When a cold can kill: Cancer, transplant patients at risk from ordinary infections

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When a cold can kill: Cancer, transplant patients at risk from ordinary viral infections

Flu shots, hand hygiene and a healthy fear of public germs can help keep them safe during recovery, experts say

Oct. 21, 2014
Bridget Clawson

Bridget Clawson survived the rigors of breast cancer treatment only to nearly succumb to viral pneumonia.

Photo by Robert Hood / Fred Hutch News Service

When Bridget Clawson was diagnosed with breast cancer in 2009, she naturally assumed that that was the disease she had to beat.

So when she survived a partial mastectomy, nearly a year of chemotherapy and weeks of radiation – only to wind up in a hospital emergency room with a case of viral pneumonia that almost killed her, the 59-year-old Edmonds, Washington, woman couldn’t quite believe it.

“I realized, oh my goodness, I could have died,” she recalled. “It was a shock that it could be anything else other than my cancer treatment.”

What Clawson didn’t know then – like most cancer patients and those who’ve just had stem cell transplants – is that ordinary viral infections can pose an extraordinary risk to people with compromised immune systems.

From the germs that cause influenza to those that trigger the common cold, respiratory viruses can cause severe illness, costly complications and even death in patients already battling disease, said Dr. Steven Pergam, director of infection control at Seattle Cancer Care Alliance and an infectious disease researcher at Fred Hutchinson Cancer Research Center.

“In our population, influenza can be devastating,” Pergam said. “A severe infection in a cancer or transplant patient can cost $500,000.”

Worse, patients can survive their original ailments, only to die from simple respiratory disease.

Over half of transplant patients will develop a respiratory infection

The risk is real. More than half of transplant patients will develop at least one respiratory virus during the first 100 days after their procedure, Pergam said, citing a 2010 study in the journal Blood.

And infections in cancer patients are a common cause of illness and death, according to the 2012 guidelines for prevention and treatment issued by the Journal of the National Comprehensive Cancer Network.

The biggest culprits are the germs most people would expect: Influenza strains A and B are problems, of course. But so are some lesser-known bugs including adenovirus, bocavirus, coronavirus, rhinovirus, metapneumovirus – and four strains of parainfluenza, a close cousin to the flu.

One of the most worrisome infectious agents is respiratory syncytial virus, or RSV, which caused outbreaks in 2007 and 2012 at SCCA, raising alarm among patients and forcing staff to put emergency control plans into place.

Keeping vulnerable patients from catching the bugs can be difficult, said Sara Podczervinski, SCCA’s infection prevention and control practitioner. When flu spikes in Seattle in the winter months, it hits already-ill patients, too.

“Folks are in the community,” she said. “It’s not hard to pick up a respiratory virus.”

SCCA staff sent home at the first sign of sniffle or cough

SCCA works hard to prevent illness from spreading via the hospital. Intensive programs haveboosted staff flu shot rates to 97 percent and there’s a new effort this year to vaccinate patients, families and caregivers, too. Hospital culture frowns on people who come to work sick; at the sound of a sniffle or cough, they’re forced to go home.

“Transmission from patients to staff should really be a ‘never event,’” Pergam said in a recent presentation about infection prevention.

In addition to getting vaccinated, staffers are urged to follow validated infection control measures, including isolating or masking patients with known infections and making sure to practice good hand hygiene.

The message isn’t lost on patients. Debbie Berg, 55, a technology office manager at SCCA, said she became extremely worried about catching infections after her January 2011 autologous stem cell transplant to treat multiple myeloma.

“You freak out,” she said. “If you’re in a movie theater and you hear someone coughing? Even now, I have heightened anxiety about getting a cold.”

Steve Lovell, 56, a retired Alaska Airlines project manager, still struggles with graft-vs.-host disease after his 2010 allogeneic stem cell transplant to treat myelodysplastic syndrome, or MDS, a type of blood cancer. Treatment for the condition undercuts his immune system, making him still vulnerable to infection.

Right after the transplant, he was aggressive about infection control, demanding that home caregivers get flu shots and scrutinizing his environment for signs of germs.

“It was a real big fear in the fall of 2012,” he said. “When I went out to a restaurant, I went to Ivar’s because I could see them cooking the food and see that they were wearing gloves.”

Even now, with his immune system still weak from GVHD effects, he said won’t place restaurant silverware directly on the table for fear it’ll become contaminated.

Bridget Clawson’s cancer remains in remission, but she said she’s still very careful about preventing infections. She changed her diet, avoiding red meat and processed foods and adding more vegetables and fruit in an effort to boost her immune system. If she feels a cold coming on, she drinks more water and gets extra rest. And she washes her hands frequently.

‘I do a lot of bacterial wipes and hand sanitizer’

“I do a lot of bacterial wipes and hand sanitizer,” said Clawson, who is the human resources director for Snohomish County and a grandmother of six. “I strike a balance about not being phobic about germs, but being aware.”

That’s the same balance Podczervinski, who is Clawson’s daughter-in-law, underscores with staff at SCCA.

“Patients going through cancer treatment or going through transplant are very vulnerable to respiratory infections,” she said. “It’s very important that they are protected. It could save their lives.”

Also in the news:

JoNel Aleccia is a staff writer at Fred Hutchinson Cancer Research Center. From 2008 to 2014, she was a national health reporter for NBC News and msnbc.com. Before that, she was a reporter, editor and columnist for more than two decades at newspapers in the Northwest. Reach her at jaleccia@fredhutch.org

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