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Medical
Resources :: General Medical Issues :: Medical Evaluation of the Internationally
Adopted Child (page 3 of 3)
| Documentation of Immunizations among Internationally
Adopted Children |
| • Schulte, Maloney, Aronson et al.
Pediatrics February 2002;109(2) e22 |
| • 34% had documented immunizations in pre-adoptive
records |
| • 66% did not have documentation |
| • Variability of immunizations “up to date”
at 1 yr |
| • Polio (77%); DTP (59%); Hep B (29%) |
| • 5% had records of one or more vaccine doses administered
before birth |
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| Immunization Dilemmas |
| • Hostetter & Johnson Society for
Pediatric Research May 1998 “Overall, despite written evidence
of age-appropriate immunization, only 35% of Chinese, Russian, and
EE adoptees exhibited protective titers to diphtheria and tetanus.” |
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| What to do about Immunizations? |
| • For children under 18 months, I have
been repeating all vaccines, except for children in foster care in
Guatemala and South Korea |
| • For children greater than 18 months of age, I
draw antibody titers and create an individualized immunization plan
(neutralizing, ELISA) |
| • Hib, Varivax, Prevnar are easy as they are not
given in most countries outside the U.S. |
| • Hib is given in Central America |
| • If there is a schedule from the record make sure
the intervals are appropriate and that the vaccines weren’t given
too young |
| • You may end up removing one vaccine in a series
and salvage others if the titers are adequate |
| • Measles cannot be accepted if it is given less
than one year of age |
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| Summary on Immunizations for Children Adopted from
Abroad |
| • There is no consensus |
| • Do titers or re-immunize or both |
| • Negotiate a plan with parent(s) |
| • Consider cost, risks, benefits |
| • We need more research to establish consensus
and standard of care |
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| Hepatitis C, Syphilis |
| • No child had these diseases in the
study |
| • 2/1500 (0.13%) Hepatitis C since 1994 |
| • 2 new HCV positive children < 1 yo |
| • 2/1500 (0.13%) Syphilis since 1994 |
| • 10/478 (2.1%) FTA positive in study |
| As of 28-March-2002 |
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| HIV Infection in Children Adopted from
Abroad |
| • 7299 + children tested
in 17 centers in the U.S. since the early 1990s |
| • 12 children with HIV infection (0.16%) |
| Russia |
1 |
| Cambodia |
4 |
| Romania |
4 |
| Panama |
1 |
| Vietnam |
2 |
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| HIV Infection |
| • Russia 12 month old girl in 1998 |
| • Cambodia all 4 negative in country |
| • Vietnam 2 negative in country |
| • Panama 1 negative in country |
| • Romania 2 negative in country, 2 known to be
infected before adoption |
| • 10/12 negative at time of adoption (83%) |
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| Gastrointestinal tract pathogens |
| • Giardia infection was common |
| • 117 children with one or more pathogens noted |
| • 87/461 (19%) Giardia lamblia antigen detected |
| • Being born in EE--Russia, Romania, Moldova, Bulgaria,
and Hungary--was a risk factor for the acquisition of G. lamblia (intestinalis) |
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| Giardiasis |
| • To not treat a child from an orphanage
with Giardia because the symptoms are minimal would be a mistake |
| • Failure to Thrive is probably universal in this
population and Giardia probably plays its part |
| • Public Health is a major issue--kids spread this
to families and friends! |
| • Treat it with Metronidazole made as a tasty benzoate
suspension (1-800-861-0933) |
| • Apthorp, Vitality, Miller, Clayton & Edward |
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| Gastrointestinal tract pathogens |
| Campylobacter spp. |
5 |
| Shigella spp. |
3 |
| Salmonella spp. |
2 |
| Cryptosporidia spp. |
4 |
| Dientamoeba fragilis |
10 |
| Ascaris lumbricoides |
1 |
| Hymenolepis nana |
3 |
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| Gastrointestinal tract non-pathogens |
| Blastocystis hominis |
18 |
| Entamoeba coli |
7 |
| Endolimax nana |
4 |
| Chilomastix mesnili |
1 |
| Entamoeba hartmanni |
1 |
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| Helicobacter pylori Infection |
| • Is this a real player in children
with failure to thrive, reflux esophagitis, diarrhea, and other non-specific
gastrointestinal problems? |
| • With the new diagnostic stool H. pylori antigen
test, it will probably be diagnosed more often and may very well be
found to be a considerable cause of poor growth in children from orphanages |
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| Skin problems in Orphans |
| • Scabies incognito--Treat with Elimite
5% when in doubt |
| • Urticaria pigmentosa (mastocytosis)--I see it
too often in little ones from Asia |
| • Acropustulosis of childhood--Is this related
to Scabies? Dapsone works! |
| • Don’t forgot about Fungus! |
| • Eczema could very well be related to Zinc deficiency |
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| Anemia |
| • We all know iron deficiency anemia |
| • Bone up on your “Anemias of Asia” |
| • Know Thalassemia and you will decrease anxiety |
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International Pediatric Health Services, PLLC
Dr. Jane Aronson, FAAP
338 East 30th Street, #1R
New York, NY 10016
P: 212.207.6666
F: 212.207.6665
E: E-mail
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