Overseas Adoptees Should Be Retested for Tuberculosis (TB)

The number of American families adopting foreign children continues to grow at a quick pace. In 2006, nearly 21,000 children were adopted from countries around the world into a United States family. This number of children has grown three times the number it was 15 years ago. With international adoptions, the United States recommends an initial health screening. Health screenings vary depending on the country of origin of the adopted children and by care providers and health specialist. While it can be difficult for health professionals to completely evaluate many children because they have very limited, if any, documented family health history, it is an important facet of the adoption.

The government recommends specific tests and evaluations on foreign adoptees, to not only better treat the children, but to also try and prevent spread of infection in the U.S. Recently, The International Adoption Center of the University of Cincinnati Children's Hospital Medical Center conducted research that showed how important it is for children adopted from foreign countries to not only have their initial test for Tuberculosis (TB), but to also have follow-up tests, as directed by doctors, in case the disease doesn't show up on the initial test, but the child actually does have TB.

TB cases in the United States are most often among the foreign-born population and majority of the internationally adopted children (IAC) are from developing countries where TB is prevalent. Health providers seem to focus more on treating children for TB because of their raised risk for contraction of severe disease and the risk for reactivation of tuberculosis.

The International Adoption Center of the University of Cincinnati performed research to demonstrate the importance of having children from other countries, who were adopted into the United States, be screened more than once for TB. Their research was performed to show how many children who received their initial tuberculin skin test, and followed up with the repeat testing at the age of three months or older, that had latent tuberculosis infection. The researchers evaluated internationally adopted children who were seen at the University of Cincinnati Medical Center and had their tuberculin skin test no later than 2 months after arriving in the U.S. Children who were not diagnosed with TB at the initial testing were tested again after at least 3 months and the results were evaluated to compare the number of children initially diagnosed during the first tests and those that were diagnosed at the follow-up visit.

During the five years of the study there were 769 international adopted children seen for their initial visits at the center and 549 met the requirements for inclusion in the study. A little over half of the children in the study were girls and the mean age was 23 months. The eligible children represented 29 different countries, but over three-quarters of them came from Russia, China, Guatemala, Kazakhstan, or South Korea, which follows the pattern seen nationally. Over 81 percent of IAC had evidence of BCG vaccination, a vaccine used to try and prevent TB infections. However, only a small percent of children from South Korea had evidence of the vaccination. There were only a limited few children who had documented records of receiving multiple BCG vaccinations and the dates.

Most IAC involved in the research were seen within a couple weeks of arriving in the United States for their initial TB testing. 527 children had their test results read within the time parameters of 72 hours and were able to be included in the study. Of those eligible, 111 had evidence of latent tuberculosis infection (LTBI) and 191 had repeat TB tests. Almost half of these had negative initial test results. LTBI was found in 20 percent of those retested. After diagnosis the children began the recommended nine-month therapy. The majority of the children diagnosed with LTBI were from Guatemala, Africa, and Russia.