Infectious diseases in internationally adopted children: Epidemiology and risk factors^[1]

Abstract

The aim of this study was to determine type, prevalence and risk factors for infectious diseases in internationally adopted children. The number of internationally adopted children is still increasing and the countries of origin change with time. Regular reassessment of the epidemiology of infectious diseases is essential in order to recommend appropriate screening and treatment for these children. A retrospective cohort study was conducted between 01/01/1998 and 12/31/2001. Of 552 children evaluated, 77% were females. Median age was 13 months. Children originated mainly from China (n = 319, 57.8%) and other Asian countries (n = 112, 20.3%). Overall, 105 children (19.0%) were found to have at least one type of infection diagnosed on initial screening. In our cohort, 57 of 342 children (16.7%) were infected with one or more pathogenic intestinal parasites; the most common was Giardia lamblia, found in 44 of 342 tested children (12.8%). Increasing age was associated with an increased risk of parasitic infection, with children 12–24 months (adjusted OR: 7.9; 95% CI: 2.6–24.5), and children > 24 months (adjusted OR: 25.3; 95% CI: 7.7–83.1) being significantly more at risk than children < 12 months. Stool cultures were positive in 13 of 159 tested children (8.2%). Eleven percent (41 of 371) of children tested had a tuberculin skin testing (TST) reaction ≥ 10 mm. Eastern European (adjusted OR: 3.5; 95% CI: 1.1–11.1) and Latin American (adjusted OR: 4.9, 95% CI: 1.5–15.8) children were more likely to have a positive TST. Serological evidence of active or chronic hepatitis B infection was found in six children (1.0%). Two children had syphilis and one had hepatitis A. All children screened for hepatitis C and HIV were negative. Our study shows a high intestinal parasite infection rate, high rates of latent tuberculosis and lower hepatitis B rates than previously reported. If undetected, some of these diseases may have serious long-term consequences. Screening should be performed for all internationally adopted children at the time of arrival into the adoptive home.

Keywords

Adoption - screening - tuberculosis - intestinal parasites - hepatitis B

¹ This study was presented in part at the Canadian Pediatric Society 80th Annual Meeting, Calgary, Canada, June 2003.