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Orr MM, Molina AL, Hanna SL, Kiser C, Hofto ME. Infectious Disease Screening of International Adoptees: A 7-Year Experience. Clin Pediatr (Phila) 2024; 63:153-157. [PMID: 37119027 DOI: 10.1177/00099228231171238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Affiliation(s)
- Mary M Orr
- Department of Pediatrics, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Adolfo L Molina
- Department of Pediatrics, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Samantha L Hanna
- Department of Pediatrics, Saint Louis University, St. Louis, MO, USA
| | - Carin Kiser
- Department of Pediatrics, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Meghan E Hofto
- Department of Pediatrics, The University of Alabama at Birmingham, Birmingham, AL, USA
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Parasitic Infections in Internationally Adopted Children: A Twelve-Year Retrospective Study. Pathogens 2022; 11:pathogens11030354. [PMID: 35335678 PMCID: PMC8949827 DOI: 10.3390/pathogens11030354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 02/19/2022] [Accepted: 03/11/2022] [Indexed: 01/25/2023] Open
Abstract
Parasitic infections (PIs) are among the most frequent infectious diseases globally. Previous studies reported discrepant results regarding the prevalence of PIs in internationally adopted children (IAC). Data from IAC referred to our paediatric university hospital in 2009–2021 were collected to evaluate the frequency of PIs by the use of stool microscopic examination, antigen assays for Giardia lamblia and Cryptosporidium parvum, and serological tests for Toxocara canis, Strongyloides stercoralis, Schistosoma mansoni, Echinococcus spp., Taenia solium, and Trypanosoma cruzi. Uni- and multivariate logistic regression analyses were performed to evaluate risk factors for PIs and eosinophilia. The proportion of IAC with at least one positive test was 26.83% (640/2385); 2.13% (n = 51) had positive tests for 2 or 3 parasites. A positive assay for helminthic infection was retrieved in 11.07% of children (n = 264), and 17.86% (n = 426) presented with eosinophilia. The most common positive tests were anti-Toxocara canis antibodies (n = 312; 13.8%), followed by positive stool antigen for Giardia lamblia (n = 290; 12.16%), and positive microscopic stool examination for Blastocystis hominis (n = 76; 3.19%). A statistically significant association was found between PIs and region of origin (children from Latin America and Africa were more likely to present PIs than children from Eastern Europe), age 5–14 years, and eosinophilia. No significant association was observed between PIs and gender, vitamin D deficiency, or anemia. In conclusion, PIs are relevant in IAC and an accurate protocol is needed to evaluate IAC once they arrive in their adoptive country.
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Goutines J, Miller LC, Sorge F. Infections and nutritional status of internationally adopted children in France. Acta Paediatr 2021; 110:1359-1365. [PMID: 33040353 DOI: 10.1111/apa.15612] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 08/16/2020] [Accepted: 10/05/2020] [Indexed: 11/28/2022]
Abstract
AIM In the context of global changes in the epidemiology of internationally adopted children (IACs), the prevalence of infectious diseases and nutritional impairment has not been recently reviewed. Moreover, in France, these characteristics of the children according to their continents of origin and preadoption special needs (SN) status have been incompletely explored. METHODS Demographic, infectious data and anthropometric of all the newly arrived IACs seen in a specialised clinic for international adoptees in Paris, France, between 2013 and 2016 were retrospectively reviewed. RESULTS Three hundred and fifty IACs [mean age: 3.4 years (±2.7), 204 male] from 39 countries were included; 55% had SN. Ninety-nine patients had at least one infection, 42% being classified as 'serious' (chronic viral infection, tuberculosis or malaria). Chronic viral infection was diagnosed in 26 (7%) patients (HIV: 16 cases, HBV: 5, HCV: 4) and affected especially Asian children (P < .001). The prevalence of stunting, underweight, wasting and microcephaly was, respectively, 25%, 22%, 15% and 8%. Stunting was more frequent in children from Eastern Europe (P = .02), while SN children were more often microcephalic or underweight (respectively P = .03 and .02). CONCLUSION The prevalence of serious infections and nutritional impairment remains high in IACs and requires early detection and careful follow-up.
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Affiliation(s)
- Juliette Goutines
- Department of Paediatrics Necker‐Enfants‐Malades University Hospital Paris France
| | - Laurie C. Miller
- Department of Paediatrics Necker‐Enfants‐Malades University Hospital Paris France
| | - Frederic Sorge
- Department of Paediatrics Necker‐Enfants‐Malades University Hospital Paris France
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Intestinal parasites may be associated with later behavioral problems in internationally adopted children. PLoS One 2021; 16:e0245786. [PMID: 33493225 PMCID: PMC7833226 DOI: 10.1371/journal.pone.0245786] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 12/29/2020] [Indexed: 01/09/2023] Open
Abstract
Aim At arrival in new home country, internationally adopted children often have intestinal parasites. International adoptees also exhibit more behavioral problems than their biological peers. We examined whether intestinal parasite infections in international adoptees on arrival in Finland are associated with their later behavioral and emotional problems. Methods Data for this study were sourced from the Finnish Adoption Study (FinAdo) based on parental questionnaires for all internationally adopted children under 18 years (n = 1450) who arrived in Finland from 1985 to 2007. A total of 1293 families provided sufficient information on the adoptee’s background, parasitic status on arrival, and behavioral symptoms at the median time of 5 years after arrival (mean age = 7.8 years). Behavioral and emotional disorders were evaluated with the Child Behavior Checklist (CBCL). Statistical analyses were conducted using linear regression. Results Of the 1293 families, parents of 206 adoptive children reported intestinal parasites in their adopted children on arrival. Parasite-infected children had subsequently higher CBCL problem scores than the children without parasites (p < 0.001). The association between intestinal parasites and later behavioral problems was stronger than that between intestinal parasites and any other factors measured in this study, except disability. Limitations The control group was naturally provided by the adopted children without parasite infections, but we could not compare the adopted children to non-adopted children without a defined parasite infection. We were unable to specify the effects associated with a specific parasite type. It was not possible either to include multiple environmental factors that could have been associated with behavioral problems in the models, which indicated only modest explanatory values. Conclusions In this study, intestinal parasite infections in early childhood may be associated with children’s later psychological wellbeing, even in children who move to a country with a low prevalence of parasites. Our findings may support further developments pertaining to the gut-brain theory.
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Discrepancies between Vaccine Documentation and Serologic Status for Diphtheria, Tetanus, and Hepatitis B in Internationally Adopted Children. Vaccines (Basel) 2020; 8:vaccines8030489. [PMID: 32872676 PMCID: PMC7563378 DOI: 10.3390/vaccines8030489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 08/25/2020] [Accepted: 08/27/2020] [Indexed: 12/04/2022] Open
Abstract
Internationally Adopted Children (IAC) often show suboptimal immunisation coverage, but available data are discordant. Data at the first evaluation of 2073 IAC (median age: 6 years) referred to the Meyer Children’s University Hospital (Florence, Italy) in 2009–2019 were analysed in order to evaluate their immunisation status against diphtheria, tetanus, and hepatitis B. Negative antibody titres were observed in 11.5% of the IAC for diphtheria, 18.6% for tetanus, and 39.0% for hepatitis B. At multivariate analysis, originating from Africa was an independent risk factor for seronegativity for the three diseases (p < 0.001), while age below four years was an independent factor associated with protective immunity, only considering hepatitis B (p < 0.001). Vaccine documentation was an additional factor independently associated with protective immunity. However, a discrepancy between documentation (indicating previous vaccinations) and serology (showing negative antibody titres) was evidenced in 3.8% of the children for diphtheria, 12.6% for tetanus, and 29.6% for hepatitis B. This finding suggests that although vaccine documentation may reflect the presence of protective antibody titres, it should not be accepted as absolute evidence of protective immunity, underlining the importance of a complete assessment of immunisation status in IAC, particularly in those originating from Africa and aged over four years.
