B and Adoption from Asia FAQ (Part 2 of 2)
By Allison Martin Reviewed by Jerri
Ann Jenista, MD
The Hepatitis B and Adoption from Asia FAQ provides information and
resources for adoptive parents about hepatitis B. This article is not
intended to replace individual consulation with your doctor. For more
information, check our listings of adoption
health clinics and hepatitis B support
organizations and medical articles.
Part 1 | Part 2
Medical tests for your child
When you return home with your child, it is essential that he or she
receive a battery of tests and inoculations, including Hepatitis B. (A
standard "battery" of tests includes: HIV, Hepatitis B panel,
parasites, syphilis, TB, complete blood count, and unrinalysis.) In some
cases, these tests will be repeated over time and/or follow-up tests may
Most international adoption medical clinics recommend that testing for
Hepatitis B include testing for:
- the Hepatitis B surface antibody,
- the Hepatitis B core antibody, and the
- Hepatitis B surface antigen.
(In my personal experience and the experience of other members of the
Adoptive Parents of Vietnam mailing
list, pediatricians may not include the Hepatitis B core antibody,
unless you request it or the antigen is positive.)
Interpretation of hepatitis B testing can be fairly complicated, so you
may want to consult a expert if you do get back a report indicating the
hepatitis B virus is present in your child (i.e., the Hepatitis B surface
antigen test is positive).
You will want to begin medical testing of your child as soon possible
after their arrival home. According to Dr. Jenista,
"The follow-up test is important even if your child has already
been tested as negative, as there have been reports of adoptive children
testing positive after a prior negative test. This is likely due to
either inaccurate test results or interpretation, age of the baby, or
to subsequent exposure in the orphanage or elsewhere."
As Hepatitis B exposure can occur at any point before adoption and may
have a 6 month incubation period, many international adoption medical
experts recommend that you test your child again six (6) months
after she or he is in your home. Thus, children (including babies) should
be tested upon arrival and 6 months later.
The main purpose of these basic tests are to determine 1) if hepatitis
B was ever present and 2) if it is still active. In general, these hepatitis
tests check for the presence of either:
antigens (test reaction to actual parts
of the virus), or
antibodies (test reaction to a substance
produced by the human body in response to the virus - either to
the core or to the surface of the virus).
Antibodies may be present despite chronic infection with hepatitis B.
Thus, a surface antigen test must always be obtained. If surface antigen
is positive, the person is infected regardless of presence of any anitbodies
(core, surface or "e"). (Dr. Jenista, pers.comm.)
If the antigen test is positive, then additional tests may be undertaken.
What do the tests mean?
Understanding Hepatitis B test results is no easy task, because the interpretation
of one test may be dependent on the results of another. Also, doctors,
labs, parents and patients often confuse the names of the tests.
The Hepatitis B surface antigen test indicates whether or not
your child currently has Hepatitis B. It actually tests for the virus
itself. (The hepatitis B"e" antigen (HBeAg) test also indicates
the presence of the virus, along with amount of infectiousness.)
The other two tests - the antibody tests (surface and core)
- measure either your child's current or your child's past reaction
to Hepatitis B.
The most important test is for the hepatitis B surface antigen (HBsAg).
The results of this test indicate whether or not your child has the virus
A positive (+) hepatitis B surface antigen (HBsAg) test results means
that your child has hepatitis B.
A a negative (-) hepatitis B surface antigen (HBsAg) test result means
that he or she does not have the virus now.
Please see the charts referenced under Hepatitis
B Resources: Organizations & Links for information on interpreting
Hepatitis B vaccinations
Dr. Jerri Ann Jenista explains that in the cases of international adoption,
"Immunizations are frequently not given or are poorly documented.
Occasionally, records that are 'too perfect'-- for example, with exactly,
1 or 2 month intervals between doses -- merely reflect slavish attention
to the vaccine schedule recommendations. Even when vaccines have been
given reliably, the immune response may have been inadequate in the
severely malnourished or chronically ill child. When in doubt, it is
always best to repeat the series of vaccinations, as there is no harm
in re-immunization, provided the HIV status is known.
