CDC Commentary: Health of the Internationally Adopted Child

Sharmila Shetty, MD


November 01, 2010

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Hello. I'm Dr. Sharmila Shetty from the Division of Global Migration and Quarantine at the Centers for Disease Control and Prevention. I'm happy to be speaking with you today as part of the CDC Expert Commentary Series on Medscape.

Each year, more than 12,000 children from a host of countries are adopted by families in the United States. The adoption of a child is a joyous event. However, parents should be advised that the health of their child is something that should be addressed soon after their arrival.

Infectious diseases are among the most common conditions identified in international adoptees coming to the United States. Most of these infectious diseases, such as tuberculosis and Chagas disease, are not commonly seen in this country. Children may be infected but show no symptoms at all. Therefore, physicians should advise parents to take their adopted child for a physical exam and screening as soon as possible.

The initial medical visit for an international adoptee should include a medical history and physical exam, as well as screening for infectious diseases. Screening tests for internationally adopted children should include:

  • Hepatitis B surface antigen;

  • Non-treponemal and treponemal tests for syphilis (regardless of history or report of treatment); and

  • HIV 1 and HIV 2 serologic testing.

In addition, internationally adopted children should have tuberculosis screening and a stool exam for ova and parasites (O&P). For tuberculosis, CDC recommends the tuberculin skin test (or TST) for children of all ages, or an interferon-gamma release assay for children older than 5 years. Note that if the child is malnourished and has a negative TST result, then the test should be repeated after the child is adequately nourished.

When testing for O&P, 3 specimens should be collected on 3 consecutive mornings from all children, regardless of symptoms. In children with eosinophilia and negative stool O&P exams, Strongyloides serologies should also be done. If gastrointestinal tract signs or symptoms are present, stool specimens should be sent for culture and stool antigen testing for giardia, cryptosporidia, and rotavirus.

For children 12 months of age or older who come from a country with endemic Chagas disease, serologic testing for Trypanosoma cruzi should be considered. Countries endemic for Chagas include much of Mexico and Central and South America.

Internationally adopted children rarely have diseases such as typhoid fever, malaria, leprosy, or melioidosis. Thus, CDC does not recommend routine screening for these diseases. However, findings of fever, splenomegaly, respiratory tract infection, anemia, or eosinophilia, depending on endemic diseases in the child's country of origin, should prompt an evaluation.

For more information on endemic diseases in specific countries, please visit the CDC Travelers' Health Website.

In addition to these infectious diseases, the examining physician should look for other medical and developmental issues. Evaluation of hearing and vision, growth and development, nutritional status, blood lead concentration, CBC with red blood cell indices, newborn screening and/or TSH levels, and examination for congenital abnormalities should all be part of the initial examination of any internationally adopted child.

Also, all international adoptees should receive immunizations according to the ACIP-recommended schedule in the United States.

There are also some health precautions that adoptive families should take. In addition to having updated vaccinations for travel abroad, families should be vaccinated or otherwise immune to hepatitis A infection before they travel to pick up their child. Close contacts of the child should also be vaccinated or otherwise immune.

For more information on CDC's recommendations for internationally adopted children, please visit CDC's Immigrant and Refugee Health Website at the address listed on your screen.

Thank you for your time.

Web Resources

CDC Immigrant and Refugee Health

CDC Immunizations Schedules

CDC Traveler's Health

CDC Chagas Disease

CDC Viral Hepatitis

CDC Parasitic Diseases

CDC International Adoption and Prevention of Lead Poisoning

Dr. Sharmila Shetty is a Medical Officer in the Division of Global Migration and Quarantine at Centers for Disease Control and Prevention (CDC). She received her medical degree from Mount Sinai School of Medicine and completed her residency in Pediatrics at North Shore University Hospital in New York. Dr. Shetty then worked with the medical humanitarian organization Medecins Sans Frontieres/Doctors Without Borders in Lebanon, Uganda, and Sudan, providing clinical pediatric care. Subsequently, she completed an Epidemic Intelligence Service Fellowship at CDC in 2004 with the Mycotic Diseases Branch. Following her fellowship, Dr. Shetty worked with the Red Cross in Indonesia doing tsunami relief work and as a faculty member in the International Health Department at the Johns Hopkins School of Public Health. Dr. Shetty returned to CDC in 2009 and is presently working on the health concerns of US-bound refugees and immigrants as well as issues around international adoptees.


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