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Nielsen AV, Kjærgaard J, Pedersen TM, Helmuth IG, Nygaard U, Nielsen HW, Christensen VB, Kurtzhals JAL, Poulsen A. Infectious diseases detected by screening after arrival to Denmark in internationally adopted children. Acta Paediatr 2020; 109:1004-1010. [PMID: 31580515 DOI: 10.1111/apa.15045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 08/05/2019] [Accepted: 10/02/2019] [Indexed: 11/28/2022]
Abstract
AIM To show the prevalence of selected infectious diseases among internationally adopted children (IAC) in Denmark. BACKGROUND Each year approximately 200 IAC arrive in Denmark. These are at increased risk of infectious diseases rarely seen in Danish children. Studies from the 1990s showed that 60% of IAC had infectious diseases and that the majority of these were undetected without screening. METHODS The study is a prospective study of medical records from children seen in the adoption clinic at Copenhagen University Hospital in the period 2009-2013. Screening was done for hepatitis A (HAV), B (HBV) and C (HCV), syphilis, HIV, tuberculosis (TB) and intestinal parasites. RESULTS In 245 IAC tested, 2% had evidence of recent HAV infection, 3% with HBV and one child with HCV, and no cases of HIV were found. One child had antibodies against syphilis (anti-Trpa AB positivity), and 2% were latently infected with tuberculosis. We found 30% infected with pathogenic intestinal parasites. Only 46% had serologic evidence of immunisation against HBV. CONCLUSION The prevalence of infections in IAC was lower than previously reported but compared to the general population, a higher prevalence of intestinal parasites, hepatitis and tuberculosis was found. We recommend that IAC are offered screening shortly after arrival.
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Affiliation(s)
- Agnethe Vale Nielsen
- The Department of Pediatrics and Adolescent Medicine Copenhagen University Hospital Rigshospitalet Copenhagen Denmark
| | - Jesper Kjærgaard
- The Department of Pediatrics and Adolescent Medicine Copenhagen University Hospital Rigshospitalet Copenhagen Denmark
| | - Tine Marie Pedersen
- Copenhagen Prospective Studies on Asthma in Childhood Health Sciences University of Copenhagen Naestved Denmark
- Department of Pediatrics Naestved Hospital Naestved Denmark
| | - Ida Glode Helmuth
- The Department of Pediatrics and Adolescent Medicine Copenhagen University Hospital Rigshospitalet Copenhagen Denmark
| | - Ulrikka Nygaard
- The Department of Pediatrics and Adolescent Medicine Copenhagen University Hospital Rigshospitalet Copenhagen Denmark
| | - Helle Winter Nielsen
- The Department of Pediatrics and Adolescent Medicine Copenhagen University Hospital Rigshospitalet Copenhagen Denmark
| | - Vibeke Brix Christensen
- The Department of Pediatrics and Adolescent Medicine Copenhagen University Hospital Rigshospitalet Copenhagen Denmark
| | - Jørgen Anders Lindholm Kurtzhals
- Centre for Medical Parasitology at Department of Clinical Microbiology Copenhagen University Hospital Rigshospitalet Copenhagen Denmark
- Department of Immunology and Microbiology University of Copenhagen Copenhagen Denmark
| | - Anja Poulsen
- The Department of Pediatrics and Adolescent Medicine Copenhagen University Hospital Rigshospitalet Copenhagen Denmark
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Intestinal Parasitic Infections in Internationally Adopted Children: A 10-Year Retrospective Study. Pediatr Infect Dis J 2019; 38:983-989. [PMID: 31460872 DOI: 10.1097/inf.0000000000002399] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Intestinal parasitic infections (IPIs) represent one of the leading causes of morbidity in the world. Children involved in international adoptions constitute a special group of subjects with specific problems and specific healthcare needs. Nevertheless, in current literature there are insufficient data on IPI in this subset of children. This study aims to evaluate the prevalence of IPI in a cohort of internationally adopted children and to investigate epidemiologic factors and clinical features related to IPIs. METHODS A retrospective study involving internationally adopted children <18 years old for which results from 3 fecal parasitologic tests were available, evaluated between September 1, 2008 and April 31, 2018 at a tertiary level university hospital in Rome. Univariate and multivariate logistic regression analyses were carried out to identify demographic factors and clinical features associated with IPIs. Two comparisons were performed, the first one according to the positivity of the parasitologic examination of the feces and the second one according to the pathogenicity of the identified strains. RESULTS Of 584 children evaluated, 346 (59.3%) had a positive parasitologic examination (143 pathogenic parasites and 203 nonpathogenic parasites) and 238 (40.8%) had a negative parasitologic examination. About 28.9% of children were positive for 2 or more parasites. A statistically significant positive association was found between IPIs and age, macroarea of origin (Africa and Latin America), living in institutions before adoption and vitamin D deficiency (P < 0.05). CONCLUSIONS Intestinal parasites represent a widespread infection among internationally adopted children, especially in school-age children and those from Latin America and Africa. Importantly, the parasites found in adopted children were not pathogenic in most cases and did not cause significant alterations in growth, major micronutrient deficits or malnutrition.
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Kimes K, Marchalik R, Aivaz O, Norton SA. Postinjection abscesses and granulomas in children adopted from Russia. Pediatr Dermatol 2019; 36:e93-e94. [PMID: 31042815 DOI: 10.1111/pde.13835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Up to 1.3 million children from the former Soviet Union (fSU) and Eastern Europe have been placed in institutional care worldwide. With the hope of ensuring the child's health in the immediate post-adoption period, these children are known to receive many injections of vaccines, vitamins, and medications, many unnecessary and often administered with unsafe technique. This practice can lead to formation of suppurative granulomas in these children. Though rare, dermatologists should be aware of these conditions in adoptees from Eastern Europe.
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Affiliation(s)
- Kate Kimes
- San Antonio Uniformed Services Health Education Consortium, San Antonio, Texas
| | - Rachel Marchalik
- Georgetown University School of Medicine, Washington, District of Columbia
| | - Ohara Aivaz
- Cedars-Sinai Medical Group, Los Angeles, California
| | - Scott A Norton
- Children's National Health System, Washington, District of Columbia
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Venturini E, Piccini P, Tersigni C, Chiappini E, Galli L. Systematic review shows that immunising internationally adopted children is a major challenge for primary health care. Acta Paediatr 2019; 108:411-418. [PMID: 30368909 DOI: 10.1111/apa.14625] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 08/30/2018] [Accepted: 10/23/2018] [Indexed: 11/30/2022]
Abstract
AIM This systematic review aimed to provide an overview of the immunisation of internationally adopted children and to discuss possible vaccination strategies. METHODS A literature search was performed covering papers published in English from 1988 to 15 June 2018 using the Ovid MEDLINE, EMBASE and Cochrane Library databases. This identified 749 studies and 41 full texts were evaluated. RESULTS Overall, 19 studies conducted between 1988 and 2016 fulfilled our inclusion criteria. These covered 7663 children aged 1.1-5.7 years adopted from Asia, Eastern Europe, Africa and South and Central America. Tetanus protective antibody levels ranged from 35 to 95%, and similar data were reported for diphtheria. A higher percentage of adoptees had protective antibody levels for polio (50-93%) and measles (62-95%). More than a third (35%) did not have protective antibody titres for hepatitis B. Only one study investigated adoptees with protective antibodies against haemophilus influenza, and it reported that this was around 66%. CONCLUSION The appropriate immunisation of internationally adopted children is a major challenge for primary health care and a number of different approaches have been suggested, with no clear conclusions. Further studies on the cost-effectiveness of different approaches should be performed to optimise screening strategies and develop recommendations.
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Affiliation(s)
- Elisabetta Venturini
- Department of Health Sciences University of Florence Anna Meyer Children's University Hospital Florence Italy
| | - Paola Piccini
- Department of Health Sciences University of Florence Anna Meyer Children's University Hospital Florence Italy
| | - Chiara Tersigni
- Department of Health Sciences University of Florence Anna Meyer Children's University Hospital Florence Italy
| | - Elena Chiappini
- Department of Health Sciences University of Florence Anna Meyer Children's University Hospital Florence Italy
| | - Luisa Galli
- Department of Health Sciences University of Florence Anna Meyer Children's University Hospital Florence Italy
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Chiappini E, Bortone B, Borgi S, Sollai S, Matucci T, Galli L, de Martino M. Infectious Diseases in Internationally Adopted Children and Intercountry Discrepancies Among Screening Protocols, A Narrative Review. Front Pediatr 2019; 7:448. [PMID: 31788456 PMCID: PMC6853896 DOI: 10.3389/fped.2019.00448] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 10/15/2019] [Indexed: 11/13/2022] Open
Abstract
Internationally adopted children (IAC) require thorough health assessments at time of arrival in the host country. As these children are at higher risk for infectious diseases, such as gastrointestinal parasites, tuberculosis, hepatitis, syphilis, and human immunodeficiency virus, early diagnosis of infectious diseases is fundamental for the optimal management of the child and, also, to reduce the risk of transmission to the adopting community. Comparative analysis of the screening protocols adopted in Europe, the United States, and Canada revealed different approaches to the adopted children. A homogeneous and internationally shared standard of care in the management of IAC should be provided.
