After transplant, you will be at risk for infections. Although it may be burdensome, it is important to follow your transplant center's instructions on how to avoid infection. Until your immune system recovers, your body will not have all the tools it needs to fight infection on its own, and some infections do not respond well to medication.
The first two to four weeks post-transplant are critical, but protecting against infection is an ongoing concern up to a year after your transplant, longer if you develop graft-versus-host disease.
We suggest you view our webcast on infections post-transplant for a discussion of infectious complications that can occur.
Patients who undergo a splenectomy (the removal of the spleen) or have chronic GVHD are typically given antibiotics and sometimes antiviral medications to help prevent infection. Some patients are given antibiotics to take home so that they can take them at the first sign of fever.
Your medical team will give you guidelines to help you prevent infections until your immune system recovers. The most important of these is frequent, thorough handwashing with soap and water, especially in these circumstances:
- before eating or preparing food
- before taking medications
- after changing diapers (if you are permitted to do so)
- after touching plants or dirt (if you are permitted to do so)
- after going to the restroom
- after touching animals
- after touching bodily fluids or items that might have come in contact with bodily fluids such as clothing, bedding or toilets
- after going outdoors or to a public place
- after removing gloves
- after collecting or depositing garbage (if you are permitted to do so)
- before and after touching catheters and wounds
During the first six months after transplant, and longer for patients on immunosuppressive drugs, many transplant centers recommend that these additional precautions be observed:
- Avoid crowds or people who have infections
- Clean kitchen counters and bathrooms daily with a solution of one part bleach to 10 parts water
- Avoid people who have recently been vaccinated with chicken pox or polio
- Avoid changing a baby’s diapers
- Avoid gardening
- Do not smoke, or be around people who smoke, cigarettes, cigars or pipe
- Do not smoke, or or be around people who smoke, marijuana
- Avoid walking, wading, swimming or playing in ponds or lakes
- Avoid construction sites and remodeling projects while you are at risk for infections
- Treat well water before drinking
If You Have Pets
- Avoid adopting ill or juvenile pets (juvenile pets are more likely to scratch than mature pets)
- Avoid contact with an animal that is ill and get it medical attention
- Avoid reptiles such as lizards, snakes, turtles and iguanas and items they touch
- Avoid chicks and ducklings
- Avoid exotic pets such as monkeys or chinchillas
- Feed pets only high quality commercial food or thoroughly cooked human food
- Avoid contact with animal feces; do not clean litter boxes or cages or dispose of animal waste
- Do not touch bird droppings. Use disposable gloves and a mask if you must be near bird droppings.
- Avoid cleaning fish tanks
- Do not place cat litter boxes in areas of the house where food is prepared or eaten
- Keep cats indoors and do not adopt stray cats
- Cover backyard sandboxes to prevent cats from using it as a litter box.
At the first sign of any fever or infection, immediately call your doctor. Infections are easier to treat it detected early. Even infections that you would brush off or simply deal with yourself prior to your transplant can pose a serious threat to transplant patients.
Re-vaccination after transplant
After a stem cell transplant, antibodies provided by vaccines you previously received may decline. Unless you are re-vaccinated, you will be at risk for developing a preventable disease. Your transplant center will provide you with its recommended re-vaccination schedule.
The Centers for Disease Control re-vaccination guidelines suggest that patients be re-vaccinated for diphtheria, tetanus, pneumococcus, hemophilus, influenza type B, measles, mumps, rubella and polio at several points after transplant. To view this schedule visit the Vaccines and Immunization for Hematopoietic Stem Cell Transplant (HSCT) Recipients by the Center for Disease Control and Prevention. You can also download guidelines published for transplant survivors by the Center for International Blood & Marrow Transplant Research that include a suggested re-vaccination schedule. Contact BMT InfoNet for a print copy of the guidelines.