Immediate Separation is Required
Children with cystic fibrosis must be immediately separated from each other to prevent person-to-person transmission of Pseudomonas aeruginosa and other dangerous respiratory pathogens. 1, 2, 3
Why Separation is Critical
The evidence on this issue is unequivocal and based on high-quality data:
The American Academy of Pediatrics explicitly recommends that children with CF avoid direct contact with other CF patients due to documented person-to-person transmission of P. aeruginosa. 2
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 year in non-isolated children - a dramatic five-fold difference in time to infection. 1, 2
The Wisconsin randomized controlled trial documented earlier acquisition of P. aeruginosa among screened infants examined at a CF center where they were not isolated from older children with CF, many of whom had established lung infections. 1
The European Respiratory Society and Cystic Fibrosis Foundation both recommend that patients with CF avoid close contact with other individuals who have CF to prevent transmission of P. aeruginosa and other pathogens. 3
Why the Other Options Are Inadequate
Face masks alone (Option A) are insufficient:
- The 2003 Cystic Fibrosis Foundation infection control recommendations specifically call for segregating asymptomatic patients from those with established disease, not simply using masks during contact. 1
- Person-to-person transmission has been documented even in clinical settings, indicating that proximity itself is the risk factor. 1
Influenza vaccination (Option B), while important, does not address the immediate risk:
- The WHO and AAP do recommend annual influenza vaccination for all children with CF as part of routine care. 2, 3
- However, vaccination prevents influenza infection - it does nothing to prevent the transmission of P. aeruginosa, Burkholderia cepacia complex, or other CF-specific pathogens between patients. 2, 3
- This is a necessary preventive measure but not the answer to the immediate situation of two CF children playing together.
Clinical Context
- Chronic P. aeruginosa infection leads to irreversible lung damage and significantly impacts survival in CF patients. 4
- Early acquisition of this pathogen (at age 1 versus 5.6 years) means years of additional lung damage during critical developmental periods. 1, 2
- Regular microbiologic monitoring combined with aggressive antibiotic treatment can reduce chronic P. aeruginosa infections, but prevention of acquisition through patient segregation remains the primary strategy. 2
The correct answer is C - immediately separate them.