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Affiliation(s)
- Elena Chiappini
- Department of Health Science, Anna Meyer Children University Hospital, University of Florence, Florence, Italy
| | - Barbara Bortone
- Department of Health Science, Anna Meyer Children University Hospital, University of Florence, Florence, Italy
| | - Sara Borgi
- Department of Health Science, Anna Meyer Children University Hospital, University of Florence, Florence, Italy
| | - Sara Sollai
- Department of Health Science, Anna Meyer Children University Hospital, University of Florence, Florence, Italy
| | - Tommaso Matucci
- Department of Health Science, Anna Meyer Children University Hospital, University of Florence, Florence, Italy
| | - Luisa Galli
- Department of Health Science, Anna Meyer Children University Hospital, University of Florence, Florence, Italy
| | - Maurizio de Martino
- Department of Health Science, Anna Meyer Children University Hospital, University of Florence, Florence, Italy
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Son M, Park YS, Jung MH, Kang JH, Choi UY. Risk factors for latent tuberculosis infection in children in South Korea. Postgrad Med 2018; 130:637-643. [PMID: 30095331 DOI: 10.1080/00325481.2018.1510709] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES In South Korea, latent tuberculosis infection (LTBI) screening is a critical strategy associated with efforts to reduce the incidence of tuberculosis (TB). Currently, only children with a known history of TB contact are considered as pediatric high-risk groups for LTBI, and consequently, LTBI screening is only provided to these children. However, to reduce the incidence of TB, the high-risk groups that undergo LTBI screening should be expanded. This study aimed to assess the risk factors for LTBI among children living in South Korea with no known history of TB contact for the identification of additional high-risk groups. We investigated the risk factors for LTBI among US visa applicant children, who undergo LTBI screening regardless of their TB contact history. METHODS We obtained data on demographic characteristics, medical history, Bacillus Calmette-Guerin (BCG) vaccination history, and results of LTBI screening for children aged 2-14 years. A tuberculin skin test was used for the diagnosis of LTBI, and an induration of 10 mm or greater was used to define a positive test. Adjusted odds ratios and 95% confidence intervals were calculated to determine the association between clinical and demographic variables and LTBI. RESULTS Of the 1,664 study participants, 91 (5.5%) had LTBI. The binary logistic regression analysis showed that children born in high TB burden foreign countries had the highest odds of LTBI when considering all the risk factors investigated. Increasing age, absence of BCG vaccination, and a previous diagnosis of asthma were also significant risk factors for LTBI. CONCLUSION These results indicate that children born in high TB burden foreign countries should be considered a high-risk group for LTBI in South Korea; the inclusion of these children in LTBI screening should be considered.
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Affiliation(s)
- Minji Son
- a Department of Pediatrics, College of Medicine , The Catholic University of Korea , Seoul , Republic of Korea
| | - Yoon Seon Park
- a Department of Pediatrics, College of Medicine , The Catholic University of Korea , Seoul , Republic of Korea
| | - Min Ho Jung
- a Department of Pediatrics, College of Medicine , The Catholic University of Korea , Seoul , Republic of Korea
| | - Jin Han Kang
- a Department of Pediatrics, College of Medicine , The Catholic University of Korea , Seoul , Republic of Korea
| | - Ui Yoon Choi
- a Department of Pediatrics, College of Medicine , The Catholic University of Korea , Seoul , Republic of Korea.,b Department of Pediatrics, St. Paul's Hospital, College of Medicine , The Catholic University of Korea , Seoul , Republic of Korea
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Abstract
One million children develop tuberculosis disease each year, and 210,000 die from complications of tuberculosis. Childhood tuberculosis is very different from adult tuberculosis in epidemiology, clinical and radiographic presentation, and treatment. This review highlights the many unique features of childhood tuberculosis, with special emphasis on very young children and adolescents, who are most likely to develop disease after infection has occurred.
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Sollai S, Ghetti F, Bianchi L, de Martino M, Galli L, Chiappini E. Infectious diseases prevalence, vaccination coverage, and diagnostic challenges in a population of internationally adopted children referred to a Tertiary Care Children's Hospital from 2009 to 2015. Medicine (Baltimore) 2017; 96:e6300. [PMID: 28328809 PMCID: PMC5371446 DOI: 10.1097/md.0000000000006300] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Infectious diseases are common in internationally adopted children (IAC).With the objective to evaluate infectious diseases prevalence in a large cohort of IAC and to explore possible risk factors for tuberculosis (TB) and parasitic infections, clinical and laboratory data at first screening visit of all IAC (<18 years) consecutively referred to our Center in 2009 to 2015 were collected and analyzed.In total, 1612 children (median age: 5.40 years; interquartile range: 3.00-7.90) were enrolled, 123/1612 (7.60%) having medical conditions included in the special needs definition. The most frequent cutaneous infections were Molluscum contagiosum (42/1612; 2.60%) and Tinea capitis (37/1612; 2.30%). Viral hepatitis prevalence was <1% (hepatitis B virus [HBV]: 13 children, 0.80%; hepatitis C virus: 1 child, 0.10%; hepatitis A virus: 6 children, 0.40%). A parasitic infection was diagnosed in 372/1612 (23.10%) children. No risk factors for parasitosis were evidenced. Active TB was diagnosed in 4/1355 (0.3%) children, latent TB in 222/1355 (16.40%). Only 3.7% (51/1355) children had concordant positive tuberculin skin test (TST) and QuantiFERON-TB-Gold In-Tube (QFT-G-IT) results. Risk factors for TST+/QFT-G-IT- results were previous Bacille de Calmette-Guérin vaccination (adjusted odds ratio [aOR]: 2.18; 96% confidence interval [CI]: 1.26-3.79; P = 0.006), and age ≥5 years (aOR: 1.49; 95% CI: 1.06-2.11; P = 0.02). The proportion of children with nonprotective titers for vaccine-preventable diseases (VPD) ranged from 15.70% (208/1323) for tetanus to 35.10% (469/1337) for HBV.Infectious diseases were commonly observed in our cohort. The high rate of discordant TST/QFT-G results brings up questions regarding the optimal management of these children, and suggests that, at least in children older than 5 years, only QFT-G-IT results may be reliable. The low proportion of children protected for VPD, confirms importance of a timely screening.
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Abstract
Children who are adopted internationally have an increased risk of infectious diseases due to endemic conditions and variable access to preventive health care, such as vaccines, in their country of origin. Pediatricians and other providers who care for children should be familiar with the recommended screening for newly arrived international adoptees. Testing for gastrointestinal pathogens, tuberculosis, hepatitis, syphilis, and HIV should be routinely performed. Other endemic diseases and common skin infections may need to be assessed. Evaluation of the child's immunization record is also important, as nearly all international adoptees will require catch-up vaccines. The provider may also be asked to review medical records prior to adoption, provide travel advice, and ensure that parents and other close contacts are up-to-date on immunizations prior to the arrival of the newest family member. The pediatrician serves a unique role in facilitating the evaluation, treatment, and prevention of infectious diseases in international adoptees. [Pediatr Ann. 2017;46(2):e56-e60.].
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Abstract
BACKGROUND International adoption of HIV-infected children is becoming increasingly common. Their health has not yet been described. METHODS HIV-infected international adoptees or refugees in foster care aged 0-20 years followed at Seattle Children's Hospital or Children's Hospital Colorado between January 1, 2004 and May 31, 2013 were included. Parameters were collected through retrospective chart review of baseline (first 6 months at study site) and annual follow-up visits. RESULTS Africa (90%) was the primary region of origin for the 79 children who met inclusion criteria. Median follow-up was 3 years (range: 0-7). At baseline, acute malnutrition was uncommon (8%); however, stunting occurred in 32%. Most stunting resolved during the study period. The most common medical issues at baseline were dermatologic (Tinea and Molluscum contagiosum) and gastrointestinal (parasites and diarrhea). Almost half (48%) had either mental health issues or behavioral problems. Educational delays (50%) were also common. Upon adoption, only 1% was severely (CD4% < 15%) immunosuppressed. Fifty-nine (75%) were on antiretroviral therapy (ART); 45 of these (76%) had suppressed viral load (VL). Of 14 children on ART with detectable VL, 11 (79%) demonstrated non-nucleoside reverse transcriptase inhibitor resistance and 1 (7%) protease inhibitor resistance. CONCLUSIONS In this cohort of HIV-infected international adoptees, severe immunosuppression was uncommon. Most medical issues were mild. Stunting was common at baseline but largely resolved. Mental health issues, behavioral problems, and educational delays were common. Most children were on ART at adoption and most of these showed suppressed VL. Non-nucleoside reverse transcriptase inhibitor mutations were present in most viremic children.
