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Immunity and infection prevention

Visitors and public places

Support from family and friends matters a great deal during treatment, but infections also most often arrive through people. This topic explains how to arrange visits safely, how to go to public places, use transport, visit shops and attend gatherings, which places to avoid for a while and how to cope with feeling isolated.

Last updated: ~7 min read
In a softly lit open doorway, a faceless figure rubs their hands, with transparent glowing droplets around them; warm golden and teal light.
Figure 1.Concept: a healthy visitor cleans their hands at the door — care and protection together.

01Short answer

Visitors should come only when they are well: anyone with a fever, cough, runny nose, sore throat, diarrhea, vomiting, a rash, or recent contact with chickenpox, measles or shingles should postpone their visit. Every visitor should wash their hands or use a hand rub on arrival; a mask helps during respiratory virus season. Limit the number and length of visits, and plan visits from young children with special care. In public places, especially during neutropenia, avoid crowds and closed, stuffy spaces, use a well-fitting mask (FFP2/N95 type), carry hand rub and avoid rush hours. Swimming pools, lakes and hot tubs, building sites, farms and petting zoos carry a temporary risk. Discuss going to weddings, funerals and other large gatherings with your team in the light of your blood counts. You do not need to isolate — a sensible plan is enough.

02Simple explanation

Having loved ones close helps both emotionally and practically during treatment. But a cold, flu or stomach bug that a healthy person shrugs off can be serious for you.

The simplest rule: anyone who is ill stays away. This should not cause embarrassment or hurt feelings. Tell people in advance that if they feel unwell, the kindest thing they can do is call or video chat.

Everyone who comes should wash their hands at the door. During flu and respiratory virus season, a mask on the visitor gives extra protection. Keep visits short and visitors few, and air the room.

Going to public places is not forbidden, but choosing the time and place wisely matters. Shopping early in the morning, walking in the open air, and taking a taxi or your own car instead of a crowded bus all lower the risk considerably. On the days when your neutrophils are lowest, it is better to avoid crowds.

Feeling isolated affects health too. Video calls, short meetings outdoors and activities you enjoy all keep you connected to people. The goal is not to keep away from people, but to keep away from germs.

03Scientific explanation

Respiratory viruses (flu, RSV, SARS-CoV-2, parainfluenza, rhinoviruses) spread mainly by droplets and aerosols, especially in closed, poorly ventilated spaces. In people with acute leukemia or after a transplant they can cause severe pneumonia. According to CDC guidance, well-fitting respirators (N95/FFP2) give people at high risk better protection than ordinary medical masks; ventilation, hand hygiene, vaccination and avoiding contact with people who are ill together form the most effective approach.

Chickenpox and measles are highly contagious and can be severe in people with weak immunity. After contact with someone who has them, depending on immune status, a preventive antiviral medicine or immunoglobulin may be considered within a short time — which is why it is important to tell your team about any contact straight away. Live vaccines given to family members (MMR, chickenpox, rotavirus) are usually allowed; special care is advised only if a rash follows chickenpox vaccination and with nappy contact after rotavirus vaccination (IDSA 2013).

Environmental risks: building and demolition work releases large numbers of Aspergillus spores into the air and raises the risk of fungal pneumonia during prolonged deep neutropenia. Water in swimming pools, lakes, rivers and hot tubs can carry bacteria and parasites (for example Pseudomonas and Cryptosporidium); for people with a central venous catheter or PICC line, getting the catheter wet is also an infection risk. Farms, petting zoos and direct contact with animals are sources of salmonella and other zoonoses.

Hospitals and clinics can also be sources of infection. That is why wearing a mask in the waiting room, hand hygiene, keeping waits short where possible and keeping a distance from people who are ill all matter. Many hematology wards have their own visiting rules: for example, limits on the number of visitors, visits from children, fresh flowers and food. These rules are there for your safety and that of other patients.

04What happens in the body?

