[drasusi]

My son tested negative, but my husband tested positive just over a year ago! I think it might have been easier to give meds to my son......

[cjrogers]

We tested positive skin, negative xray.

Someone asked if you have to tell people:

No. But you do have to submit immunizations to schools, etc. unless you home school and that will show the result of the test.

So it will follow your child through college. that is why we treated with the INH (with xray follow up). then there is no question or issue.

[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.

[mommytoEli]

wow...that was very informative! thanks for the info!!!

[PackGirl]

Originally Posted by mommytoEli

weird about not all of your kids getting the bcg...and i guess that will make another good poll....why would only some of the children receive the bcg.

My three boys were all born at a facilitator's clinic. They all got the bcg... although... I guess it would make sense that they did test negative...since they tested NEGATIVE for every other vaccine on their sheet!!! They do have the scars though from the bcg!!!!!

Our little girl was born at her mom's home....and was with a different attorney.... guess that is why she didnt get it... (at least I have no record nor does she have a scar) It was clearly marked on the boys' records....

[Christie.Josh]

Our doctor was strongly suggesting that we do not test since he has the vaccination on his record and since the trademark scar is there. She also said that since he was putting on weight so well that he showed no signs of TB. He was underweight when he came home, but packed on the pounds at a record pace with an american diet.
She said that he should never be tested with the skin test, only the x-ray.
Confused??? What do I do? Is there a more specialized skin test that we can do that won't be affected by the BCG or how long after the BCG do you wait??

We were also told by an adoption specialist doctor that the BCG is pretty effective against the more deadly forms of TB.

[gwenrenee007]

I'm in the same boat, but I am deciding to test. I would rather give her the meds now if she tests positive. Also, I think they may test for this upon entry for school so if they are positive you will ultimately have to give the meds. The report Nicalysn posted is alarming and is the deciding factor for me.

or what happens if your child wants to adopt in the future? or anything that they may require testing for? Just a thought.

[mommytoEli]

Originally Posted by Christie.Josh

Our doctor was strongly suggesting that we do not test since he has the vaccination on his record and since the trademark scar is there. She also said that since he was putting on weight so well that he showed no signs of TB. He was underweight when he came home, but packed on the pounds at a record pace with an american diet.
She said that he should never be tested with the skin test, only the x-ray.
Confused??? What do I do? Is there a more specialized skin test that we can do that won't be affected by the BCG or how long after the BCG do you wait??

We were also told by an adoption specialist doctor that the BCG is pretty effective against the more deadly forms of TB.

all you can do is what your doctor tells you to do. if you don't agree....get a second opinion to make you feel better. sometimes doctors differ on points of view.

i know that when eli tested positive his primary doctor asked why i had him tested in the first place since he a) had the vaccine, b) was so young, and c) showed no signs.....and i told her...i had no reason other than the older kids needed one for school, so i just threw eli in there too....why not? in the end, his reaction was deemed too large to be bc of the shot...and he had been negative when i did the same thing a year earlier. i asked the doctor who followed his tb case in our old state why we needed to do meds if his xray was clear, and she said, based on his skin test reaction, it was obvious he had been exposed in the last 12 months, and therefore actually had latent tb, despite the vaccination.both doctors that agreed he had indeed been exposed and needed meds were born in other countries and also had the bcg shot. my opinion is, that even though something may provide a good level of preventative protection, doesn't it make it 100% effective. you know? just like the op a few posts back said her children were negative on all their shots. sometimes shots are expired, sometimes it is a bad batch, sometimes people just don't react to the vaccine as they should...sometimes, they are just not effective....i think.

if i had asked my doctor to test eli, she probably would have told me i didn't need to. in the beginning she was obviously disappointed i had done it without talking to her(our insurance was an hmo where when you want your kids to get shots/tb tests, etc, you just go to a nurse visit in another office)...but in the end...she also agreed he had tb! so for us, i think finding out was a total fluke. had i asked and needed to rely on chest xrays i probably would have just made sure to do them regularly...and i'm guessing that's what i'll have to do from now on since i think i heard for many people once they skin test positive, they always will????but maybe i'm wrong on that.

a funny story about chest xrays....when eli got his done, he was SO MAD i remember him being a pill and freaking out. first of all, we tried to remove his shirt...and one thing you have to know about eli is bc of his senspry integration disorder...being naked is a big fat NO! finally the xray tech took the pic with eli's shirt on bc the 2 of us together could not pry the shirt off his body! then it took a team of nurses to hold him down....and he still moved away from them. he's TWO! so the other day i get a copy of his medical file in the mail to take to his new doctor, and i read it. "DIFFICULT PATIENT," and "PATIENT WAS UNCOOPERATIVE AND DIFFICULT, REFUSED TO COMPLY." written in BIG letters on the lab orders for that day....lol. awww....my child has been deemed a difficult patient at the ripe old age of 2.

