How to avoid secondary infections with CLL

You cant prevent every infection, but you can take steps to stack the odds in your favor. Read on to learn about the strategies that medical oncologists most often recommend to help people with CLL reduce their risk of secondary infection.

Prophylactic Medications

Being proactive is often far better than treating an infection once it has taken hold, Dr. Swenson says.

However, Preethi Prasad, MD, a medical oncologist at Houston Methodist West Hospital in Texas, advises that not everyone with CLL needs prophylactic medications. Several factors can influence whether your healthcare team recommends prophylactic medications, she says, including the following:

• The type of treatment youre receiving
• How advanced the CLL is
• Whether youve had previous or recurrent infections

Your cancer care team may prescribe one or more of the following prophylactic medications:

• Antiviral Medications Doctors commonly prescribe acyclovir (Zovirax) to help prevent viruses such as those that cause herpes zoster (shingles) and herpes simplex (cold sores and genital herpes) from becoming active again and causing illness. Many CLL therapies call for at least this kind of antiviral prevention, says Tara M. Graff, DO, a medical oncologist and director of Clinical Research for Mission Cancer + Blood, part of the University of Iowa Health Care in Des Moines.
• Antibiotics Some CLL treatments increase the risk of infections such as Pneumocystis jirovecii pneumonia, a serious lung infection that can develop in people with weakened immune systems. To help lower that risk, your healthcare team may prescribe trimethoprim-sulfamethoxazole (Bactrim), Dr. Graff says.
• Antifungal Medications Some people may also benefit from medications such as fluconazole (Diflucan), which Swenson says can help protect against certain fungal infections.

Intravenous Immunoglobulin Infusions

Vaccines

Commonly Recommended Vaccines During CLL Treatment

• Annual injectable influenza (flu) vaccine
• COVID-19 vaccine
• Pneumococcal vaccine to help protect against pneumonia and other pneumococcal infections
• Recombinant shingles vaccine (Shingrix)
• Respiratory syncytial virus vaccine

Prasad says that, depending on your age, vaccination history, and other risk factors, your oncologist may also recommend the following:

• Tetanus, diphtheria, and pertussis vaccine
• The human papillomavirus vaccine
• The hepatitis B vaccine

Which Vaccines Are Not Recommended During CLL Treatment?

• The older live shingles vaccine Zostavax
• The measles, mumps, and rubella vaccine
• The yellow fever vaccine
• The nasal spray flu vaccine (FluMist), which also contains a weakened form of the virus, although the injectable flu shot is safe for people with CLL

When to Get Vaccinated

Everyday Habits for Infection Prevention

• Wash your hands often. Use soap and water, especially before eating and after spending time in public places. This can help you remove germs and keep them from entering your body.
• Avoid common sources of infection. Steer clear of anyone who is visibly sick or has recently had exposure to an illness. Wearing a mask in crowded indoor settings may provide extra protection.
• Practice safe food handling. Avoid raw or undercooked meat, unpasteurized dairy products, and foods that are prone to mold growth, such as certain soft cheeses. This can reduce your risk of foodborne illness.
• Take care of your teeth and gums. Get dental checkups every six months and practice good oral hygiene to help prevent dental infections. These can become more serious when your immune system is weakened.
• Be careful around pets. You dont need to stay away from your furry family members, but do take extra care to avoid bites and scratches. If you have a cat, rodent, or bird, ask someone else to clean the litter box or cage, if possible, to reduce your exposure to animal waste and the germs it can carry.
• Encourage your household to get vaccinated. Ask the people you live with to stay up to date on their recommended vaccines. When they have the added protection of vaccines, theyre less likely to bring infections home.
• Focus on general wellness. Drink plenty of fluids and stay as physically active as your condition allows. This can help your body function at its best.

When to Call Your Doctor

• Fever of 100.4 F or higher
• Shaking chills
• A new or worsening cough, shortness of breath, or chest pain
• A cold, sinus discomfort, or other illness that isnt improving
• New skin redness, warmth, swelling, or drainage
• A painful rash, especially one that appears only on one side of your body, which could be a sign of shingles
• Difficulty swallowing or new mouth sores
• Burning with urination or cloudy urine
• Confusion or unusual mental fogginess
• New or rapidly enlarging lymph nodes
• Unexplained weight loss
• Extreme fatigue
• Unusual bruising or bleeding

The Takeaway