When should you seek urgent help?

Call your hematology team straight away if: your temperature is 38 °C or higher; you develop a cough, breathlessness, sore throat or fever after a visit or gathering; you have been in contact with someone who has chickenpox, shingles, measles, flu or COVID-19 — even if you feel well, some protective treatments need to start soon after contact; you notice redness around your catheter or a fever after swimming in a pool or lake.

Rules for visitors

Only people who are well should come; anyone with a fever, cough, runny nose, sore throat, diarrhea, vomiting or a rash should postpone. Anyone recently in contact with chickenpox, shingles or measles should check with your team first. Hands are washed on arrival. A mask is worn during respiratory virus season. Visitors are few and visits short. Instead of kisses and hugs, other ways of showing warmth are chosen. Visitors should not bring pets or raw food.

Children and grandchildren

Children often catch colds and stomach bugs, so their visits need special care. Healthy children can come for a short time after washing their hands. If chickenpox, measles or flu is going around at nursery or school, tell your team. If your child is the one having treatment, the children’s hematology team decides about going to school.

Public places, transport and gatherings

Avoid crowded, stuffy indoor spaces, especially during neutropenia. Go shopping early in the morning or at quiet times. On crowded transport, wear a well-fitting mask, carry hand rub and avoid touching your face. In restaurants, sit outdoors or somewhere well ventilated. If you want to go to a large gathering — a wedding, a funeral, a holiday celebration — discuss it with your team in advance: a short stay, a mask and a seat away from the crowd lower the risk.

A quiet park path in soft morning light with a few trees in the distance; no people, the air looks clear and spacious.
Figure 2.Walks in the open air in quiet places are possible during treatment too.

Places to avoid for a while

Building and renovation sites; swimming pools, lakes, rivers, the sea and hot tubs (especially if you have a catheter and during neutropenia); farms, petting zoos and animal shows; non-essential visits to hospitals and clinics; crowded events when flu and other viruses are spreading. Agree any travel plans, especially abroad, with your team in advance.

How to cope with feeling isolated

Video calls, short meetings outdoors, phone conversations, messages and shared online activities keep you connected to the people you love. Tell friends specific ways they can help: shopping, cooking, looking after children. If you feel lonely or anxious, tell your team — psychological support is part of treatment too.

A softly glowing tablet screen on a dark background; teal lines of light run from the screen to several small glowing points in the distance, no faces.
Figure 3.Connection instead of isolation: video calls keep loved ones close.

05A sensible plan: visits and outings

A little planning protects both your safety and your connection with people.

Know your counts — Ask your team which are your most vulnerable days.1Know your countsAsk your team which are your most vulnerable days.
Prepare your visitors — Anyone ill stays away; everyone who comes washes their hands.2Prepare your visitorsAnyone ill stays away; everyone who comes washes their hands.
Choose the place and time — Open air, quiet hours, short visits, a mask.3Choose the place and timeOpen air, quiet hours, short visits, a mask.
Stay connected — Video calls and a support network.4Stay connectedVideo calls and a support network.
Fewer infectionsSimple rules lower the risk.
Connection with loved onesSafe contact instead of isolation.
After contact or with a feverCall your team straight away.

06Activities and a safer approach

ActivityRiskSafer approach
A healthy visitor at homeLowHand washing, short visit, fresh air; a mask in season
A visitor who is illHighPostpone the visit; phone or video instead
A walk in the open airLowQuiet places; away from dust and building sites
Shop, marketMediumQuiet hours, mask, hand rub, short visit
Crowded public transportMedium–highA taxi or own car if possible; a mask
Weddings, funerals, large gatheringsHigh (during neutropenia)Discuss with your team; short stay, mask, seat away from the crowd
Swimming pool, lake, hot tubHigh (during neutropenia and with a catheter)Avoid during treatment; ask your team

* This table is general information. The risk depends on your blood counts, the stage of treatment and the season — your hematology team gives specific advice.