You can finish a series started in another country with a United States
brand with no problem. Also, if there is question about the number or
efficacy of vaccine, give a booster 6-18 months after the last
Dr. Wexler, Executive Director of the Hepatitis
B Coalition (pers. comm.), recommends the following strategy with
regard to hepatitis B testing and vaccination for children who have been
"This is the U.S. recommendation: For infants of women who are
known to be HBsAg-positive, these high-risk infants should have completed
the birth dose of HBIG and 3 doses of hepatitis B vaccine by 6 months
of age according to CDC recommendations. (They need HBsAg and anti-HBs
testing at 9-15 months of age to document their hepatitis B status.)
For infants and children who are adopted from other countries whose
hepatitis B status is unknown or uncertain at the time of arrival, these
children should have a hepatitis B panel drawn (see below) at their
first physician visit and the child should also receive the first dose
in the hepatitis B vaccine series.
The hepatitis B panel includes at least HBsAg, anti-HBs, and anti-HBc.
Antibody serology tests (anti-HBc and anti-HBs) for children under 18
months of age may be unreliable in that the results may reflect maternal
antibody that was transplacentally passed to the infant and has not
yet disappeared from the infant. For this reason, if an infant under
18 months of age appears "immune" according to these test
results, continue to give the series of three hepatitis B shots to make
sure he or she is adequately protected.
If the child is found to be HBsAg positive, vaccinate no further (for
hepatitis B), do additional testing as appropriate, and retest in 6
Dr. Jenista provides the following guidelines
for vaccinations for Asian Adoptees:
If child has anti-HBs (surface antibody) and anti-HBc (core
antibody) and is over 18 months, he is immune. No need to vaccinate.
If child has anti-HBs and/or anti-HBC and is under 18 months, this
may be maternal antibody. Either vaccinate and retest in 6 months or
retest in 6 months and vaccinate if antibody is gone.
If child has anti-HBs alone at any age and also a documented
history of hepatitis B vaccine, finish hepatitis B series. Can retest
at 6 months but probably not necessary.
If child has no markers posistive or interpretation no clear at any
age, vaccinate and retest in 6 months.
What if my child has Hepatitis
Excellent references for organizations, email support groups, and free
articles on raising a child who has hepatitis B are available at Hepatitis
B Resources: Organizations & Links. Be sure to check into
B Support Mailing Lists for up-to-date information and parental
Dr. Worman explains that in neonates and children, acute infection usually
not clinically apparent. He writes (pers.comm.):
"I personally would say that children who are HBsAg positive (from
Asia or elsewhere) should be treated just like any other children.
They should go to school, play and participate in any activities as
any other kid would. MOST chronically infected children will not
suffer from significant liver disease in their lifetimes, however, they
are at an increased risk of developing cirrhosis and hepatocellular
carcinoma (I don't know the exact numbers). Such individuals should
be considered as potentially infectious to close household contacts
and (when they grow up) sexual partners (and as adults, women may pass
infection to their children). Close household contacts, and sexual
partners of infected adults, should be vaccinated."
In Dr. Jenista's article entitled, "Is
There Life after Hepatitis B?", she explains that Hepatitis
B is not a "death sentence". Dr. Jenista states that,
"Although complete data are not in, we realize that the majority
of chronic carriers will never have any adverse effect of their infection
at all. Methods for detecting and treating complications of hepatitis
B are improving every year. With careful follow-up, most children with
chronic hepatitis B can look forward to a full and normal life."
End of Part 2.
Return to Part 1.
Annotated links to the above references for this article may be found
at Hepatitis B Resources: Organizations &
Jerri Ann Jenista, MD is a pediatrician
and well known author of articles on adoption medical issues.
Allison Martin, MPA is the webmaster
of Adopt Vietnam, and Children's
Disabilities Information. Formerly she was a biologist with the U.S.
Environmental Protection Agency.