[Niclayson]

Over the past 2 years as I’ve been working toward my PhD, I have become much more educated about International Adoption Medicine. As I’ve said in previous posts I have even had the opportunity to spend some time at Tufts University with Dr. Miller at the IAC there.

Anyhow, thought I might be able to provide some info.

Latent TB infection (meaning you ARE infected with TB but do not have active disease that you can spread to others) occurs in 3-19% of IA kids, depending on which study you read.

Some parents see 3% and figure…that’s a low # so why bother screening my child. The reason to screen is to protect your child. Latent TB can develop over time into active disease. Active disease can disseminate (or spread) to many body systems. It can invade bones and one of the scariest things it can do is cause meningitis. The conversion to active disease usually occurs in the first 2 years but can happen as long as 20 some years later.

Children under the age of 2 are at the greatest risk of catching TB and at even greater risk of having latent TB turn into the active form. That is the reason the American Academy of pediatrics recommends any child who has latent TB should be treated for 9 months with isoniazid to prevent the child from developing active TB.

Since many of the children have been vaccinated with bacilli Calmette-Guerin (BCG), some clinicians incorrectly assume that the tuberculin skin testing will always be positive and if positive, the results are inaccurate. Current tuberculosis experts agree that foreign born children with a positive tuberculin skin test are more likely to have a latent TB infection than simply a reaction to the BCG vaccine. As such, any IA child that presents with a tuberculin skin test induration (raised, not just red area) greater than or equal to 10mm (including those with a documented history of BCG vaccination), should be considered positive and further evaluation and treatment should be initiated (CDC, 2007).

This is an excerpt from a paper I wrote that contains a scary story about TB…

Since the visa medical exam does not screen adopted children for many common infectious diseases, this unfortunately creates a risk of disease transmission to adoptive families and the public. Several documented cases of infectious disease transmission as a direct result of international adoption already exist. One of the worst exposures was from tuberculosis, a disease that is included in the visa screening!
In the summer of 1998, a 36-year-old woman living in rural North Dakota began to experience hip pain. Her medical evaluation revealed tuberculous arthritis, which had caused not only a pelvic abscess but osteomyelitis of her femoral head. Since North Dakota has a low incidence of tuberculosis and the woman had not traveled recently, the physicians began to search for the source of infection. The woman and her husband had adopted 7-year-old twin boys from the Marshall Islands in 1996. When evaluated, one of the boys was diagnosed with extensive tubercular disease by chest radiography. Contact testing revealed that the boy had infected 120 people, 56 of them young children. The child had TB symptoms; he was 11 pounds and 2 inches shorter than his twin, had had a dry cough for months, and a classroom teacher had reported that the child frequently fell asleep during class. The source child had been inappropriately screened on arrival to the United States; a tuberculin skin test was given but not read (Curtis et al., 1999). This was a preventable incident.

This is the reason to screen and treat. Hope this is helpful.

References

Center for Disease Control and Prevention (2007). Chapter 8: International travel with
infants and young children. Travelers’ Health: Yellow Book. Retrieved November
20, 2007, from http://wwwn.cdc.gov/travel/yellowBookCh8-Adoptions.aspx

Curtis, A., Ridzon, R., Vogel, R., McDonough, S., Hargreaves, J., Ferry, J., et al. (1999).
Extensive transmission of mycobacterium tuberculosis from a child. The New
England Journal of Medicine, 341(20), 1491-1495.