Internationally Adopted Children—Immigration Status

Abstract

To the Editor. The number of internationally adopted children arriving in the United States has increased dramatically (13 620 in 1997, compared with 9945 in 1986). Many children have received vaccines in their birth countries; however, the efficacy of the vaccines and the accuracy of the records are sometimes questionable. Hostetter et al1have reported protective diptheria and tetanus titers in only 38% of Chinese, Russian, or Eastern European children with written evidence of age-appropriate vaccines.We have observed that polio titers also may not be protective. Four children in our clinic with written evidence of 3 to 6 polio vaccines were found to have incompletely protective titers. The children were from Lithuania (1), Russia (2), and China (1). They ranged in age from 12 months to 8 years. In 3 children, protective titers to Type 1 and Type 2 polio were found, but no titers to Type 3 polio were measured. In one child, protective titers to Type 1 were absent, but were present for Types 2 and 3.Although the Red Book recommends that “written documentation should be accepted as evidence of prior immunization,”2 clinicians caring for internationally adopted children should be aware of the possibility of incomplete immunity to polio, and should either revaccinate or verify immunity to all 3 types of polio. Revaccination or verification of protective titers should be considered for all immunizations in this population.

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