Two CF children in same class

Question

Hello,

Our son (7 years old, CF) and another girl with CF are in the same class. With regards to social aspects we do find this positive. However, her health condition has now deteriorated (transplantation is planned). Since four weeks she is Pseudomonas positive and a therapy with antibiotics did not succeed. We know about this diagnosis since two days. Which measures (e.g. hygiene) are recommended? Our son hardly has any lung problems. Do we have to expect an infection even though the lung is in a good condition.

Many thanks

Answer

Dear questioner,
You have a child with CF and in the same school class there is another child with CF. This is certainly found very seldom. Many years ago, even summer camps were organized where CF children spent their holidays together. Unfortunately, this contact resulted in cross infections of the different pathogens. By using modern techniques it was possible to prove that the infections were actually transmitted from one child to the other and that it was not the proof of a new pathogen like e.g. Pseudomonas aeruginosa. Therefore, the risk of colonisation cannot be excluded even if the lung function is pretty good. (Data from Hoiby et al. numbered the risk of a cross-infection of the pseudomonas-free patient of 1% per day). Furthermore, avoiding a direct or close contact of children at that age nor the adherence of stric hygienic rules (e.g. regular disinfection of the hands) can not be expected at that age. Last but not least there is an increased risk for a patient awaiting a lung transplantation to "pick up" a multiresistant or mucoid Pseudmonas strain. Therefore it can only be recommended to separate those 2 children into different classes to lower the risk of cross-infection. We had already a question about 2 children with CF going "only" to the same school, not to the same class (please see this former question and answer in the public comment field). Even if the children do not share the same class room, the risk of cross-infection cannot totally be excluded even if it is very small. So in that case, there is no clear right or wrong about the decision, if your child can go to the same school as the other child with CF and the decision depends on many different factors (please see the former answer on this topic).
It would be advisable to do monthly swabs to be able to react quickly in case of a possible colonization with Pseudomonas.

Best regards,
Barbara Kahl together with Prof. Hebestreit and Prof. Tümmler

23.04.2010

23.4.10 The topic "School - 2 children with CF" has extensively been discussed with several experts. A consent answer has been found and can be read here to have more information on the topic:

"School - 2 children with CF"
Hello,
our son Dennis will start school in summer. Currently we learnt that there
is already another child with CF at that school (third grade). Now our
doctor is concerned, because the girl at that school is “badly off” and
already had several bacteria, among them pseudomonas.
Are we actually compelled to send our son to a different school?
Many thanks in advance,
Karin
A:
Dear questioner:
This is not an uncommon situation in CF. However, your question is not easy
to answer as there is no clear right or wrong.
On one hand it is highly unlikely that your son will have such a close
contact to the other child with CF mentioned that a non-negilable risk of
cross infection occurs. The chance to be confronted with Pseudomonas
bacteria, which in general can be found in any everyday surrounding, thus
also in the new school even without a child with CF, is doubtlessly several
times higher.
On the other hand, there exists a certain possibility that both children
come across each other in the schoolyard or the corridors or they will use
the same gym or class room after the other. Even if the risk of infection is
minimal as long as there is no direct physical contact or both children do
not stay in one small room for a longer time period, it is important to
recognize that there is some risk. However, this risk can be minimized
further, if good hygienic precautions are taken (e.g. disinfection of
equipment if one child with CF has expectorated secretions accidentally on
it) and the two children would never be in the same room together. However,
with children, it is sometimes difficult to guarantee a full segregation
(meeting at school events, sports days, in the dinner hall etc) and then the
risk increases.
Thus: The decision, if your child can go to the same school as the other
child with CF depends on his particular environment, and needs an extensive
discussion with you as parents about how secure you feel about segregation
being maintained and therefore favour your child going to that school,
considering the fact that the risk is very small. On the other hand you have
to consider how difficult it would logistically be to send your child to
another school in case the worries about the risk of cross-infection, which
cannot totally be excluded, weigh too heavy.
With kind regards
Dr. H.-G. Posselt