07Key terms

Respiratory viruses
Viruses that cause flu, RSV, COVID-19 and colds.
Respirator (FFP2/N95)
A close-fitting mask that filters small particles well.
Ventilation
Refreshing the air in a room; it lowers the concentration of viruses.
Post-exposure prophylaxis
Treatment given after contact with an infectious person to prevent infection.
Chickenpox
A highly contagious viral infection; it can be severe with weak immunity.
Shingles
Reactivation of the chickenpox virus; the rash can be contagious.
Aspergillus
A mould found in building dust and soil.
PICC line
A long-term venous catheter placed through the arm; it must not get wet.
Zoonosis
An infection that passes from animals to people.
Social isolation
Feeling cut off from people; it can affect mental health.

08Key points

  • A visitor who is ill stays away — phone or video is better.
  • Every visitor washes their hands on arrival.
  • A mask helps during respiratory virus season.
  • During neutropenia, avoid crowds and stuffy spaces.
  • Quiet hours and open air lower the risk.
  • Pools, lakes, building sites and farms carry a temporary risk.
  • Tell your team straight away about contact with an infectious person.
  • You do not need to isolate — stay connected safely.

09Frequently asked questions

Relatives want to visit, but one has a cold. How do I say it?

Say it openly and kindly: “I would love to see you, but my immunity is low. Coming once you are better would be the best care you could give me.” Most people understand. Mentioning your doctor’s advice also helps.

Can I go to work or school?

That depends on the type of treatment, your blood counts and the nature of your work. Some people keep working during treatment, while others work from home for a while. Make the decision together with your team.

Can I go to a mosque, church or other place of worship?

Yes, with care: avoid the busiest times, wear a mask, clean your hands and do not use shared cups or dishes. On the days when your neutrophils are lowest, praying at home may be safer.

Can I fly?

Sometimes, but talk to your team first: they will consider your blood counts, platelets, the risk of blood clots and access to medical care at your destination. Use a mask and hand rub on the flight.

How long do I need these precautions?

The strictest precautions are usually needed during neutropenia and in the months after a transplant. After treatment ends and the immune system recovers, the rules are gradually relaxed. Your team will tell you when you can return to normal life.

Can people bring flowers to the hospital?

Many hematology wards do not allow fresh flowers or potted plants, because they can carry fungal spores and bacteria. A card, a book or a photo can be brought instead. Check the ward’s rules in advance.

10Questions for your doctor

Take these questions to your appointment. The ones you save are collected on the “My questions” page and stay on this device only.

  1. Is it safe for me to have visitors right now?

  2. Can I go to public places, places of worship or shops?

  3. Do I need to wear a mask, and where?

  4. At what blood counts can I move about more freely?

My questions

12Sources

  1. Centers for Disease Control and Prevention (CDC). Information for Patients Who Are Getting Chemotherapy
  2. Centers for Disease Control and Prevention (CDC). Preventing Infections in Cancer Patients
  3. Centers for Disease Control and Prevention (CDC). Preventing Respiratory Illnesses
  4. Centers for Disease Control and Prevention (CDC). Masks and Respiratory Viruses Prevention
  5. Centers for Disease Control and Prevention (CDC). Flu and Cancer
  6. Centers for Disease Control and Prevention (CDC). Aspergillosis Basics
  7. American Cancer Society. Preventing Infections in People with Cancer
  8. Blood Cancer UK. Preventing infection
  9. Macmillan Cancer Support. Infection
  10. Cancer Research UK. Your blood, bone marrow and cancer drugs
  11. Clinical Infectious Diseases (IDSA), 2014. 2013 IDSA Clinical Practice Guideline for Vaccination of the Immunocompromised Host
  12. World Health Organization (WHO). World Hand Hygiene Day
Medical disclaimerThis information is for educational purposes only and does not replace medical advice.
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