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Greenaway C, Thu Ma A, Kloda LA, Klein M, Cnossen S, Schwarzer G, Shrier I. The Seroprevalence of Hepatitis C Antibodies in Immigrants and Refugees from Intermediate and High Endemic Countries: A Systematic Review and Meta-Analysis. PLoS One 2015; 10:e0141715. [PMID: 26558905 PMCID: PMC4641717 DOI: 10.1371/journal.pone.0141715] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 10/12/2015] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND & AIMS Hepatitis C virus (HCV) infection is a significant global health issue that leads to 350,000 preventable deaths annually due to associated cirrhosis and hepatocellular carcinoma (HCC). Immigrants and refugees (migrants) originating from intermediate/high HCV endemic countries are likely at increased risk for HCV infection due to HCV exposure in their countries of origin. The aim of this study was to estimate the HCV seroprevalence of the migrant population living in low HCV prevalence countries. METHODS Four electronic databases were searched from database inception until June 17, 2014 for studies reporting the prevalence of HCV antibodies among migrants. Seroprevalence estimates were pooled with a random-effect model and were stratified by age group, region of origin and migration status and a meta-regression was modeled to explore heterogeneity. RESULTS Data from 50 studies representing 38,635 migrants from all world regions were included. The overall anti-HCV prevalence (representing previous and current infections) was 1.9% (95% CI, 1.4-2.7%, I2 96.1). Older age and region of origin, particularly Sub-Saharan Africa, Asia, and Eastern Europe were the strongest predictors of HCV seroprevalence. The estimated HCV seroprevalence of migrants from these regions was >2% and is higher than that reported for most host populations. CONCLUSION Adult migrants originating from Asia, Sub-Saharan Africa and Eastern Europe are at increased risk for HCV and may benefit from targeted HCV screening.
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Affiliation(s)
- Christina Greenaway
- Division of Infectious Diseases, Jewish General Hospital, McGill University, Montreal, Canada
- Centre for Clinical Epidemiology, Lady Davis Research Institute for Medical Research, Jewish General Hospital, Montreal, Canada
- Department of Epidemiology and Biostatistics, McGill University, Montreal, Canada
| | - Ann Thu Ma
- Department of Internal Medicine, Centre Hospitalier de l’Université de Montréal, Montreal, Canada
| | | | - Marina Klein
- Division of Infectious Diseases, McGill University Health Center, McGill University, Montreal, Canada
| | - Sonya Cnossen
- Centre for Clinical Epidemiology, Lady Davis Research Institute for Medical Research, Jewish General Hospital, Montreal, Canada
| | - Guido Schwarzer
- Institute of Medical Biometry and Statistics, Medical Centre - University of Freiburg, Freiburg, Germany
| | - Ian Shrier
- Centre for Clinical Epidemiology, Lady Davis Research Institute for Medical Research, Jewish General Hospital, Montreal, Canada
- Department of Epidemiology and Biostatistics, McGill University, Montreal, Canada
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Importation and Transmission of Parasitic and Other Infectious Diseases Associated with International Adoptees and Refugees Immigrating into the United States of America. BIOMED RESEARCH INTERNATIONAL 2015; 2015:763715. [PMID: 26583130 PMCID: PMC4637084 DOI: 10.1155/2015/763715] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2015] [Revised: 08/19/2015] [Accepted: 08/27/2015] [Indexed: 11/29/2022]
Abstract
Each year, hundreds of millions of people travel across international borders or even oceans, and up to 230 million may remain for long periods. Among these, 3–5 million settle permanently in their new homes, with about 1 million migrating permanently to the United States of America. This may result in transport of parasites and other pathogens, which might become established, infecting individuals in the new location. Beyond concern of disease spread, the health of migrants is of concern since the rigors, circumstances, and living conditions surrounding migrations may increase the vulnerability of migrants to infections. International adoptees and refugees are a small subset of these migrants but are of special significance inasmuch as adoptees may be more vulnerable to infection due to their immature immune status, and refugees may be more vulnerable due to substandard living conditions. Both originate from diverse regions, but often from environments of low hygiene and health care standards. This review examines recent examples of infections reported from adoptees and refugees entering the USA through 2010, highlighting the most common origin countries and the diseases most frequently involved, including Chagas disease, Balamuthia amebic meningoencephalitis, giardiasis, microsporidiosis, hepatitis, measles, pertussis, tuberculosis, malaria, intestinal helminths, and syphilis.
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Hénaff F, Hazart I, Picherot G, Baqué F, Gras-Le Guen C, Launay E. Frequency and characteristics of infectious diseases in internationally adopted children: a retrospective study in Nantes from 2010 to 2012. J Travel Med 2015; 22:179-85. [PMID: 25787709 DOI: 10.1111/jtm.12196] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Revised: 01/08/2015] [Accepted: 01/19/2015] [Indexed: 12/01/2022]
Abstract
BACKGROUND AND AIMS Internationally adopted children are more susceptible to developing and carrying acute or chronic infectious diseases. Specialized consultations exist in the main French cities; however, specialized consultation with a pediatrician is not mandatory. The main objective of this study was to determine the frequency and characteristics of infections (bacterial, viral, and parasitic) among a group of international adoptees in Nantes over a 3-year period. METHODS A retrospective chart review was conducted of internationally adopted children who went through the Medical Guidance for Adopted Children Consultation between 2010 and 2012. RESULTS A total of 133 children were included in the study. Of these, 55% had an infectious disease; 8% were severe infections. We found a frequency of 38% [confidence interval (CI) 95% 30-46] for parasitic intestinal and 35% (CI 95% 27-43) for dermatologic infections. African children were more likely to have infections that required hospitalization [odds ratio (OR) = 12, p = 0.004, CI 95% 1.3-113.7] and more likely to carry extended-spectrum β-lactamase-producing bacteria. CONCLUSION The frequency of infectious diseases, and sometimes severe diseases, found among our cohort of internationally adopted children highlights the need for systematic, specialized medical care.
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Sciauvaud J, Rigal E, Pascal J, Nourrisson C, Poirier P, Poirier V, Vidal M, Mrozek N, Laurichesse H, Beytout J, Labbe A, Lesens O. Transmission of infectious diseases from internationally adopted children to their adoptive families. Clin Microbiol Infect 2014; 20:746-51. [DOI: 10.1111/1469-0691.12454] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2013] [Revised: 11/05/2013] [Accepted: 11/07/2013] [Indexed: 11/28/2022]
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Abstract
Thousands of international adoptees join families in the United States every year. Many have been in institutional care and are from countries or areas with a high risk of several infectious diseases. Focused infectious disease testing is important to ensure the health of the adoptee, as well as their new family and the larger community in which they now live. Newly arrived internationally adopted children should be screened for specific infections, including viral, bacterial, and parasitic infections. They should ideally be seen shortly after arrival by a multidisciplinary team at a center specializing in international adoption.
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Abstract
PURPOSE OF REVIEW To provide an update and overview of infectious disease issues in children of international adoption. RECENT FINDINGS International adoption by US families has decreased since 2004. Countries from where children are adopted have changed by 2011, with Ethiopia the second largest contributor of international adoptees after China. Since 2003, international adoptees are older, as fewer young children (<1 year of age) have been available for adoption. Although children are declared healthy in their home countries, medical disorders are often missed or become apparent after adoption. Comprehensive evaluations by providers in the USA after adoption frequently identify unsuspected medical disorders, infections, as well as delayed or incomplete vaccination in these recently adopted children. Early identification of infections allows treatment of potential communicable diseases and updating of immunizations. SUMMARY All international adoptees on arrival in the USA should be evaluated by a health practitioner knowledgeable in adoption medicine to identify medical problems, especially infections.
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Affiliation(s)
- Kristina N Feja
- Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital, 254 Easton Avenue, New Brunswick, NJ 08901, USA
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Tottenham N. Risk and developmental heterogeneity in previously institutionalized children. J Adolesc Health 2012; 51:S29-33. [PMID: 22794530 PMCID: PMC3400928 DOI: 10.1016/j.jadohealth.2012.04.004] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2011] [Revised: 04/03/2012] [Accepted: 04/05/2012] [Indexed: 12/16/2022]
Abstract
This article presents an overview of the developmental outcomes of children adopted from institutional care. The author describes how institutional care is a risk factor for typical human development and describes the areas of development, both behavioral and neurobiological, that are most vulnerable to this risk. Also described is variation in outcome and resilience, where some children thrive despite exposure to adverse rearing conditions. The author concludes with an emphasis on heterogeneity in outcome, describing how the risk associated with institutional care is not a deterministic factor but rather an influential one.
