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High prevalence of infectious diseases identified in international adoptees
LONDON — Infectious diseases were common among international adoptees in Italy, according to Silvia Garazzino, MD.
More than half of the children had at least one infection: 102 of the adoptees had a parasitic infection such as amoebiasis, giardiasis or toxocariasis.
“Although the living conditions of pre-adopted children may widely vary, most adoptees reside in orphanages and experience malnutrition, environmental deprivation and exposure to infectious diseases,” Garazzino, of the division of infectious diseases at Regina Margherita Children’s Hospital in Turin, Italy, told Infectious Disease News. “After arrival in Italy, many adopted children are therefore at risk of developing infections acquired in their country of origin. Many infectious diseases, such as tuberculosis and Chagas disease, may be initially asymptomatic.”
Garazzino and colleagues conducted a retrospective study of 254 international adoptees who were adopted in Italy from 2010 to 2011. The children underwent clinical assessment and biochemical and radiological tests in an international adoption center following the national screening protocol for health assessment of international adoptees formed by the Italian Society of Pediatrics.
The study included 140 boys and 114 girls with a mean age of 4.6 years. The children came from Africa, Asia, South America and Eastern Europe, with the four most common countries of origin being Ethiopia, Vietnam, China and the Russian Federation.
Thirteen children had other intestinal protozoa, seven had roundworms infestation and one each had schistosomiasis and malaria. Children born in Eastern Europe were more likely to have Toxocara infection, but African children were more likely to have amoebiasis and giardiasis. Eight children each had latent and active TB, one had hepatitis C and three had hepatitis B. Twelve children had congenital cytomegalovirus, which was more prevalent among adoptees from the Russian Federation.
“Medical records of prior health conditions and immunizations are often incomplete, if not absent, and screening tests are sometimes not performed in the country of origin,” Garazzino said. “Therefore, the initial medical assessment for an international adoptee should include a screening for infectious diseases.”
Disclosure: Dr. Garazzino reports no relevant financial disclosures.
Perspective
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Infectious diseases are also among the most common medical diagnoses identified in international adoptees after arrival in the United States. The findings from this study from adoptees in Europe reinforce current CDC guidelines that all international adoptees should be screened for hepatitis B, syphilis, HIV, certain intestinal parasites and tuberculosis — all international adoptees should be screened for these infections on arrival in the United States. Additional screening should include tests for hepatitis C; stool ova and parasites with specific request for Giardia intestinalis and Cryptosporidium species testing; in children with eosinophilia and negative stool ova and parasite examinations Strongyloides species serologic testing, as well as Schistosoma and Filariais species serologic testing for adoptees from endemic areas; and Trypanosoma cruzi serologic testing for adoptees from endemic areas.