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Get hepatitis shots for all family members ...


Robin Hilborn
June 2009

What kind of diseases could your child bring home from abroad? For starters, hepatitis A and B, tuberculosis and measles, all of which are known to be transmitted from children to adults close to them. So before you leave home, update routine immunizations and get hepatitis A and B vaccine for all family members, not just those travelling.

A February 2009 advisory from Centers for Disease Control and Prevention (CDC) underscored the need to protect family members. The CDC's Advisory Committee on Immunization Practices noted a number of recent cases of hepatitis A in family members and recommended vaccination for all household contacts of international adoptees.

CDC had already recommended a hep A shot for parents travelling abroad on adoption trips, but not for family staying behind. Now it urges vaccination for anyone -- family members, caregivers, friends -- who'll be in close contact with the child within two months after arriving from countries where hepatitis A is prevalent. "Those potential household contacts that travel abroad should be vaccinated prior to departure; the remaining household contacts should ideally be vaccinated prior to the arrival of the adoptee."

For more recommendations on protecting yourself and family members, I'd like to refer to the article "Preventing Infectious Diseases during and after International Adoption" by Lin H. Chen, MD; Elizabeth D. Barnett, MD; and Mary E. Wilson, MD, in Annals of Internal Medicine, Sept. 2, 2003 (free PDF). The authors suggest how the family doctor can counsel families of internationally adopted children; I've condensed their remarks ...

Vaccines for international travel

Families travelling to pick up adopted children should be protected against diseases they may encounter. Records should be reviewed to update routine immunizations, such as measles, diphtheria and polio.

Travellers to most parts of the world, except Scandinavia, Australia, New Zealand, Japan, parts of Europe, and parts of North America, will benefit from protection against hepatitis A. Although it is a two-dose series, a single dose administered at least two weeks before travel provides adequate protection for the trip.

In areas where safety of food and water cannot be guaranteed, protection against typhoid is also desirable. Travellers to parts of Africa and South America where yellow fever is endemic should receive yellow fever vaccine and information about preventing mosquito bites.

Individuals travelling to parts of Asia and the Indian subcontinent in the warm season may be candidates for Japanese encephalitis vaccine, especially if travel includes rural areas during transmission season and extends one month or longer.

Preventing malaria

Families travelling to malaria areas should be protected by reducing exposure to mosquitoes (by using bed nets and insect repellents with N,N-diethyl-m-toluamide) and taking appropriate drugs, such as chloroquine (in areas where chloroquine resistance is not present), atovaquone and proguanil, mefloquine and doxycycline. If the destination is a dengue-endemic country, the risk for dengue (a mosquito-borne virus) should be addressed. The traveller should minimize the risks for animal bites (and rabies), fresh water exposure (leptospirosis and schistosomiasis), soil contamination (hookworm, cutaneous larva migrans, and strongyloides), and blood and body fluid contact (hepatitis B and C viruses and HIV).

Protecting family members

A screening after arrival sometimes reveals previously undetected infections. These organisms, which can be transmitted from adopted child to family and close friends, include tuberculosis organisms, hepatitis A virus, hepatitis B virus, measles virus, intestinal parasites and Bordetella pertussis. Doctors need to warn of the risks of close contact with a child with uncertain infection and vaccination status.

• Routine immunizations. Siblings' routine immunizations can be updated if necessary because of the small but possible risk for exposure to diseases, such as measles and pertussis. Adult family members may find that they are not protected optimally against tetanus or diphtheria, boosters for which should be given every ten years throughout life. Adult family members and caretakers should be vaccinated against measles before international travel unless they are immune by birth before 1957 or have a reliable history of measles (physician-diagnosed), serology or documented receipt of two doses of live attenuated measles vaccines given at least one month apart after the first birthday.

• Hepatitis A and B. Immunization against hepatitis A and B is desirable for family members and others in close contact with the adopted child. Hepatitis A vaccine may be given to children starting at two years old. Hepatitis B vaccine is now given routinely to children, but older adolescents and adults may be unprotected. Initiation of the three-dose vaccine series before adoption is advised for close family and friends.

• Cytomegalovirus. There is no vaccine to prevent cytomegalovirus. Handwashing when caring for the adopted child, especially when changing diapers, should protect against disease transmission if the child is a carrier.

• Tuberculosis. The tuberculosis vaccine, Bacille Calmette-Guérin, is not recommended for adoptive families in the U.S. The adopted child should receive tuberculin skin testing on arrival. If positive, the child should be evaluated for active tuberculosis and if found, family members may have been at risk for transmission. If they remain well, skin testing three months after exposure should identify whether transmission has occurred.

• Other infectious diseases. Family members may also be at risk for other infectious diseases, such as scabies and fungal skin infections. Assessing and treating children with skin rashes early may prevent transmission. Excellent hand hygiene and early diagnosis and treatment of the child may prevent transmission of diarrheal diseases or intestinal parasites.


Families of internationally-adopted children face the risk of acquiring infections because of close contact with a child who may have a range of infections. Some of them may be inapparent or may not manifest in adopted children until many years after the adoption.

Increased attention to preventive measures for family members and early diagnosis of infectious diseases in adopted children can reduce transmission of the organisms causing these infections.

Those providing health care to families planning international adoption should know about standard pretravel advice, as well as the spectrum of possible infections in adopted children, so that they can protect the health of the travelers and family members and close friends who will welcome the new child into the home.

Robin Hilborn is editor of Family Helper magazine and webmaster of Family Helper web site. See his biography.
Adapted from the Family Helper publication Health Issues in Intercountry Adoption.

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Contact: Robin Hilborn,
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Copyright 2009 Robin R. Hilborn
Updated June 2, 2009

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