Minnesota International Adoptee Hepatitis A Study UPDATE

Pediatrics has reported findings of a new study conducted on international adoptees and their contacts between 2007 and 2009. Thirty-one cases of Hepatitis A were detected during this timeframe. Almost a third of the cases were NOT the adoptees. Adults and children were exposed to Hepatitis A from the international adoptees in child care facilities.

This underscores the responsibility that adoptive parents have in getting their families vaccinated to Hepatitis A and testing their internationally adopted children immediately upon arrival to the US.

“Twenty-one cases were recently-arrived, foreign-born adoptees (all were younger than 5 years of age, and only 6 were symptomatic), eight cases were direct contacts of an infected adoptee, and two cases were secondary contacts of an adoptee.”

Adoption of foreign children by US families increased by a factor of nearly 2.5 from 1990 to 2008. Hepatitis A commonly occurs in each of the 20 most common countries of birth of orphans coming to the United States. For people in these countries, the hepatitis A infection most frequently occurs as infants or young children. Signs and symptoms of hepatitis A, including jaundice, dark urine, fever, headache, malaise, nausea, vomiting, abdominal pain, and anorexia, are not always visible in infected persons (for example, fewer than 10% of children younger than 5 years of age with hepatitis A have jaundice), but it is still infectious in these persons. Hepatitis A is transmitted through fecal-oral contamination.

No secondary cases occurred among household contacts who had been vaccinated before exposure to a hepatitis A–infected adoptee. Seventeen children and six adults were exposed to hepatitis A–infected adoptees in two child care facilities. Of 9 children aged more than 1 year (the age at which they can receive the vaccine) in those child care facilities, 3 were previously vaccinated. Of the 6 adult child care providers exposed in these 2 facilities, 3 had previous immunity (including 2 who were vaccinated previously and 1 who had a history of hepatitis A infection).

Hepatitis A is a disease that can be prevented with a vaccine, and since 1996, the US Advisory Committee on Immunization Practices (ACIP) has recommended hepatitis A vaccine for travelers to countries with intermediate or high endemicity of hepatitis A (including individuals traveling to adopt children).

For the cases in Minnesota, symptoms were observed an average of 43 days after the associated adoptee arrived in the United States. Of the eight cases had direct contact with a hepatitis A–infected adoptee, 2 had history of international travel in addition to adoptee contact. One of the direct-contact cases received a hepatitis A vaccine after 4 weeks of exposure but subsequently became ill.

The report recommends that clinicians should be aware of the ACIP’s 2009 guidelines for hepatitis A vaccination of close personal contacts of international adoptees in addition to travelers to endemic areas and universal vaccination of children. The report further recommends that clinicians should counsel those seeking to adopt international adoptees regarding the need for vaccination among those who will have close personal contact with the adoptee. In addition, the report specifies that clinicians and public health professionals should be aware of the potential for community based transmission of hepatitis A associated with international adoptees and carefully evaluate new cases of hepatitis A for history of contact with an international adoptee. Further, because most hepatitis A–infected young children will not have overt symptoms with hepatitis A infection, the report recommends that clinicians include hepatitis A among the screening tests offered to international adoptees from endemic areas.”

International adoption raises risk of exposure to hepatitis A
[Imperfect Parent 7/7/11 by Roger Caldwell]

Update: The American Academy of Pediatrics published the article recommending Hepatitis A vaccinations for all contacts in September 2011. It is available in free pdf here .

“All previously nonimmune unvaccinated people who anticipate close exposure to international adoptees during the 60 days after their arrival should receive hepatitis A immunization, ideally 2 or more weeks before the arrival of the adopted child.”

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