copied by n from Medscape

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Laurie Barclay, MD

Sept. 3, 2003 — Tuberculosis, hepatitis A, hepatitis B, and measles have been

transmitted from internationally adopted children to their families and

communities, so healthcare providers should advise these families of standard

travel precautions, according to a review published in the Sept. 2 issue of the

ls of Internal Medicine.

" Families of internationally adopted children face risks associated with

travel if they pick up their children overseas, " write Lin H. Chen, MD, from

Auburn Hospital in Cambridge, Massachusetts, and colleagues. " Unlike other

travelers, they also face risks because of close contact with a child with

uncertain

infection and vaccination status. "

This review discusses infectious diseases common in children adopted overseas

and their potential for transmission. Adoptive parents must consider the

destination, prevalence of disease in the adopted child's country, and the

child's

health status, and they should prepare accordingly by updating routine

immunizations, getting vaccines for hepatitis B, and possibly for hepatitis A.

According to the American Academy of Pediatrics, initial infectious disease

screening of internationally adopted children should include hepatitis B

surface antigen, surface antibody, and core antibody tests; Mantoux skin test;

stool

examination for ova and parasites; syphilis serology; complete blood count

with erythrocyte indices; and hepatitis C virus test for all children from

China, Russia, eastern Europe, and southeast Asia, as well as for other children

as

indicated based on history.

Vaccines routinely administered to children in the U.S. are often not given

to children overseas, and vaccination history is often difficult to obtain.

Some experts recommend repeated immunizations combined with judicious use of

screening, while others recommend an individualized approach for each child that

minimizes the number of injections or venipunctures. Although serotesting

before varicella immunization is probably cost-effective to reduce unnecessary

vaccination, cost-effectiveness approaches have not yet been developed for other

vaccines.

" Those providing healthcare to families planning international adoption

should know about standard pretravel advice, as well as the spectrum of possible

infections in adopted children, so that they can protect the health of the

travelers and family members and close friends who will welcome the new child

into

the home, " the authors write. " Increased attention to preventive measures for

family members and early diagnosis of infectious diseases in adopted children

can reduce transmission of the organisms causing these infections. "

Ann Intern Med. 2003;139;371-378

Reviewed by Brunilda Nazario, MD