Catch-Up Care Is Essential for Foreign Adoptees
Last month, the Centers for Disease Control and Prevention temporarily suspended adoption processing from an orphanage in China’s Hunan Province, after determining that it was the source of nine measles cases in recently adopted children.
This was the second time since 1997 that the agency suspended adoptions from abroad. The previous, which occurred in February 2001, also pertained to a measles outbreak and also originated in a Chinese orphanage.
Both cases represented very little threat to the public’s health, since most Americans are immune to measles, the CDC said. The agency has found only one secondary case of measles so far–in an unvaccinated college student who had close contact with one of the infected children. In the 2001 outbreak, four of the 14 measles cases occurred in unvaccinated U.S.-born individuals. So the events, while not worrisome, do highlight the need for new adoptive parents to be tuned in to a range of health issues that can arise with foreign-born children. Parents need to be ready to play catch-up on vaccinations, and make sure they select a pediatrician who knows how to recognize childhood diseases that are becoming less familiar to doctors in the States.
“Remember, doctors here are seeing [these children] in the context of middle-class America-cleaned up, dressed nicely,” says pediatrician Deborah Borchers. “So diseases prevalent in the developing world, where these children are coming from, don’t immediately spring to their minds.” Dr. Borchers is a member of the American Academy of Pediatrics’ Committee on Early Childhood, Adoption and Dependent Care. She also has three girls adopted from China. Not until she began adopting 10 years ago did she realize how ill-prepared many of her colleagues were to adequately screen children from abroad.
“Physicians need to think ‘outside of the box’ when it comes to evaluating these children with what seems like routine illnesses,” she says. With regard to the latest measles cases, for example, Dr. Borchers and another expert said they had heard through “the doctor rumor mill” that at least one of the children was initially misdiagnosed as having coxsackie virus, which can also give symptoms of fever and rash.
The CDC couldn’t confirm the claim. “However, it isn’t surprising, because doctors in the U.S. don’t see that many measles cases anymore,” said Dr. Marty Cetron, deputy director of the agency’s Division of Quarantine and Global Migration, which has been investigating the current cases. Measles is one of the most infectious diseases in the world, but the U.S. sees fewer than 100 measles cases per year on average, mostly imported from other countries.
U.S. Americans adopted 21,616 foreign children in 2003, mostly from China and Russia, according to the State Department. The CDC reports that infectious diseases have been found in up to 60% of children adopted from abroad-depending on the country of origin-and many infections can show no symptoms.
Mary Staat, who directs the International Adoption Center in Cincinnati, says it’s worth it to require parents to show proof they’ve had their children evaluated for infectious diseases, although that’s currently not required. “Tuberculosis is a prime example, because it is so prevalent in many host countries, is a silent infection in children and can only be detected by doing screens,” she says. The American Academy of Pediatrics advises pediatricians to screen and if necessary, immunize, internationally adopted children against the vaccine-preventable diseases specified by immigration law, and to screen them for HIV, tuberculosis, intestinal parasites and hepatitis C.
“There is no regulation from the U.S. side that governs how these kids are cared for in their countries of origins, and the parents may have to play catch up,” says Margaret Hostetter, who founded Yale University’s International Adoption Clinic. “Parents should be accepting of the environment from which the child comes and recognize there may be infectious diseases in that environment we may not have here,” she says.
A U.S. law passed in 1996 requires all immigrants applying for a permanent visa to show proof of immunity to a slew of vaccine-preventable diseases, such as measles, mumps, polio and hepatitis B. International adoption groups and health experts succeeded in amending the law to exempt adopted children under 11 years of age, arguing the requirement placed an unnecessary burden on the children and lengthened what is already a heavily bureaucratic and emotionally exhausting experience for the prospective parents.
“We couldn’t guarantee the vaccine records from most host countries were reliable,” says Dr. Borchers. Studies conducted in the last few decades often showed discrepancies between what was recorded on children’s immunization records and what actually showed up in post-adoption blood screens, she says. Follow-up investigation found that even well-intentioned vaccination programs had been rendered ineffective because health officials had improperly stored the vaccines or administered them at the wrong dosage or at the wrong time in the child’s life.
The CDC hasn’t determined yet if the children who came down with the measles had health records that indicated they had been vaccinated against the disease in China. In the case of the 2001 outbreak, the 10 orphans involved were not vaccinated prior to adoption.
In addition to following through on screening and vaccinations, parents of newly adopted children should cocoon for a few weeks after arrival, as difficult as that is when it’s time to show off the newest member of the family, experts say. It’s especially important in those initial weeks to minimize contact between the child and family members or friends who may be have compromised immune systems.
“It’s in the best interest of these children, from both an emotional and health point of view to have a fairly low key, reserved life for a few weeks after they arrive,” says Dr. Jerri Ann Jenista, a pediatrician who specializes in international adoptions. During this time, parents can observe the infant or toddler for any signs of sickness. “Last year, because of SARS it was easy,” she says. “We told all families to go home, lock the doors and not leave the house for a while. So we know it can be done when there’s a major impetus.”
Originally published in the Wall Street Journal
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