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

Infection Control for Children with Cystic Fibrosis

No, children with cystic fibrosis should avoid close contact with each other to prevent cross-infection of respiratory pathogens, particularly Pseudomonas aeruginosa and Mycobacterium abscessus. 1, 2

Evidence for Segregation

The risk of person-to-person transmission between CF patients is well-established and clinically significant:

• Children with CF who were isolated from other CF patients acquired P. aeruginosa at a median age of 5.6 years, compared to only 1.0 years in non-isolated children 2—this represents a dramatic 4.6-year delay in acquiring this problematic pathogen 2

• The Cystic Fibrosis Foundation issued specific recommendations in 2003 to minimize person-to-person transmission by segregating patients from each other 3, 1

• Whole genome sequencing studies have confirmed frequent transmission of M. abscessus between CF patients despite conventional infection control measures 1

Why Other Options Are Inadequate

Antibiotics Alone (Option C)

• Antibiotic therapy does not prevent cross-infection because it treats existing infections but cannot prevent transmission of antibiotic-resistant strains or new pathogens 1
• Children on antibiotics can still harbor and transmit resistant organisms to other CF patients 1

Masks Alone (Option D)

• Masks may reduce droplet transmission but cannot be relied upon as the sole preventive measure 1
• The European Respiratory Society notes that masks alone do not adequately prevent cross-infection between CF patients 1

Specific Distance Requirements

When CF patients must be in shared spaces:

• Maintain at least 3 feet (and preferably 6 feet) of distance from all other CF patients 1
• This applies particularly in outpatient clinic settings and any shared activities 1
• Standard hand hygiene and cough etiquette should still be practiced with all contacts 1

Clinical Implications

• Local infection control policies may preclude CF patients from participating in standard group-based programs where other CF patients are present 1
• CF centers should implement comprehensive infection prevention strategies including proper cleaning of respiratory therapy equipment and environmental reservoirs 1
• Environmental sources like nebulizers, medical equipment, sinks, and toilets can harbor P. aeruginosa and require decontamination 1

The correct answer is B: avoid close contact with each other to prevent cross-infection.