Investigators from France sought to determine the rates and types of infectious diseases among internationally adopted children and the frequency of transmission of these diseases to adoptive family members. All children seen in the Clermont-Ferrand Hospital adoption clinic in France from 2009 to 2011 were eligible and had their medical records reviewed for demographic, laboratory, radiologic, vaccination, and clinical data. Screening at the adoption clinic included serologies for hepatitis (A, B, and C), cytomegalovirus (CMV), syphilis, malaria, typhoid, HTLV, and HIV; stool for parasite and bacteria analysis; tuberculin skin test and chest x-ray for TB; nasal swab for Staphylococcus aureus; and a clinical examination for skin infections. Parents of eligible children were asked to complete a questionnaire to confirm demographic and adoptive data as well as to provide information regarding whether any infectious diseases diagnosed in the child at the clinic visit spread to family members.
Medical records from 142 internationally adopted children were reviewed with 122 families (86%) completing the questionnaire. Haiti and Ethiopia were the most common countries of origin, accounting for 80% of adoptees. Vaccination status was incomplete in 67% of children, and 66% required at least 1 tetanus booster. There were 171 infections identified among the 142 children, including chronic hepatitis B (n = 2), hepatitis A (n = 3), CMV (n = 1), latent TB (n = 2), S aureus (n = 5), tinea capitis (n = 44), scabies (n = 4), molluscum (n = 15), Giardia intestinalis (n = 23), Salmonella (n = 2), Shigella (n = 1), Clostridium difficile (n = 1), and Entamoeba histolytica (n = 7). No child had malaria, typhoid, HIV, HTLV, or hepatitis C. Infections were transmitted to adoptive family members in 12% of cases (n = 20). The most commonly transmitted infection was tinea (n = 15); there were 2 transmitted cases of molluscum and pediculosis, and 1 transmission case each of hepatitis A, scabies, Giardia, CMV, and methicillin-sensitive S aureus.
The authors conclude that internationally adopted children infrequently transmit infectious diseases to their adoptive families and these diseases are most often benign.
Dr Sutter has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.
Nearly 20,000 children are adopted internationally annually, most from developing nations with high rates of transmissible infectious diseases.1 The current study highlights the need for comprehensive screening for infections after the child emigrates to ensure the health of the entire family. The potential for transmission of enteric disease appeared particularly significant: 56% of children had a positive stool test for a parasite. Although transmissions in this cohort were primarily dermatologic infections, outbreaks such as measles, tuberculosis, giardiasis, hepatitis A, and antibiotic-resistant enteric bacterial infections have...