Hepatitis B Vaccination - International Adoption

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Hepatitis B. Vaccination Imperative for Families Adopting Abroad

Hepatitis B Vaccination Imperative for Families Adopting Abroad

Wanting to Adopt? Pregnant?

This article was originally printed in: The Bulletin of the Joint Council on International Children's Services - Summer 1998 issue. Vaccination for hepatitis B should be considered essential for families contemplating intercountry adoption. While the risk of an adopted child from abroad being a hepatitis B carrier varies from country to country, concerns over the possibility of transmission to other 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 hepatitis B carriage after arrival in the U.S. Their stories were typical of families contacting adoption medical 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 United States for seven months before he was tested for hepatitis B 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 a hepatitis B carrier. She was anxious about her child's health, but she was also quite disturbed about her risk and her family's risk for contracting hepatitis B 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.

Each year in the U.S. -

150,000 people contract hepatitis B
more than 11,000 require hospital care
close to 5,000 people die from hepatitis B

Source: Centers for Disease Control and Prevention
Visual diagnosis impossible The story of the Chinese boy illustrated a mythology about hepatitis B. The facts are that most children who are carriers of hepatitis B are healthy in their appearance, and no one can tell if a person is a carrier by just looking at him. All children adopted from abroad should be tested for hepatitis B soon after arrival in the U.S. The standard list of laboratory studies that should be performed on all internationally adopted children within a few weeks of their arrival in the U.S. is found on many adoptions websites, including my own.

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 hepatitis B carriers have not completed the vaccine series when they find out the diagnosis for their children.

In-house transmission When a family calls me to discuss hepatitis B carriage, I find my time on e-mail or the phone to be divided equally between the prognosis/treatment of chronic hepatitis B infection and the in-household transmission risks. People are very anxious about the possible infection of family members, friends, and school mates. 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 prevention of infection at home or at work. Usually people do not know the infection status of children or adults in any environment 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.

Hand washing is also essential to the prevention of infection. People with hepatitis B carriage should not share toothbrushes or razor blades.

A Chance for Control What concerns me is that the majority of families do not complete their hepatitis B vaccine series before the adoption is complete. We have so little control during the adoption process and here is an opportunity for control. For other children at home, there is usually no issue, because hepatits B vaccine has become a universal vaccine in the U.S. since 1991. Pediatricians are actively working to catch up kids who missed the series in the first year of life. In New York State and other locales, all children entering kindergarten in September, 1998, must be vaccinated.

The time needed for an international adoption allows for easy completion of the three vaccine 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 everyone knew he or she was protected against in-household transmission with effective vaccination. We simply need to make hepatitis B vaccine universal for families considering an international adoption.

Dr. Jane Ellen Aronson is Director of International Adoption Medical Consultation Services and Chief of Pediatric Infectious Diseases at Winthrop Pediatric Associates, 222 Station Plaza North, Suite 611, Mineola, NY 11501. Phone: 516-663-4417; Fax 516-739-6535; E-mail: Jaronmink@aol.com