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Internationally adopted children should be screened for hepatitis A immunity
Abdulla RY. Pediatrics. 2010;126:e1039-1044.
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Screening all internationally adopted children for hepatitis A virus yielded useful information for determining the need for immunization, according to recent data.
“Most internationally adopted children come from [hepatitis A virus]-endemic countries, are young, and may have unrecognized infections with prolonged shedding, which places their new families and other close contacts at risk for acquiring [hepatitis A virus] infection,” wrote researchers from the Cincinnati Children’s Hospital Medical Center.
Between Sept. 25, 2006, and Sept. 30, 2008, the researchers examined children at the medical center’s International Adoption Center to determine the prevalence of hepatitis A virus infection in this population. They conducted serological testing within 4 months of arrival in the US and collected data from patient records to make their assessment.
Two hundred seventy-nine children had total hepatitis A virus serological test results available. Data indicated that 29% were positive, with immunity varying according to birth region and country. Among children born in the Asia/Pacific-Rim region, only 17% had immunity compared with 72% of those born in Africa.
Results also suggested that hepatitis A virus immunity increased with age; only 13% of children aged younger than 2 years had immunity compared with 80% of children aged at least 12 years (P<.0001). Children aged younger than 12 months, 12 to 17 months and 18 to 23 months, however, had comparable rates of immunity.
Age-specific prevalence also fluctuated according to country of birth, the researchers said, with Chinese and Russian children aged younger than 2 years having the lowest proportion of immunity, at 9% and 29%, respectively. In contrast, prevalence was highest among children from Guatemala (79%) and Ethiopia (93%).
The likelihood of immunity increased by 33% with each year of age (OR=1.33; 95% CI, 1.19-1.48). The researchers said in multivariate analysis, increasing age and region were independently associated with immunity.
When tested for acute hepatitis A virus infection, 1% of 270 children had immunoglobulin M antibody to the disease. They included one child aged 18 months from Kazakhstan, one aged 27 months from Russia and one aged 41 months from the Latin American/Caribbean region. Testing was performed 7, 16 and 24 days, respectively, after arrival in the US. All were asymptomatic, and all family members of each child had received hepatitis A vaccine before traveling.
The father of the 27-month-old girl adopted from Russia developed hepatitis A virus infection after returning to the US. His infection did not resolve for 2.5 months.
“Given the high [hepatitis A virus] prevalence among internationally adopted children in most countries, especially among those >2 years of age, screening is likely to be cost-effective for internationally adopted children,” the researchers wrote. “Policymakers should revisit guidelines for the screening of internationally adopted children, to determine the best approach for screening in the changing environment of international adoption and [hepatitis A virus] epidemiological features.”