Being Immunocompromised: What Does it Mean?

People who are immunocompromised are affected more frequently and severely by infections.

The term immunocompromised (or immunosuppressed) refers to people who have an ‘immunodeficiency’ or a weakened immune system, meaning their ability to fight infections and diseases is reduced (NIS n.d.)

There are two types of immunodeficiency:

(Mayo Clinic 2020; British Society for Immunology 2017)

Primary immunodeficiencies comprise over 400 disorders that are caused by defects in the immune system. Consequently, the immune system functions less efficiently than normal, potentially causing complications. These disorders are often inherited (ASCIA 2019).

Primary immunodeficiencies may be mild and evade detection for years, or they may be severe enough to be noticed right at birth (Mayo Clinic 2020).

They fall broadly into one of six categories depending on which part of the immune system has been impacted:

(Mayo Clinic 2020; Fernandez 2019; British Society for Immunology 2017)

Secondary immunodeficiencies are more common than primary immunodeficiencies. They are acquired after the immune system is weakened by an external factor (Primary Immunodeficiency UK 2017). These causes may include:

• HIV infection;
• Malnutrition; and
• Immunosuppressive treatments such as chemotherapy.

British Society for Immunology 2017; Fernandez 2019)

Secondary immunodeficiencies may also affect critically ill, older or hospitalised people (Fernandez 2019)

Currently, the only known risk factor for primary immunodeficiency is having a family history of a primary immunodeficiency disorder (Mayo Clinic 2020).

• Blood tests can be used to measure if a person has a normal level of blood cells and immune system cells. They can also determine if the immune system is responding properly.
• Prenatal or DNA tests may be used.

(Mayo Clinic 2020)

Symptoms and effects may vary depending on the type of immunodeficiency. They can include:

• Infections that are:
  • More frequent, persistent or harder to treat than what is typical;
  • Opportunistic (infections that occur more often or are more severe in immunocompromised people);
  • Caused by unusual bacteria, viruses, fungi or parasites.
• Frequent and recurring pneumonia, bronchitis, sinus infections, ear infections, meningitis or skin infections;
• Inflammation and infection of internal organs;
• Blood disorders (e.g. anaemia, low platelet count);
• Digestive issues (e.g. cramping, nausea);
• Delayed growth and development;
• Autoimmune disorders;
• Cancer;
• Damage to the heart, lungs, nervous system or digestive tract; and
• Death from a serious infection.

(Mayo Clinic 2020; AIDSinfo 2019; ASCIA 2019)

Additionally, those who are immunocompromised are more at risk of illness and death from some vaccine-preventable illnesses (Australian Immunisation Handbook 2019).

• Practice good hygiene;
• Avoid contact with people who are sick;
• Receive vaccinations as per the advice of you own GP;
• Maintain dental hygiene and health;
• Maintain a healthy, balanced diet;
• Regular physical exercise;
• Avoid risky food items (e.g. unpasteurised milk, raw meat, cross-contaminated food);
• Take precautionary measures around animals and pets, especially if they are sick;
• Take precautionary measures with travel;
• Prevent insect bites;
• Practice safe sex;
• Get enough sleep; and
• Manage stress.

(Mayo Clinic 2020; Canadian Paediatric Society 2019)

Please note that immunodeficiency treatment will differ based on many factors including the type of immunodeficiency, the individual and treatment options available.

Primary immunodeficiency disorders may be treated in several ways:

• Managing, treating and preventing infections contracted by the individual;
• Therapies to boost the immune system; and
• Stem cell transplantation, which provides an individual with a normally functioning immune system.

(Mayo Clinic 2020)

Secondary immunodeficiencies can potentially be resolved if the underlying condition is treated (Primary Immunodeficiency UK 2017).

• Australian Government Department of Health, Vaccination for People Who are Immunocompromised, https://immunisationhandbook.health.gov.au/vaccination-for-special-risk-groups/vaccination-for-people-who-are-immuno compromised
• Australasian Society of Clinical Immunology and Allergy, https://www.allergy.org.au/

• AIDSinfo 2019, What is an Opportunistic Infection?, AIDSinfo, viewed 19 March 2020, https://aidsinfo.nih.gov/understanding-hiv-aids/fact-sheets/26/86/what-is-an-opportunistic-infection-
• Australasian Society of Clinical Immunology and Allergy 2019, Primary Immunodeficiency (PIDs), Australasian Society of Clinical Immunology and Allergy, viewed 19 March 2020, https://www.allergy.org.au/hp/hp-information/immune-diseases/primary-immunodeficiency
• Australian Immunisation Handbook 2019, Vaccination for people who are immunocompromised, Australian Immunisation Handbook, viewed 19 March 2020, https://immunisationhandbook.health.gov.au/vaccination-for-special-risk-groups/vaccination-for-people-who-are-immunocompromised
• British Society for Immunology 2017, Immunodeficiency, British Society for Immunology, viewed 19 March 2020, https://www.immunology.org/policy-and-public-affairs/briefings-and-position-statements/immunodeficiency
• Canadian Paediatric Society 2019, Safe Living Strategies for the Immunocompromised Child, Canadian Paediatric Society, viewed 19 March 2020, https://www.cps.ca/en/documents/position/immunocompromised-child
• Fernandez, J 2019, Overview of Immunodeficiency Disorders, MSD Manual, viewed 19 March 2020, https://www.msdmanuals.com/en-au/professional/immunology-allergic-disorders/immunode ficiency-disorders/overview-of-immunodeficiency-disorders
• Mayo Clinic 2020, Primary Immunodeficiency, Mayo Clinic, viewed 19 March 2020, https://www.mayoclinic.org/diseases-conditions/primary-immunodeficiency/symptoms -causes/syc-20376905
• National Cancer Institute n.d., NCI Dictionary of Cancer Terms, National Cancer Institute, viewed 19 March 2020, https://www.cancer.gov/publications/dictionaries/cancer-terms/def/immunocompromised
• Primary Immunodeficiency UK 2017, Secondary Immunodeficiency (SID), Primary Immunodeficiency UK, viewed 19 March 2020, http://www.piduk.org/static/media/up/secondaryimmunodeficiency.pdf

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