Vaccination for hepatitis B virus (HBV) infection should be considered essential for families contemplating intercountry adoption. While the risk of an adopted child from abroad being chronically infected with HBV varies from country to country, concerns over the possibility of transmission to others can be alleviated if family members seek the readily available hepatitis B vaccination series before the child arrives.
Recently, I was the consulting pediatrician for two families whose adopted children from abroad had been diagnosed with chronic HBV infection after arrival in the U.S. Their stories were typical of families contacting adoption medicine specialists across the country. One child was a 14-month-old boy from China, and the other was a one-year-old girl from Russia. The boy had actually been in the U.S. for seven months before he was tested for HBV infection. His mother told me that the pediatrician felt that the child did not need to be tested because he looked healthy. The mother and father had not been vaccinated against hepatitis B.
The mother of the little girl from Russia contacted me because she had just been told by the pediatrician that the child was chronically infected with HBV. She was anxious about her child’s health, but she was also quite disturbed about her risk and her family’s risk for contracting HBV infection. No one in the family had been vaccinated.
I discussed the issue of in-household transmission and reassured both families. They have all begun the process of completing the hepatitis B vaccine series.
Visual diagnosis is impossible
Among my patients, the vast majority of parents had either not completed or even begun the hepatitis B vaccine series by the time their adoption was completed. Most of the families who contact me from around the U.S. whose children are chronically infected with HBV have not completed their hepatitis B vaccine series when they find out the diagnosis for their children.
I would rather see the family in a position of comfort and control knowing that with a completed hepatitis B vaccine series, they are essentially safe.
In addition to vaccination, it is, of course, essential that everyone understand the concept of “standard precautions” for pre-vention of infection at home or at work. Usually people do not know the infection status of children or adults in any environ-ment since this is confidential information.
When someone is bleeding, gloves should be available so that a family member, teacher, or friend can safely assist the bleeding patient. Blood on surfaces should be cleaned up with a simple bleach solution. Most schools have requirements for gloves and bleach for handling blood exposure. People with chronic HBV infection should not share toothbrushes or razor blades.
A chance for control
The time needed for an international adoption allows for easy completion of the three-dose series over a six-month period. It can be administered by a family physician, internist, nurse practitioner, physician assistant, or even the prospective pediatrician for the adoptee.
The pain and guilt that families feel could be completely replaced with a feeling of control if they knew they were protected against in-household transmission with effective vaccination. We simply need to make hepatitis B vaccine universal for families considering an international adoption.
Hepatitis B infection and Special Needs Adoptions from Abroad
Hepatitis A vaccine
Adopting a child from abroad?
Adapted with permission from The Bulletin of the Joint Council on International Children’s Services, Summer 1998.
The Joint Council on International Children’s Services, Ph: (703) 535-8045
|This page last updated August 18, 2008 11:26 AM EST|