Our Services :: Vaccines for Families Traveling Abroad :: Hepatitis B. Vaccination Imperative for Families Adopting Abroad
By Dr. Jane Aronson, as published in The Bulliten of the Joint Council on International Children's Services, Summer 1998

Updated article for Hepatitis B Vaccine for Families Adopting from Abroad

Vaccination for hepatitis B virus (HBV) should be considered essential for families contemplating inter-country 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 HBV infection soon after arrival in the U.S. even if they were tested in their native country. 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 (http://orphandoctor.com).

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 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 with concerns about chronic HBV infection, I find my time divided equally between discussing the prognosis or treatment of chronic HBV infection and the in-household transmission risks. People are very anxious about the possible infection of family members, friends, and schoolmates. 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. People with chronic HBV infection should not share toothbrushes or razor blades.

Medical Needs

Some families choose to adopt a child chronically infected with HBV; others are surprised at the diagnosis. Either way, these families should seek consultation from a physician who is either a liver specialist or an infectious disease specialist.

Hepatitis A

Anyone traveling to countries other than the United States, Canada, Western Europe, Japan, New Zealand, and Australia for any reason (not just adoption) should be vaccinated against the hepatitis A virus (HAV). Besides the risk of contracting the virus abroad from food or water, there have been reports of infected children transmitting HAV to their adoptive families. HAV infection does not lead to chronic infection, but the disease can be serious.

Other vaccines

International travelers may need other vaccines or health advice as well. CDC states: ”Travelers, including adoptive parents and any accompanying family members who pick up the child, should visit a health-care provider or travel medicine specialist as soon as travel is considered to ensure that their routine vaccinations are up to date and to obtain pre-travel advice tailored to their own medical history and the country they will visit.”

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 by protecting all family members against possible in-household transmission of HBV. Family members should have blood drawn after completing the vaccination series to make sure they are immune (positive hepatitis B surface antibody). Family members who have already completed the hepatitis B vaccine series or who have had HBV infection in the past need not be immunized.

Most children born in the U.S. will already be protected against HBV infection because hepatitis B vaccine has been routinely recommended since 1991. In almost every state, children entering kindergarten must be vaccinated against hepatitis B. Hepatitis A vaccine is also now recommended for every infant as part of the routine childhood immunization schedule.

The time needed for an international adoption allows for easy completion of the three-dose hepatitis B series and the two-dose hepatitis A series over a six-month period. A combination hepatitis A/hepatitis B is available for use in adults when both vaccines are recommended. These vaccines 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 when a family member has unknowingly been put at risk of infection could be replaced with a feeling of control if they knew everyone in the household was protected against transmission of HBV. We simply need to make hepatitis B vaccine universal for families considering an international adoption.

For more information about hepatitis B, read Hepatitis B-C in the Medical Resources/Infectious Diseases and Parasites section of this site.

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