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This podcast is presented by the Centers for Disease Control and Prevention. CDC - safer, healthier people.

Dr. Brunette: Many American families are now choosing to adopt children from other countries. In fact, we’ve seen the number of international adoptions double in the last 10 years. In 2005 alone, American families adopted almost 23,000 children from 116 countries. These statistics represent a lot of happy families – and a lot of international travel. Today we’ll be talking about ways adoptive families can protect their own health and the health of their new children.

For some expert advice, we’ll be talking to Dr. Phyllis Kozarsky. She is a travel health specialist in the CDC’s Division of Global Migration and Quarantine. Dr. Kozarsky, welcome to the show.

Dr. Kozarsky: Thanks, Dr. Brunette.

Dr. Brunette: The topic of immigration has been in the news a lot recently. A special type of immigration that involves children and families is international adoption. Many American families are interested in adopting children from other countries. Does CDC have recommendations for this special type of travel?

Dr. Kozarsky: Yes. As for all international travelers, CDC recommends that all family members who travel overseas to bring home a child should see a health-care provider or travel medicine specialist before their trip. As soon as families make travel plans, they should also make appointments with their doctor – typically about 4-6 weeks before planned departure. This way, they will have time to get needed vaccinations and make other important preparations.

Dr. Brunette: If I were a parent interested in adopting internationally, what health issues need I be concerned about?

Dr. Kozarsky: That’s a great question, Dr. Brunette. We’re now seeing more and more adoptions from developing countries. Children from developing countries may not have received all the immunizations that children here in the United States usually get. They may also have been exposed to diseases that aren’t common in the United States, since infections that cause such diseases are usually prevented by vaccination.

For example, several cases of hepatitis A, which is a liver disease, were recently reported in the family of a child adopted from Ethiopia. Most children under the age of 6 do not get sick from the infection, but they can spread it to older children and adults, who often get sick. In this situation, the adopted child didn’t show signs or symptoms of being sick with hepatitis A, but some family members did get sick because they hadn’t been vaccinated against hepatitis A.

In another example, cases of measles were identified among children being adopted from China and their unvaccinated family members.

Dr. Brunette: Hmmm. What steps then should adoptive families take to protect their health?

Dr. Kozarsky: Families who are traveling internationally to adopt children should make sure they’re up-to-date with all their routine immunizations, which includes a current influenza vaccination. In particular, they should be protected against measles. That is, they should have had a case of measles or have been vaccinated against measles. As mentioned before, hepatitis A is another vaccination that needs to be considered. The recommendations for routine immunizations can be seen on the CDC Vaccines and Immunizations website at www.cdc.gov/vaccines. Adoptive parents should also keep in mind that even family members who stay home may be exposed when the new child joins the household, so these recommendations also apply to family members who didn’t actually travel themselves.

Dr. Brunette. How do parents know if the child they’re adopting is carrying an infectious disease? Should parents take the child to see a doctor before they come to the United States?

Dr. Kozarsky: All immigrants, including adopted children, and all refugees coming to the United States must have a medical exam overseas by a doctor designated by the Department of State. The medical exam consists of a brief physical exam and a medical history. This screening focuses mostly on detecting serious contagious diseases. Screening for infectious diseases is important for the health of the adopted child, as well as that of the adoptive family and other people the child might come in contact with.

Parents shouldn’t rely on this medical exam to detect all possible disabilities and illnesses, and the child needs to see a doctor once the family returns home. As part of the exam in the United States, the American Academy of Pediatrics recommends that all internationally adopted children be screened for hepatitis B, HIV, syphilis, tuberculosis, and certain parasites, and also have a complete blood count.

Another consideration is that some adopted children may have been exposed to lead in the environment. An elevated level of lead in a child’s blood can cause learning, attention, behavioral, and developmental problems. Your doctor can do a test to measure lead in the child’s blood; if the measurement is high, there are options for treatment.

Dr. Brunette: I understand that immigrants, including adopted children, must meet certain health requirements to get a visa allowing them to come to the United States. What happens if a child has an illness or disability that may make him or her ineligible for a visa?

Dr. Kozarsky: Adoptive parents shouldn’t get discouraged. A visa may still be issued after the illness has been treated or after a waiver has been approved by the Bureau of Citizenship and Immigration Services.

Dr. Brunette: Can adopted children be vaccinated after they’ve arrived in the United States?

Dr. Kozarsky: Yes. If the child is younger than 11, parents have a 30-day grace period after the child arrives in the United States to have the child vaccinated.

Dr. Brunette: Wow! This is a lot of information. Where can prospective adoptive parents go to review these things and find out more about healthy international adoptions?

Dr. Kozarsky: Just go to the CDC Travelers’ Health website at www.cdc.gov/travel.

Dr. Brunette: Well, thank you, Dr. Kozarsky, for joining us today and sharing this information with us.

The CDC Travelers’ Health and Animal Importation Branch is pleased to present this travel tip and wishes all travelers a safer, healthier trip.

To access the most accurate and relevant health information that affects you, your family and your community, please visit www.cdc.gov.