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Affiliation(s)
- Nim Tottenham
- Department of Psychology, University of California Los Angeles, Los Angeles, California 90095, USA.
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Tottenham N, Hare TA, Millner A, Gilhooly T, Zevin JD, Casey BJ. Elevated amygdala response to faces following early deprivation. Dev Sci 2012; 14:190-204. [PMID: 21399712 DOI: 10.1111/j.1467-7687.2010.00971.x] [Citation(s) in RCA: 300] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
A functional neuroimaging study examined the long-term neural correlates of early adverse rearing conditions in humans as they relate to socio-emotional development. Previously institutionalized (PI) children and a same-aged comparison group were scanned using functional magnetic resonance imaging (fMRI) while performing an Emotional Face Go/Nogo task. PI children showed heightened activity of the amygdala, a region that supports emotional learning and reactivity to emotional stimuli, and corresponding decreases in cortical regions that support perceptual and cognitive functions. Amygdala activity was associated with decreased eye-contact as measured by eye-tracking methods and during a live dyadic interaction. The association between early rearing environment and subsequent eye-contact was mediated by amygdala activity. These data support the hypothesis that early adversity alters human brain development in a way that can persist into childhood, and they offer insight into the socio-emotional disturbances in human behavior following early adversity.
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Affiliation(s)
- N Tottenham
- Department of Psychology, UCLA, Los Angeles, CA 90095-1563, USA.
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Staat MA, Rice M, Donauer S, Mukkada S, Holloway M, Cassedy A, Kelley J, Salisbury S. Intestinal parasite screening in internationally adopted children: importance of multiple stool specimens. Pediatrics 2011; 128:e613-22. [PMID: 21824880 PMCID: PMC9923786 DOI: 10.1542/peds.2010-3032] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Our goal was to determine the prevalence of intestinal parasites in internationally adopted children, to examine factors associated with infection, and to determine if evaluating multiple stool specimens increases the yield of parasite identification. METHODS We evaluated internationally adopted children with at least 1 stool specimen submitted for ova and parasite testing within 120 days after arrival to the United States. In children submitting 3 stool specimens, in which at least 1 specimen was positive for the pathogen studied, we examined whether multiple stool specimens increased the likelihood of pathogen identification. RESULTS Of the 1042 children studied, 27% had at least 1 pathogen identified; with pathogen-specific prevalence of Giardia intestinalis (19%), Blastocystis hominis (10%), Dientamoeba fragilis (5%), Entamoeba histolytica (1%), Ascaris lumbricoides (1%), and Hymenolepsis species (1%). The lowest prevalence occurred in South Korean (0%), Guatemalan (9%), and Chinese (13%) children, and the highest prevalence occurred in Ethiopian (55%) and Ukrainian (74%) children. Increasing age was significantly associated with parasite identification, whereas malnutrition and gastrointestinal symptoms were not. Overall, the yield of 1 stool specimen was 79% with pathogen recovery significantly increasing for 2 (92%) and 3 (100%) specimens, respectively (P < .0001). Pathogen identification also significantly increased with evaluation of additional stool specimens for children with and without gastrointestinal symptoms. CONCLUSIONS We provide data for evidence-based guidelines for intestinal parasite screening in internationally adopted children. Gastrointestinal symptoms were not predictive of pathogen recovery, and multiple stool specimens increased pathogen identification in this high-risk group of children.
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Affiliation(s)
- Mary Allen Staat
- Division of Infectious Diseases, MLC 7013, International Adoption Center, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, ML 7036, Cincinnati, OH 45229-3039, USA.
| | - Marilyn Rice
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Stephanie Donauer
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Sheena Mukkada
- College of Medicine, University of Cincinnati, Cincinnati, Ohio; and
| | - Michol Holloway
- College of Medicine, George Washington University, Washington, DC
| | - Amy Cassedy
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Jennifer Kelley
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Shelia Salisbury
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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Hotez PJ, Gurwith M. Europe's neglected infections of poverty. Int J Infect Dis 2011; 15:e611-9. [DOI: 10.1016/j.ijid.2011.05.006] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2010] [Revised: 03/20/2011] [Accepted: 05/06/2011] [Indexed: 11/24/2022] Open
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Sweet K, Sutherland W, Ehresmann K, Lynfield R. Hepatitis A infection in recent international adoptees and their contacts in Minnesota, 2007-2009. Pediatrics 2011; 128:e333-8. [PMID: 21727107 DOI: 10.1542/peds.2010-1840] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The goal of this study was to describe hepatitis A-infected adoptees and the risk of transmission to their contacts. METHODS This was a retrospective review of adoptee-associated cases of hepatitis A and hepatitis A-infected adoptees identified in Minnesota from 2007 through 2009. RESULTS From 2007 through 2009 in Minnesota, 10 cases of hepatitis A, including 1 fulminant case, were associated with international adoptees. Eight cases were direct contacts of a hepatitis A-infected adoptee, and 2 other cases secondary contacts of an adoptee. During the same period, hepatitis A infection was identified in 21 recently arrived foreign-born adoptees; all were younger than 60 months of age, and only 6 were symptomatic. CONCLUSIONS Clinicians should be aware that transmission of hepatitis A may occur among both direct and secondary contacts of young children recently adopted from hepatitis A-endemic areas and that infected young children may be asymptomatic. Household members and other close contacts of international adoptees should be counseled about hepatitis A prevention, including vaccination. In addition, screening for hepatitis A should be considered for recently arrived adoptees from endemic areas.
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Affiliation(s)
- Kristin Sweet
- Minnesota Department of Health, St Paul, MN 55164, USA.
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Boisrame-Gastrin S, Tande D, Munck MR, Gouriou S, Nordmann P, Naas T. Salmonella carriage in adopted children from Mali: 2001-08. J Antimicrob Chemother 2011; 66:2271-6. [DOI: 10.1093/jac/dkr307] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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The role of chest radiographs and tuberculin skin tests in tuberculosis screening of internationally adopted children. Pediatr Infect Dis J 2011; 30:387-91. [PMID: 21076362 DOI: 10.1097/inf.0b013e3182029486] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Internationally adopted children (IAC) are a growing group of US immigrants who often come from countries with high tuberculosis (TB) burdens. There is limited evidence to support current TB screening guidelines in these high-risk children. Therefore, we have prospectively examined the clinical utility of tuberculin skin testing (TST) and subsequent chest radiograph screening for TB disease in recently immigrated, asymptomatic IAC. METHODS Within 6 months of immigration to the United States, we collected demographic information and assessed the nutritional status of 566 IAC who presented for routine postadoptive care. Children completed standardized clinical examination and TSTs. Chest radiographs were recommended for children with TST induration ≥ 5 mm. The association between TST induration and clinical outcome was assessed. The clinical utility of chest radiographs was evaluated. RESULTS There was no difference in age, birth country, or nutritional status between IAC with TST induration of 0 to < 5 mm and those with 5 to < 10 mm; IAC with TST ≥ 10 mm were older, more chronically malnourished, and more likely to emigrate from Guatemala. Among children with TST ≥ 5 mm (35%), 4 IAC had chest radiographs which were initially interpreted to be abnormal and consistent with TB; ultimately none were diagnosed with TB. CONCLUSIONS The 5-mm TST cut point did not capture IAC with risk factors for latent TB infection or progression to TB disease, suggesting that this is not a useful screening threshold. In contrast, a 10-mm cut point identified IAC at risk for TB infection and therefore should be a more useful screening threshold. We question the clinical utility of radiographic screening for pulmonary TB in asymptomatic children.
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Stadler LP, Donauer S, Rice M, Trehan I, Salisbury S, Staat MA. Factors associated with protective antibody levels to vaccine preventable diseases in internationally adopted children. Vaccine 2010; 29:95-103. [PMID: 21036132 PMCID: PMC3022417 DOI: 10.1016/j.vaccine.2010.09.098] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2010] [Revised: 09/24/2010] [Accepted: 09/27/2010] [Indexed: 10/18/2022]
Abstract
To determine which factors are predictive of protective antibody against vaccine-preventable diseases in internationally adopted children, we evaluated 562 children with serologic testing for at least one vaccine antigen before receiving a US vaccination. Vaccination status was defined as the number-of-doses recorded and as the presence of an up-to-date and valid record according to the American Academy of Pediatrics and the Advisory Committee on Immunization Practices guidelines. The number-of-doses recorded was the best predictor of protective antibody. These findings suggest that other options for immunization verification guidelines for internationally adopted children should be considered by policy makers.
