (common cold, viruses, etc.).

9. Wear gloves when cleaning your home and wash your hands thoroughly when you are done. Especially, if you perform tasks related to pet care, such as cleaning up pet feces.

10. Do not walk barefoot outside your home. Do not walk barefoot on dirt, sand, or even around common recreational areas: swimming pools, public showers, saunas, locker rooms, public restrooms, etc.

11. Do not wear closed shoes that have gotten wet without drying them thoroughly first. If it has fungus, throw it away.

12. Limit or eliminate salon manicures and/or pedicures. It is preferable to do them at home, using YOUR personal tools.

13. Avoid visiting caves, especially if they are dark and deep.

14. Limit or completely eliminate visits to swimming pools, beaches and/or rivers.

15. DO NOT bathe in the beach, river, swimming pool, jacuzzis or hot tubs if you have any injury or skin irritation.

16. Do not use tanning booths or tanning beds.

17. Dry your whole body thoroughly after bathing to avoid conditions that may encourage fungal growth on the skin. Avoid getting dressed when your skin is still wet.

18. Brush your teeth at least twice a day. It is especially important to do this before going to bed, flossing and using mouthwash. This avoids developing any infections or cavities that require invasive procedures.

19. Keep your home clean, especially bathrooms and kitchens. Regularly disinfect surfaces and wash towels.

20. Frequently wash bed sheets and linens.

21. Do not drink tap water.

22. Consult with your physician before undergoing any invasive cosmetic, therapeutic or surgical procedure. These include: microblading, microneedling, false eyelashes, skin peels, acupuncture, tattoos, piercings, surgeries, etc.

23. Use mosquito and insect repellents for outdoor activities.

24. Wear protective clothing when exposed to sunlight or when doing rural activities.

25. Do not use "neti pots" or "douches" with tap water. Properly sterilized water should be used instead.

26. Do not place flowers or natural plants in your room or near your bed as they may be inhabited by small insects.

Food

1. AVOID raw meats coming in contact with fruits and vegetables. For example, never chop vegetables on a chopper after having used it to cut meats. It is preferable to have two different choppers or to chop vegetables first, clean the chopper and then proceed with meats.

2. If you notice that fungus has grown on any food such as bread or cheese, DO NOT EAT IT. It is very important that you DO NOT EAT IT even after you have removed the part where the fungus has grown.

3. Wash hands thoroughly, especially before eating.

4. Use gloves when handling or cooking raw meats.

5. Wash fruits and vegetables thoroughly before consumption. It is even important to wash those fruits whose peels are not consumed, such as bananas or avocados.

6. Store food properly. Always keep refrigerated those that require it. Do not allow raw meats to come in contact with fruits or vegetables.

7. Limit or eliminate consumption of raw meats, including sushi.

Pets

If you already have pets, it is important that they are properly evaluated and cared for by a veterinarian. Make sure they are well cared for and are not carrying pathogens or parasites that could put your health at risk.

Sexual practices

Practicing pleasurable sexuality with low risk of exposure to sexually transmitted infe very important for everyone. The three main goals for the prevention of sexually transmitted infections are:

1. Correct and consistent use of condoms during oral, vaginal and anal sex.

2. Correct and consistent use of condoms for other sexual activities involving transmission of body fluids and fecal material, including oral sex.

3. Engaging in sexual activities that do not involve the transmission of bodily fluids or direct skin contact (such as mutual masturbation).

4. It is very important that people who are under immunomodulatory treatment DO NOT become pregnant without first consulting their physician.

Vaccines

Learn to recognize symptoms of infection

Signs of a urinary tract infection:

The appearance of any of these symptoms could indicate a fungal infection. These conditions can be treated with non-medical remedies, but others require medical treatment by a dermatologist:

Travel

1. Disinfect the aircraft tray table. You could use hand sanitizer or disinfectant wipes.

2. Do not drink coffee or tea on airplanes. Only drink bottled or canned beverages.

3. Do not use airplane pillows.

4. Do not drink tap water in foreign countries.

5. Use a lot of insect repellent in foreign countries.

Prevention of skin and breast cancer

1.Evaluate your skin every few months to observe the appearance of moles with irregular borders or different colors. Make an appointment with a dermatologist if you find any.

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