For Specific Groups of People:
International Adoptions
An adopted child’s birth country may have vaccination schedules that differ from the recommended immunization schedule in the United States. Differences may include the vaccines given, the recommended age for getting the vaccination, and the number of and timing between vaccine doses.
If vaccination records cannot be located or are incomplete, an internationally adopted child should be considered susceptible and be vaccinated (or revaccinated) against vaccine-preventable diseases. The child’s blood serum can be tested for antibodies to determine his or her immunity to some infections. Such serologic testing is an alternative to vaccination for certain antigens (e.g., measles, rubella, hepatitis A, and tetanus).
See "Persons Vaccinated Outside the United States, Including Internationally Adopted Children."
Additionally, the adopting parents and family should make sure they are up to date on their vaccinations to protect themselves and the adopted child. (See Immunization Schedules.)
Download a podcast
- Healthy Travel for International Adoptions Podcast (6:54 min)
The number of international adoptions, many from developing countries, has doubled in the last 10 years. This podcast discusses ways adoptive families can protect their own health and the health of their new children. (Created: 10/22/2007 by National Center for the Prevention, Detection and Control of Infectious Diseases)
Resources
- Journal articles on immunizations and international adoptions
Collected by Immunization Action Coalition (IAC) - Predictive Value of Immunization Records and Risk Factors for Immunization Failure in Internationally Adopted Children
PubMed summary of article published in Archives of Pediatrics & Adolescent Medicine - Information from Your Family Doctor: Health Aspects of International Adoption
Source: American Academy of Family Physicians - Other websites on diseases & the adopted child
- Hepatitis B (Source: Immunization Action Coalition)
- Brief Introduction to Hepatitis B for Parents of Adopted Children
- If you, your parents, or your children were born in any of these places, find out your hepatitis B status...
English version 
(47KB, 2 pages) Spanish PDF version (54KB)
- Brief Introduction to Hepatitis B for Parents of Adopted Children
- Resources for parents
- Resources for healthcare providers
General Vaccination Recommendations
for
Persons Vaccinated Outside the U.S., Including Internationally Adopted Children
Wording taken directly from General ACIP Recommendations on Immunization." Source: MMWR, Dec 1, 2006 / 55(RR15);1-48). Consult the source for references.
The ability of a clinician to determine that a person is protected on the basis of their country of origin and their records alone is limited. Vaccines administered outside the United States can generally be accepted as valid if the schedule was similar to that recommended in the United States (i.e., minimum ages and intervals). Only written documentation should be accepted as evidence of previous vaccination. Written records are more likely to predict protection if the vaccines, dates of administration, intervals between doses, and the person's age at the time of vaccination are comparable to U.S. recommendations. Although vaccines with inadequate potency have been produced in other countries, the majority of vaccines used worldwide is produced with adequate quality control standards and are potent.
The number of U.S. families adopting children from outside the United States has increased substantially in recent years. Adopted children's birth countries often have vaccination schedules that differ from the recommended childhood immunization schedule in the United States. Differences in the U.S. immunization schedule and those used in other countries include the vaccines administered, the recommended ages of administration, and the number and timing of doses.
Data are inconclusive about the extent to which an internationally adopted child's vaccination record reflects the child's protection. A child's record might indicate administration of MMR vaccine when only single-antigen measles vaccine was administered. A study of children adopted from orphanages in the People's Republic of China, Russia, and Eastern Europe determined that 67% of children with documentation of more than 3 doses of DTP before adoption had nonprotective titers to these antigens. By contrast, children adopted from these countries who received vaccination in the community (not only from orphanages) and who possessed records of 1 or more doses of DTP exhibited protective titers 67% of the time. However, antibody testing was performed by using a hemagglutination assay, which tends to underestimate protection and cannot directly be compared with antibody concentration. Data are likely to remain limited for countries other than the People's Republic of China, Russia, and Eastern Europe because of the limited number of adoptees from other countries.
Clinicians and other health-care providers can follow one of multiple approaches if a question exists about whether vaccines administered to an international adoptee were immunogenic. Repeating the vaccinations is an acceptable option. Doing so usually is safe and avoids the need to obtain and interpret serologic tests. If avoiding unnecessary injections is desired, judicious use of serologic testing might be helpful in determining which vaccinations are needed. For some vaccines, the most readily available serologic tests cannot document protection against infection. These recommendations provide guidance on possible approaches to evaluation and revaccination for each vaccine recommended universally for children in the United States. Clinicians and other health-care providers should ensure that household contacts of internationally adoptees are adequately vaccinated, particularly for measles and hepatitis B.
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Content last reviewed on July 7, 2009
Content Source: National Center for Immunization and Respiratory Diseases