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Affiliation(s)
- Laura Patricia Stadler
- Department of Pediatrics, Division of Infectious Diseases, University of Kentucky, Kentucky Children’s Hospital, Lexington, KY, United States
| | - Stephanie Donauer
- Department of Pediatrics, Cincinnati, OH, United States
- Division of Biostatistics and Epidemiology, Cincinnati, OH, United States
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
| | - Marilyn Rice
- Department of Pediatrics, Cincinnati, OH, United States
- International Adoption Center, Cincinnati, OH, United States
- Division of Infectious Diseases, Cincinnati, OH, United States
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
| | - Indi Trehan
- Department of Pediatrics, Washington University in St. Louis, St. Louis, MO, United States
| | - Shelia Salisbury
- Department of Pediatrics, Cincinnati, OH, United States
- Division of Biostatistics and Epidemiology, Cincinnati, OH, United States
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
| | - Mary Allen Staat
- Department of Pediatrics, Cincinnati, OH, United States
- International Adoption Center, Cincinnati, OH, United States
- Division of Infectious Diseases, Cincinnati, OH, United States
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
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Statement on International Adoption. Can Commun Dis Rep 2010; 36:1-17. [DOI: 10.14745/ccdr.v36i00a15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Staat MA, Stadler LP, Donauer S, Trehan I, Rice M, Salisbury S. Serologic testing to verify the immune status of internationally adopted children against vaccine preventable diseases. Vaccine 2010; 28:7947-55. [PMID: 20937322 DOI: 10.1016/j.vaccine.2010.09.069] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2010] [Revised: 09/17/2010] [Accepted: 09/22/2010] [Indexed: 10/19/2022]
Abstract
Definitive immunization guidelines for internationally adopted children are lacking. We examined whether these children had serologic evidence of protection against vaccine-preventable diseases. For children with ≥3 vaccine doses, overall protection was high for diphtheria (85%), tetanus (95%), polio (93%), hepatitis B (77%), and Hib (67%). For children ≥12 months of age with ≥1 dose of measles, mumps, or rubella vaccines, 95%, 72%, and 94% were immune, respectively. Children without immunization documentation had lower immunity. Serologic testing was useful in verifying the immunization status in internationally adopted children with and without documentation of immunizations.
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Affiliation(s)
- Mary Allen Staat
- Department of Pediatrics, International Adoption Center, Cincinnati Children’s Hospital Medical Center, 3333 BurnetAvenue, ML 7036, Cincinnati, OH 45229-3039, United States.
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Putignani L, Menichella D. Global distribution, public health and clinical impact of the protozoan pathogen cryptosporidium. Interdiscip Perspect Infect Dis 2010; 2010:753512. [PMID: 20706669 PMCID: PMC2913630 DOI: 10.1155/2010/753512] [Citation(s) in RCA: 119] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2009] [Revised: 01/07/2010] [Accepted: 05/11/2010] [Indexed: 12/19/2022] Open
Abstract
Cryptosporidium spp. are coccidians, oocysts-forming apicomplexan protozoa, which complete their life cycle both in humans and animals, through zoonotic and anthroponotic transmission, causing cryptosporidiosis. The global burden of this disease is still underascertained, due to a conundrum transmission modality, only partially unveiled, and on a plethora of detection systems still inadequate or only partially applied for worldwide surveillance. In children, cryptosporidiosis encumber is even less recorded and often misidentified due to physiological reasons such as early-age unpaired immunological response. Furthermore, malnutrition in underdeveloped countries or clinical underestimation of protozoan etiology in developed countries contribute to the underestimation of the worldwide burden. Principal key indicators of the parasite distribution were associated to environmental (e.g., geographic and temporal clusters, etc.) and host determinants of the infection (e.g., age, immunological status, travels, community behaviours). The distribution was geographically mapped to provide an updated picture of the global parasite ecosystems. The present paper aims to provide, by a critical analysis of existing literature, a link between observational epidemiological records and new insights on public health, and diagnostic and clinical impact of cryptosporidiosis.
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Affiliation(s)
- Lorenza Putignani
- Microbiology Unit, Bambino Gesù Pediatric Hospital, Scientific Institute, Piazza Sant'Onofrio 4, 00165 Rome, Italy
| | - Donato Menichella
- Microbiology Unit, Bambino Gesù Pediatric Hospital, Scientific Institute, Piazza Sant'Onofrio 4, 00165 Rome, Italy
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Abstract
BACKGROUND Tuberculosis causes significant morbidity and mortality worldwide. In the last years, international travel and immigration have led to important changes in the epidemiology of this disease. Drug resistance has emerged as an important threat to tuberculosis control. Data regarding the impact of immigration and the incidence of drug-resistant strains in children are lacking. METHODS Retrospective review of patients diagnosed with pulmonary tuberculosis at La Paz Children's Hospital in a 30-year period. Data were collected with regard to the clinical, radiologic, microbiologic, and demographic characteristics of patients, and data from the 3 decades of the study were compared using chi test and Fisher exact test. RESULTS A total of 507 cases of tuberculosis were identified, 414 of which had pulmonary involvement. During the study, there was a significant decrease in tuberculous meningitis: 10.4% in 1978-1987, 5.6% in 1988-1997, and 2.9% in 1998-2007 (P < 0.05). The most frequent reason for a consultation was case contact investigation. The adult source case was identified in 64% of patients. We observed an increase in extrafamilial contacts (8% in 1978-1987 and 18% in 1998-2007, P < 0.01), including 4 cases of immigrant caretakers. Tuberculosis in immigrant children has increased with time: 2% in the period 1978-1987, 6% in 1988-1997, and 46% in 1998-2007 (P < 0.001). The primary resistance rate to isoniazid in our population was 6.5%. CONCLUSIONS Tuberculosis in our area continues to be a major health problem, especially among foreign-born children. As drug-resistant strains are increasing, initial therapy with 4 drugs is recommended in our population.
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Ruwende J, Sanchez-Padilla E, Maguire H, Carless J, Mandal S, Shingadia D. Recent trends in tuberculosis in children in London. J Public Health (Oxf) 2010; 33:175-81. [DOI: 10.1093/pubmed/fdq046] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Tande D, Boisrame-Gastrin S, Munck MR, Hery-Arnaud G, Gouriou S, Jallot N, Nordmann P, Naas T. Intrafamilial transmission of extended-spectrum- -lactamase-producing Escherichia coli and Salmonella enterica Babelsberg among the families of internationally adopted children. J Antimicrob Chemother 2010; 65:859-65. [DOI: 10.1093/jac/dkq068] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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van Schaik R, Wolfs TF, Geelen SP. Improved general health of international adoptees, but immunization status still insufficient. Eur J Pediatr 2009; 168:1101-6. [PMID: 19125292 PMCID: PMC2714889 DOI: 10.1007/s00431-008-0895-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2008] [Accepted: 12/01/2008] [Indexed: 11/27/2022]
Abstract
We studied the demographic and clinical data from 495 adopted children seen between January 2002 and January 2007 to evaluate the medical condition and immunization status of international adoptees. The data of children from Chinese origin (53.5%) were compared to children arriving from other countries. Medical problems requiring treatment were present in 42.8% of the children. Parasitic gastrointestinal infection (22.0%) and skin abnormalities (22.4%) were diagnosed most often. Hepatitis B (1.2%) and tuberculosis (1%) were documented in some children; HIV, hepatitis C, and syphilis were not seen in any of the children. Antibody levels against diphtheria and tetanus were insufficient in about half of all children, particularly in those from China. In conclusion, most adoptive children had a good general health, with only a few having major medical problems. Many adoptive children had an inadequate immunization status.
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Affiliation(s)
- Robin van Schaik
- Department of Paediatric Immunology and Infectious Diseases, Wilhelmina Children’s Hospital /University Medical Centre Utrecht, KE 04.1331, P.O. Box 85090, 3508 AB Utrecht, The Netherlands
| | - Tom F. Wolfs
- Department of Paediatric Immunology and Infectious Diseases, Wilhelmina Children’s Hospital /University Medical Centre Utrecht, KE 04.1331, P.O. Box 85090, 3508 AB Utrecht, The Netherlands
| | - Sibyl P. Geelen
- Department of Paediatric Immunology and Infectious Diseases, Wilhelmina Children’s Hospital /University Medical Centre Utrecht, KE 04.1331, P.O. Box 85090, 3508 AB Utrecht, The Netherlands
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Abstract
Renal tuberculosis is rare in children and particularly in infants. We present a case of miliary tuberculosis with focal renal involvement in a 5-month-old male infant recently adopted from Ethiopia, and review the literature on miliary and renal tuberculosis in infants and children. Salient points regarding tuberculosis screening in internationally adopted patients are also addressed.
