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Tests and Vaccinations For Children Adopted From China

By Jacqueline Jacobs Gindler

In short, hepatitis B is endemic in Asia; about 12% of Chinese women of child-bearing age are Hepatitis B Surface Antigen (HBsAg) positive, meaning that they have been infected and are probably chronic carriers. However, among them, only about 30% are what is known as "E-antigen" positive; these are the women who are most likely to transmit Hepatitis B to the infant at the time of delivery (i.e. 90% risk of transmitting infection, vs. 10% risk for E-antigen negative moms). So the overall risk for a given infant is about 0.12 x 0.3 or about 4% chance of being infected at birth.

Many children are tested for the presence of HBsAg in China prior to being referred, and if this test is done after the child is 6 months of age, a negative result is reliable. Some children who are initially HBsAg negative (but who have in fact been exposed and infected) will turn positve during the first six months of life. So a negative result from a 3 month old, while better than a positive one, should be reconfirmed after 6 months of age.

Most orphanages also perform a few other liver function tests that are made available to the parent at the time of referral. All those that I have seen on HBsAg negative children are within normal limits. Many orphanages are now administering Hepatitis B vaccine to their charges.

Chinese adoptees are not routinely tested for HIV unless they come from provinces bordering Vietnam or Myanmar where the risk of exposure is greater. HIV testing is not required for infants to enter the U.S.

Most of these children will have received BCG vaccine very early in life. This vaccine prevents serious complications resulting from Tuberculosis (TB) early in life. It is not routinely used in the U.S. Recently vaccinated children will have a big nasty looking red bump, usually on the left upper arm. This persists for months, and gradually resolves into a tiny flat scar.

You should tell your pediatrician if your child has received BCG as some will defer skin testing of these children for exposure to TB, as the BCG vaccine itself will result in the child's having a positive skin test for some time.

A chest x-ray is not required for entry for infants. Prior to issuance of a visa, you will take your child to a place in Guangzhou where you go through an assembly line sort of affair and the child will have a cursory physical exam. Someone will listen to the chest, someone else will look in the ears and eyes, they will usually do an EKG (electrocardiogram) for some reason, and I think they weigh and measure the baby. They put the report in a sealed envelope which you take with you along with your thousands of other documents to the U.S. embassy for the visa.

Your child may have received some vaccines depending upon her age. The policy of the U.S. Public Health Service has been to accept vaccinations given to foreign adoptees provided that there is documentation of the vaccination (with a date including month, day and year), and that vaccines given in multiple doses are given according to a schedule that does not violate the minimum intervals recommended by the U.S.vaccination schedule (e.g. the minimum interval between doses of polio vaccine is 4 weeks; if the child received the second or 3rd dose less than 4 weeks after the previous dose, these doses would NOT be counted. Similarly, measles vaccination is recommended in the U.S. no earlier than 12 months of age; in most developing countries it is given at 9 months of age because the risk of exposure to measles at a young age is greater there. Hence, if your child got measles vaccine before 12 months of age, this should be repeated in the U.S.).

Children under 10 years of age who are being adopted are exempt from the immigration law amendment requiring that all immigrants be fully vaccinated with all vaccines for which they are eligible before a visa is issued; however, these children are expected to comply with school immunization requirements in the U.S.

I hope this information is useful. I know that a lot of people recommend revaccinating all foreign adoptees regardless of their prior vaccination history and/or documentation. In most cases, it is not harmful to receive extra doses of vaccines, particularly polio, and measles. It is not recommended that a child receive more than 6 doses of diphtheria and/or tetanus containing vaccines before the age of 7 years, so if your child has documentation of receipt of 3 doses of DTP vaccine (diphtheria/tetanus/pertussis) you may want to think twice about starting that series over again. Most of the problems with receiving extra doses of these vaccines are severe local reactions (swelling, tenderness, and redness at the injection site).

Fortunately, most of the children from China are relatively healthy.

©Copyright by Jacqueline Jacobs Gindler

Jacqueline Jacobs Gindler is a pediatrician and medical epidemiologist. She is currently with the National Center for Environmental Health at CDC (and presenty assigned to Beijing), and was with the National Immunization Program at CDC in Atlanta for eight years. Dr. Gindler has 2 children adopted from China. She has written a small monograph about this issue for the China Connection newsletter (
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