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

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.

Systematic review shows that immunising internationally adopted children is a major challenge for primary health care

“…with regard to the adoptees' countries of origin, the doses of the administered vaccines, the ages of the children and the laboratory methods used for antibody testing. The predictive value of the immunisation records of adoptees was investigated by several studies, but their findings were inconclusive, and they indicated that immunisation records may not reflect actual immunity (4,13,18,26). Many possible reasons were proposed for this, including falsifying vaccine certificates, inadequate vaccine conservation and decreased vaccine efficacy due to malnutrition (4,13,18,26).…”

Assessing the health of internationally adopted children

“…Studies suggest that 35–42% of international adoptees have at least one infectious disease , with even an higher prevalence in those originating from Africa .…”

“…Italy has the second highest rate of international adoption after the USA, with more than 300 adoptees every year, and has produced many publications regarding the medical care of IAC . An Italian study that assessed 1612 IAC between 2009 and 2015 found that 18% of IAC originated from Africa and half of those were from Ethiopia .…”

“…Italy has the second highest rate of international adoption after the USA, with more than 300 adoptees every year, and has produced many publications regarding the medical care of IAC . An Italian study that assessed 1612 IAC between 2009 and 2015 found that 18% of IAC originated from Africa and half of those were from Ethiopia . The paper from Chiappini et al in this issue of Acta Paediatrica represents the largest cohort of African IAC, with 762 children, including 401 from Ethiopia, assessed in 11 paediatric centres from 2009 to 2015.…”

The internationally adopted child: overview of challenging issues

“…It is crucial to know the vaccination status in children, so that they can be correctly immunised (9,(12)(13)(14)(15). According to our experience (9,15) This is not simple as their preadoptive immunisation records sometimes are lacking and frequently are scarcely reliable. It is helpful to keep in mind that an absent immunisation card correlates with a poor global protection.…”