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ten Hove RJ, van Esbroeck M, Vervoort T, van den Ende J, van Lieshout L, Verweij JJ. Molecular diagnostics of intestinal parasites in returning travellers. Eur J Clin Microbiol Infect Dis 2009; 28:1045-53. [PMID: 19415354 PMCID: PMC2758195 DOI: 10.1007/s10096-009-0745-1] [Citation(s) in RCA: 95] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2008] [Accepted: 03/31/2009] [Indexed: 11/15/2022]
Abstract
A new diagnostic strategy was assessed for the routine diagnosis of intestinal parasites in returning travellers and immigrants. Over a period of 13 months, unpreserved stool samples, patient characteristics and clinical data were collected from those attending a travel clinic. Stool samples were analysed on a daily basis by microscopic examination and antigen detection (i.e. care as usual), and compared with a weekly performed multiplex real-time polymerase chain reaction (PCR) analysis on Entamoeba histolytica, Giardia lamblia, Cryptosporidium and Strongyloides stercoralis. Microscopy and antigen assays of 2,591 stool samples showed E. histolytica, G. lamblia, Cryptosporidium and S. stercoralis in 0.3, 4.7, 0.5 and 0.1% of the cases, respectively. These detection rates were increased using real-time PCR to 0.5, 6.0, 1.3 and 0.8%, respectively. The prevalence of ten additional pathogenic parasite species identified with microscopy was, at most, 0.5%. A pre-selective decision tree based on travel history or gastro-intestinal complaints could not be made. With increased detection rates at a lower workload and the potential to extend with additional parasite targets combined with fully automated DNA isolation, molecular high-throughput screening could eventually replace microscopy to a large extent.
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Affiliation(s)
- R J ten Hove
- Department of Parasitology, Leiden University Medical Centre, P.O. Box 9600, Leiden 2300 RC, The Netherlands
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Finnell SME, Christenson JC, Downs SM. Latent tuberculosis infection in children: a call for revised treatment guidelines. Pediatrics 2009; 123:816-22. [PMID: 19255008 DOI: 10.1542/peds.2008-0433] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Guidelines for latent tuberculosis infection do not consider drug-resistance patterns when recommending treatment for immigrant children. OBJECTIVES The purpose of this research was to decide at what rate of isoniazid resistance a different regimen other than isoniazid for 9 months should be considered. METHODS We constructed a decision tree by using published data. We studied 3 regimens considered to be effective for susceptible organisms: (1) isoniazid for 9 months, (2) rifampin for 6 months, and (3) isoniazid for 9 months plus rifampin for 6 months. In addition, we evaluated a regimen of isoniazid and rifampin for 3 months. Our base case was a 2-year-old child from Russia with a tuberculin skin test reaction of 12 mm. We assumed a societal perspective and expressed results as cost and cost per case of tuberculosis prevented. We conducted sensitivity analyses to test the stability of our model. RESULTS In our baseline analysis, rifampin was the least costly treatment regimen for any child arriving from an area with an isoniazid-resistance rate of >/=11%. Treatment with isoniazid plus rifampin was the most effective but would cost more than $1 million per reactivation case prevented. Isoniazid would become the least costly regimen if any of the following thresholds were met: rifampin resistance given isoniazid resistance of more than 82%; rifampin resistance given no isoniazid resistance of >9%; cost of rifampin more than $47/month; effectiveness of rifampin lower than 63%; effectiveness of isoniazid higher than 74%; and cost of pulmonary tuberculosis less than $7661. Isoniazid and rifampin for 3 months was the least costly for all cases from areas with isoniazid resistance of <80% as long as the regimen's effectiveness was >50% for susceptible bacteria. However, this assumption remains to be proven. CONCLUSION Because of the high prevalence of isoniazid resistance, rifampin should be considered for children with latent tuberculosis infection originating from countries with >11% isoniazid resistance.
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Affiliation(s)
- S Maria E Finnell
- Indiana University School of Medicine, Children's Health Services Research, Department of Pediatrics, HITS Building, Room 1020B, 410 W 10th St, Indianapolis, IN 46202, USA.
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Stadler LP, Mezoff AG, Staat MA. Hepatitis B virus screening for internationally adopted children. Pediatrics 2008; 122:1223-8. [PMID: 19047238 DOI: 10.1542/peds.2007-2559] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES The objectives of this study were to estimate the prevalence of hepatitis B virus protection, infection, and recovery among internationally adopted children and to examine the need for repeat testing 6 months after arrival in the United States. METHODS From November 1999 through October 2006, 1282 international adoptees were screened for hepatitis B virus, and results were examined with regard to age, gender, and birth country. The prevalence of hepatitis B virus protection, infection, and recovery was determined. RESULTS The prevalence of hepatitis B virus in internationally adopted children at our large international adoption center was 4%, including 1.1% with acute or chronic infection and 2.9% with resolved infection. Overall, 64% of internationally adopted children had evidence of hepatitis B virus immunization, with protective antibodies. We also report a case that highlights the need for repeat serological testing to detect hepatitis B virus infection or immunization in internationally adopted children who might have been infected or vaccinated just before adoption and thus not have serological evidence in initial testing. CONCLUSIONS These data reinforce the American Academy of Pediatrics recommendations regarding hepatitis B virus screening and infection control measures for international adoptees.
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Affiliation(s)
- Laura Patricia Stadler
- Department of Pediatrics, International Adoption Center, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 7013, Cincinnati, OH 45229-3109, USA
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Interpretation of repeat tuberculin skin testing in international adoptees: conversions or boosting. Pediatr Infect Dis J 2008; 27:913-9. [PMID: 18776820 DOI: 10.1097/inf.0b013e3181758187] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Internationally-adopted children are a unique group of Bacille Calmette-Guérin (BCG)-vaccinated children with high rates of latent tuberculosis infection (LTBI) in whom serial tuberculin skin tests (TST) are recommended. No study has measured the incidence of TST conversion in these children. METHODS Internationally-adopted children completed baseline and follow-up TST to measure the incidence of Mycobacterium tuberculosis infection and factors associated with TST conversion. Data were collected regarding age, gender, birth country, vaccination history, history of tuberculosis (TB) exposure, previous TB screening, and preadoptive environment. All children completed physical examinations including a standardized evaluation for TB, anthropometric assessment, and documentation of BCG scar. RESULTS Fourteen percent of children (N = 390) had evidence of LTBI at baseline. Children were more likely to have LTBI if they were older, BCG vaccinated, or had been in the United States longer. An additional 13% of children had TST indurations > or = 10 mm at follow-up testing. Regardless of BCG vaccination status or nutritional status, children who were younger at baseline were more likely to have a TST induration > or = 10 mm at follow-up. CONCLUSIONS International adoptees have significant risk of LTBI. Although our findings suggest that recent infection with M. tuberculosis led to TST conversion in some children, the increase in follow-up TST induration could also be attributed to TST boosting resulting from prior BCG vaccination. When serial TST testing is completed in young, BCG-vaccinated children, interpretation of the follow-up TST should consider baseline TST results.
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Cilleruelo MJ, de Ory F, Ruiz-Contreras J, González-González R, Mellado MJ, García-Hortelano M, Villota J, García-Ascaso M, Piñeiro R, Martín-Fontelos P, Herruzo R. Internationally adopted children: what vaccines should they receive? Vaccine 2008; 26:5784-90. [PMID: 18786590 DOI: 10.1016/j.vaccine.2008.08.029] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2008] [Revised: 08/18/2008] [Accepted: 08/19/2008] [Indexed: 11/29/2022]
Abstract
It is of paramount importance to know the vaccination status in internationally adopted children, so that they can be correctly immunized. This study ascertains the seroprotection rate for vaccine-preventable diseases and the validity of the immunization cards in 637 adopted children. The absence of the immunization card (13% of children) correlated with a poor global vaccine protection. Children with immunization records (87%) had a better global seroprotection but the information obtained from the card did not accurately predict seroprotection for each particular antigen. The best variable to predict the status of seroprotection was the country of origin. The highest rate of protection was found in children from Eastern Europe and, in descending order, India, Latin America, China and Africa. General recommendations for immunization of internationally adopted children are difficult to establish. Actions for vaccination have to be mainly implemented on the basis of the existence of the immunization card and of the country of origin.
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Affiliation(s)
- M J Cilleruelo
- Department of Pediatrics, Hospital Carlos III, Madrid, Spain.
