Since 1986, more than 320,000 children have been adopted by American families from other countries. More than 20,000 children have arrived annually in each of the last 5 years, most commonly from China, Guatemala, Russia, and South Korea1 (Figure 68–1). Infectious diseases are one of the most common and immediate medical concerns among newly arrived international adoptees.2–6 The recent increase in adoptions from Africa (especially Ethiopia and Liberia) has broadened the range of infectious disease concerns among new arrivals. Infectious diseases in new adoptees affect not only the child, but may also present risks to family members and the community.7
International adoptions by the US families: 1997–2006.
Pediatricians play an important role in the care of internationally adopted children, especially in relation to infectious diseases. Pediatricians are often asked to interpret information about prior infectious diseases in preadoptive medical records given to prospective adoptive families and to provide health advice to families who travel to receive their children. Pediatricians must evaluate newly arrived adoptees for infectious diseases, and remain aware of the possibility of latent or “missed” infections that may manifest months or even years later. The physician must also assess the validity of vaccine records from various birth countries. This chapter will review these topics. Infectious disease risks to families and communities will be highlighted, and some of the diagnostic dilemmas specific to international adoptees will be considered. Detailed discussions of the specific diseases mentioned in this chapter are found in other sections of this book.
Preadoptive Screening for Infectious Diseases in the Child's Country of Origin
Nearly all children undergo testing for hepatitis B, HIV, and syphilis (“RW” in Russia or Kazakhstan, “TRUST” in China) prior to placement in international adoptions. However, the results may be outdated or inaccurate (performed in an inadequate laboratory, see HIV below). Prospective parents often ask the pediatrician for advice about repeating these tests in country before they agree to accept the child. This is rarely advisable, because laboratory accuracy and sterile phlebotomy equipment cannot be guaranteed. Furthermore, negative test results do not preclude later infection. In some countries (Ethiopia, Nepal, some regions of Russia and Kazakhstan), specialized laboratories offer polymerase chain reaction (PCR) tests for hepatitis B, hepatitis C, or HIV. These results can be reassuring in cases where maternal antibodies are suspected, but parents must be cautioned that valid test results are not guaranteed.
International Adoption and Travel Medicine
Most adoptive parents travel to receive their children; many countries require multiple trips or prolonged in-country residence in order to complete legal adoption requirements. A travel medicine consultation may help parents prepare for travel-related illnesses (e.g., diarrhea, malaria), as well as infectious diseases potentially transmitted by their new child. Travelling adults should have updated vaccinations for polio, tetanus, ...