[myguatbabes]

I voted no, but have 3 more kids that also tested negative. Could you add them please? I am blessed so far, but we will see what happens when we retest for school next year.

[DPline]

I could only vote once in that category, but both my kids are/were negative so if you want to add one there. Neither had the BCG.

Also, to comment on something posted above, I can't remember which member it was, but someone explained to me a while back that the BCG does not prevent TB but will only make it less severe (and possibly deadly) if the child does contract it. So even with the BCG vaccine they can be carrying it or contract it here.

Hopefully the person who told me this (Mindybeth, was it you???) or one of the doctors or nurses her can confirm that, but I thought it was relevent to some of the previous discussion about whether to test children who have had the vaccine.

[DeeVee]

Originally Posted by DPline

Also, to comment on something posted above, I can't remember which member it was, but someone explained to me a while back that the BCG does not prevent TB but will only make it less severe (and possibly deadly) if the child does contract it. So even with the BCG vaccine they can be carrying it or contract it here.

Yes, Debbie, that's correct. I was going to post that info last night, but I was so tired I turned off my computer and came back to this thread today. I went to our ped, the infectious disease specialist at Vanderbilt Hospital, the CDC, and an IA clinic when Carolina's test was positive (a little overkill, I guess). But the consensus was that the BCG may prevent the disease from becoming deadly, but it does not protect against coming down with TB if you were exposed. Also, the quantiferon gold TB test (new test) is NOT reliable in children, and so it should not be used as a second test to avoid giving the meds.

At first I was very leary about giving Carolina 9 months of meds. But after doing my research, the benefits far outweighed any risk, IMO.

[dovelu]

mommytoEli,

I am glad that you are getting the meds for your little boy. Your "difficult patient" note made me laugh. Apparently, my dentist has similar notes about me. The hygentist told me last time that my chart reads, "gags easily," "sensitive to pain," "throws up easily," and -- this is a quote (she claims) "basically hates being here..." And here I thought I was so brave. Oh well. I'm a 34 year old difficult patient...

Amy

ps: I adopted two kids from Guat, both were tested, both had hcg, only one developed a welt, we treated her with meds for 9 mos. with no complications, and we're done.

[KathyNC]

I voted Positive w/ Negative X-Ray for one of my boys, please add a negative for the other.

Has anyone had other members in the family test positive...I guess I'm wondering how likely it might be to be exposed during travel.

Note I did treat my son with INH. After researching, it seemed as though it was a much safer option to use the INH early as side effects seem to increase significantly with age. Carlos also has chronic ear infections/allergies/asthma etc. and I wanted to put the TB stuff behind us as quickly as possible.

Kathy

[noahsark]

This is a wonderful thread! Mommytoeli and niclayson have extremely valuable info and experiences to share. My son came home at 15 months in January. His PPD was 12mm and neg. chest x-ray. When the pediatrician said he needed to go on INH, I freaked. As a nurse, I remember learning about INH and all the side effects. I did so much research before starting the INH. I wish this thread was here in January because what Niclayson stated is indeed the AAP's recommendation. We will be done with the INH next month! Yahoo!
Maureen

[mommytoEli]

so....my difficult patient went to his new doctor today. this doctor said his reaction was "most likely caused by the bcg vaccine." i asked why it was negative a year earlier...and he said sometimes it takes a while for the immunity to build up....but whatever, that wasn't the important part.....what he did say was regardless of why he tested positive, that this was NOT a disease to mess around with or take a wait and see approach and it was his opinion that treating my son was still the best option. i thought that was interesting...the first part he disagreed with the first 2 doctors we saw, but he still agreed with the treatment. if anybody wants to see what eli looks like after 2 nurses attempt to take blood to monitor his liver on inh....here you go. they had to do both arms bc the first time he was being held down by three people, my 2 year old still got away...so they had to do the other one.