Is it safe for a child with cystic fibrosis (CF) to play with another child who also has cystic fibrosis (CF)?

Children with Cystic Fibrosis Should Avoid Close Contact with Each Other

No, children with cystic fibrosis should avoid close contact with each other to prevent cross-infection of respiratory pathogens. 1

Risk of Cross-Infection Between CF Patients

• Person-to-person transmission of respiratory pathogens, particularly Pseudomonas aeruginosa (P. aeruginosa), has been well-documented among individuals with cystic fibrosis 1
• The Wisconsin Randomized Controlled Trial showed that children with CF who were not isolated from other CF patients acquired P. aeruginosa at a median age of 1.0 years, compared to 5.6 years for those who were isolated 1
• Evidence from Australia further supports that P. aeruginosa can be transmitted between individuals with CF who are cared for at the same center 1
• In 2003, the Cystic Fibrosis Foundation (CFF) issued recommendations to minimize person-to-person transmission of infectious agents, including segregating patients from each other 1

Infection Prevention and Control Guidelines

• The CFF recommends implementation of standard infection prevention and control (IPC) guidelines in healthcare settings and situations where there is high likelihood of close contact between multiple people with CF 1
• These guidelines emphasize:
  • Standard precautions
  • Transmission-based precautions
  • Hand hygiene
  • Proper care of respiratory equipment 2
• While the implementation of IPC guidelines in non-healthcare settings (such as schools) is not specifically recommended due to potential negative psychological effects, the risk of pathogen transmission between CF patients remains 1

Distance Considerations

• The traditional recommendation of maintaining at least 1 meter (3 feet) distance between CF patients may not be sufficient 3
• Research has shown that transmission of P. aeruginosa beyond 1 meter is possible during both talking and coughing, although the probability is low (1.7%) 3
• CF patients should be educated to contain their secretions and maintain appropriate distance from other CF patients to avoid pathogen transmission 2

Evidence for Segregation Effectiveness

• Multiple studies have demonstrated a reduction in pathogen transmission with segregation policies, although the certainty of evidence is considered low to very low 4
• Cohorting patients infected with Burkholderia cepacia complex has been successful at limiting spread of this pathogen 5
• A systematic review found that observational studies support the implementation of isolation or segregation measures to reduce the risk of transmission of respiratory pathogens in CF patients 6

Balancing Social Needs and Infection Risk

• While social interaction is important for children's development, the risk of cross-infection between CF patients poses a significant threat to their long-term health outcomes 4
• The acquisition of respiratory pathogens like P. aeruginosa can significantly impact morbidity and mortality in CF patients 2
• Alternative forms of social interaction that don't involve direct contact or close proximity should be encouraged 4

Conclusion for Clinical Practice

• The evidence strongly supports avoiding close contact between children with CF to prevent cross-infection 1
• This recommendation is based on documented cases of pathogen transmission between CF patients and the significant impact these infections can have on long-term health outcomes 2
• Parents should be educated about the importance of infection prevention while also supporting their child's social development through alternative means 4