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Oliván Gonzalvo G. [Hepatitis B serological markers in children adopted from Russia and Ukraine]. An Pediatr (Barc) 2008; 68:136-9. [PMID: 18341879 DOI: 10.1157/13116228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To determine the prevalence of the hepatitis B virus (HBV) infection and to verify the immunization status against HBV of children adopted from Russia and Ukraine. PATIENTS AND METHODS Cohort study of 102 children (58.8% boys) adopted from Russia (90) and Ukraine (12) between 2002 and 2007. All children had medical records that certified they had received 3 doses of HBV vaccine from the birth country. They were evaluated within 2 weeks of their arrival (mean age of 28.3 months; range, 12 to 88 months) according to a standard protocol that includes the hepatitis B serological markers, surface antigen (HBsAg), core antibody (HBcAb), and surface antibody (HBsAb). RESULTS All children were negative for HBsAg and HBcAb (prevalence of active or previous HBV infection, 0%), and 78 (76.5%) showed a protective antibody response (HBsAb>or=10 mIU/ml) due to HBV vaccination. The results are contrasted with those observed by other researchers. CONCLUSIONS We show that children adopted from Russia and Ukraine have a relatively high prevalence of protective immunity due to effective HBV vaccination. Therefore, we recommended determining the 3 serological markers for HBV (HBsAg, HBcAb, and HBsAb). Using this, we may detect an active infection or other infection risks, and we know the immunization status. Thus we can assess the need for retest, and provide criteria for individualized vaccinations, which could avoid generalized HBV vaccination in this specific population of internationally adopted children.
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Trehan I, Meinzen-Derr JK, Jamison L, Staat MA. Tuberculosis screening in internationally adopted children: the need for initial and repeat testing. Pediatrics 2008; 122:e7-14. [PMID: 18595977 DOI: 10.1542/peds.2007-1338] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Because most internationally adopted children come from areas of high tuberculosis prevalence, an initial tuberculin skin test is recommended after arrival to the United States. We evaluated whether repeat testing of children >or=3 months after arrival to the United States would identify additional children with latent tuberculosis infection. METHODS Internationally adopted children who were seen at our International Adoption Center and had a tuberculin skin test within 2 months of arrival to the United States were eligible for the study. Children not diagnosed with tuberculosis with initial testing were retested at least 3 months later. The prevalence of tuberculosis on arrival and after repeat testing was determined, and potential risk factors for infection were examined. RESULTS Of the 527 internationally adopted children with an initial tuberculin skin test completed, 111 (21%) had evidence of latent tuberculosis infection. Repeat tuberculosis testing was complete for 191 internationally adopted children (46.9% of those who had an initially negative tuberculin skin test). Latent tuberculosis infection was found in 20% of those who were retested. No children were found to have active tuberculosis disease. Children with an initially positive tuberculin skin test result had slightly higher weight-for-age z scores at their initial clinic visit, whereas those whose tuberculin skin test result was positive after repeat testing had slightly lower weight-for-age z scores. A strong correlation between BCG immunization and tuberculin skin test result was observed. CONCLUSIONS Latent tuberculosis infection is common in internationally adopted children. A high proportion of internationally adopted children had an initially false-negative tuberculin skin test. Repeat tuberculosis testing of all internationally adopted children with an initially negative tuberculin skin test should be the standard of care for identifying tuberculosis infection and preventing tuberculosis disease in this high-risk population.
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Affiliation(s)
- Indi Trehan
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio 45229-3039, USA
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Fortin K, Carceller A, Robert M, Chevalier I, Lamarre V, Lebel MH. Prevalence of positive tuberculin skin tests in foreign-born children. J Paediatr Child Health 2007; 43:768-72. [PMID: 17803663 DOI: 10.1111/j.1440-1754.2007.01169.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIMS To evaluate the prevalence of positive tuberculin skin tests (TST) in internationally adopted and immigrant children. To identify risk factors for positive TST in these populations. METHODS The study was a retrospective medical record review in a tertiary care pediatric hospital. All children evaluated at the International Adoption and Immigrant Health Clinic of CHU Sainte-Justine in Montreal, Canada, between 01-01-1998 and 31-12-2001 were included. Demographic and anthropometrical data, BCG vaccination, TST, chest X-ray results and treatment were extracted from the medical records of the patients and analyzed. Positive TST was defined as induration = 10 mm, 48 to 72 hours after injection of five tuberculin units of purified protein derivate. RESULTS Our population included 670 children: 112 immigrants and 558 adoptees. Median age was 6.9 years for immigrants and 1.1 years for adopted children. Overall incidence of positive TST was 12.2% in our cohort: 31% in the immigrant and 8% in the adopted children groups. There was one case of active tuberculosis. Older age on arrival in Canada and BCG vaccination were identified as risk factors for positive TST in our multivariate model. For each one-year increase in age on arrival in Canada, there was a 1.2 times greater risk for positive TST. CONCLUSIONS Latent tuberculosis is a frequent problem in foreign-born children. The higher incidence in immigrant children can be explained by older age on arrival.
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Affiliation(s)
- Kristine Fortin
- Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montréal, Canada
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Mandalakas AM, Kirchner HL, Iverson S, Chesney M, Spencer MJ, Sidler A, Johnson D. Predictors of Mycobacterium tuberculosis infection in international adoptees. Pediatrics 2007; 120:e610-6. [PMID: 17766501 DOI: 10.1542/peds.2006-2817] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The objective of this study was to measure the factors that are associated with Mycobacterium tuberculosis infection in international adoptees. METHODS A retrospective chart review was conducted on 880 international adoptees who presented to the International Adoption Clinic at the University of Minnesota between 1986 and 2001. Five tuberculin units of purified protein derivative were placed intradermally on the left forearm. The largest diameter of induration was measured in millimeters between 48 and 72 hours. Nutritional status was assessed using anthropometric measures at initial screening. Data on age, birth country, and year of adoption were assessed. RESULTS Adoptees (mean age: 26 months; range: 1-200 months; 62% female) came from 33 birth countries. Twenty-eight percent and 5% had evidence of chronic and acute malnutrition, respectively. Twelve percent had evidence of M. tuberculosis infection. The odds of M. tuberculosis infection increased 7% for each subsequent year during the period studied, increased 142% with each additional year of age for children < or = 24 months of age at baseline screening, and increased 15% with each additional year of age for children > 24 months of age at the time of evaluation. Tuberculin skin test induration response was not associated with nutritional status or birth region. CONCLUSIONS Our study demonstrated a high prevalence of M. tuberculosis infection and malnutrition in internationally adopted children, placing them at considerable risk for progression to tuberculosis disease. These findings also support current guidelines recommending completion of tuberculin screening immediately after adoption.
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Affiliation(s)
- Anna M Mandalakas
- Department of Pediatrics, Case Western Reserve University, Cleveland, Ohio, USA.
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ten Hove R, Schuurman T, Kooistra M, Möller L, van Lieshout L, Verweij JJ. Detection of diarrhoea-causing protozoa in general practice patients in The Netherlands by multiplex real-time PCR. Clin Microbiol Infect 2007; 13:1001-7. [PMID: 17714523 DOI: 10.1111/j.1469-0691.2007.01788.x] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The diagnostic value of a multiplex real-time PCR for the detection of Entamoeba histolytica, Giardia lamblia and Cryptosporidium parvum/Cryptosporidium hominis was evaluated by comparing the PCR results obtained with those of routinely performed microscopy of faecal samples from patients consulting their general practitioner (GP) because of gastrointestinal complaints. Analysis of 722 faecal DNA samples revealed that the prevalence of G. lamblia was 9.3% according to PCR, as compared to 5.7% by microscopy. The number of infections detected was more than double in children of school age. Furthermore, G. lamblia infection was detected in 15 (6.6%) of 228 faecal samples submitted to the laboratory for bacterial culture only. C. parvum/C. hominis infections were not diagnosed by routine procedures, but DNA from these organisms was detected in 4.3% of 950 DNA samples. A strong association with age was noted, with Cryptosporidium being detected in 21.8% of 110 children aged <5 years. C. hominis was the most prevalent species. E. histolytica was not detected in this study population. Analysis of microscopy data revealed that the number of additional parasites missed by PCR was small. Overall, the study demonstrated that a multiplex real-time PCR approach is a feasible diagnostic alternative in the clinical laboratory for the detection of parasitic infections in patients consulting GPs because of gastrointestinal symptoms.
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Affiliation(s)
- R ten Hove
- Department of Parasitology, Leiden University Medical Center, Leiden, The Netherlands.
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Mackowiak PA, Terp S, Meir MB, Tan T. Inflammatory Reaction at the Site of a Bacille Calmette-Guerin Vaccination Scar in an Adopted Child. Clin Infect Dis 2007. [DOI: 10.1086/520019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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