Internationally adopted children: what vaccines should they receive?

Immunization Status against Measles, Mumps, Rubella and Varicella in a Large Population of Internationally Adopted Children Referred to Meyer Children's University Hospital from 2009 to 2018

Control of vaccine preventable diseases (VPDs) is a challenge for healthcare systems. Different studies highlighted the suboptimal immunization of internationally adopted children (IAC). To evaluate the immunization status against measles, mumps, rubella (MMR), and varicella (V) in a large cohort of IAC, data at first screening visit of all IAC (<18 years) consecutively referred to Meyer Children's University Hospital (Florence, Italy) from 2009 to 2018 were collected and analyzed. In total, 1927 children (median age: 5.99 years, interquartile range: 3.33-8.21) were enrolled. More than half of IAC were unprotected against MMR-V. The reliability of the vaccination documentation of the country of origin was poor, since more than a quarter of the IAC serologically tested were not protected against MMR-V, despite the vaccination documentation attesting previous vaccination. This was significantly more pronounced in children aged 15-18 years and in those originating from Africa. High rate of discordant serological results/documentation brings up questions regarding the optimal management of IACs, and suggests a rapid, careful, and complete assessment of immunization status timely after IAC's arrival. Serological testing of IAC of all ages followed by vaccination of seronegative children should be provided.

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

AIM

This systematic review aimed to provide an overview of the immunisation of internationally adopted children and to discuss possible vaccination strategies.

METHODS

A literature search was performed covering papers published in English from 1988 to 15 June 2018 using the Ovid MEDLINE, EMBASE and Cochrane Library databases. This identified 749 studies and 41 full texts were evaluated.

RESULTS

Overall, 19 studies conducted between 1988 and 2016 fulfilled our inclusion criteria. These covered 7663 children aged 1.1-5.7 years adopted from Asia, Eastern Europe, Africa and South and Central America. Tetanus protective antibody levels ranged from 35 to 95%, and similar data were reported for diphtheria. A higher percentage of adoptees had protective antibody levels for polio (50-93%) and measles (62-95%). More than a third (35%) did not have protective antibody titres for hepatitis B. Only one study investigated adoptees with protective antibodies against haemophilus influenza, and it reported that this was around 66%.

CONCLUSION

The appropriate immunisation of internationally adopted children is a major challenge for primary health care and a number of different approaches have been suggested, with no clear conclusions. Further studies on the cost-effectiveness of different approaches should be performed to optimise screening strategies and develop recommendations.

International adoption from Ethiopia: An overview of the health status at arrival in Belgium

BACKGROUND

Ethiopia is a densely populated country with a fast growing economy. Still socioeconomic and health issues render many children parentless. One thousand and twenty eight Ethiopian children have been adopted in Belgium from September 2005 to September 2015. Little has been published about their health status at arrival.

METHODS

Three hundred and fifteen children adopted from Ethiopia were clinically evaluated at the Institute of Tropical Medicine in Antwerp from 1 January 2008 until 31 December 2014. Epidemiological and medical data were collected and analysed retrospectively.

RESULTS

Data about 164 boys and 151 girls with a mean age of three years were analysed. Twenty per cent was adequately vaccinated, for 66.7% of children these data were absent. About 8.6% of the children were wasted/thin, 28.9% stunted. Skin abnormalities were seen in 40.3%, especially Tinea capitis. No children tested positive for HIV, syphilis or hepatitis C. Four children had an acute or chronic hepatitis B (HBV) infection, eight children had a cured HBV infection. Two children tested positive for malaria. Active pulmonary tuberculosis was found in six children. Sixty-two per cent had one or more intestinal parasite. Giardia lamblia (41.9%) and Blastocystis hominis (27.0%) were most frequently isolated. There is a statistically relevant association between the number of intestinal parasites and age at presentation. In this group eosinophilia had a sensitivity of 30.2%, a specificity of 79.1% for intestinal parasites and a positive likelihood ratio of 1.44 with a negative likelihood ratio of 0.88.

CONCLUSION

Apart from the high prevalence of stunting and intestinal parasites important medical problems were infrequent. A systematic clinical examination and screening for infectious diseases remain important to ensure a healthy start of a new life in Belgium.

Measles among migrants in the European Union and the European Economic Area

Aims: Progress towards meeting the goal of measles elimination in the EU and the European Economic Area (EEA) by 2015 is being obstructed, as some children are either not immunized on time or never immunized. One group thought to be at increased risk of measles is migrants; however, the extent to which this is the case is poorly understood, due to a lack of data. This paper addresses this evidence gap by providing an overview of the burden of measles in migrant populations in the EU/EEA. Methods: Data were collected through a comprehensive literature review, a country survey of EU/EEA member states and information from measles experts gathered at an infectious disease workshop. Results: Our results showed incomplete data on measles in migrant populations, as national surveillance systems do not systematically record migration-specific information; however, evidence from the literature review and country survey suggested that some measles outbreaks in the EU/EEA were due to sub-optimal vaccination coverage in migrant populations. Conclusions: We conclude that it is essential that routine surveillance of measles cases and measles, mumps and rubella (MMR) vaccination coverage become strengthened, to capture migrant-specific data. These data can help to inform the provision of preventive services, which may need to reach out to vulnerable migrant populations that currently face barriers in accessing routine immunization and health services.

Tuberculin skin test in bacille Calmette-Guérin-vaccinated children: how should we interpret the results?

BACKGROUND

The tuberculin skin test (TST) is the most useful method for the diagnosis of tuberculosis (TB). There is no evidence about the effect of bacillus Calmette-Guerin (BCG) vaccine on the interpretation of TST results.

OBJECTIVE

The aim of this study was to evaluate TST results in a population of immigrants and adopted children, analyzing the effect of the vaccine on TST.

METHODS

Cross-sectional observational study including immigrants or adopted children evaluated in our unit between January 2003 and December 2008 was made. Children diagnosed with TB, live attenuated virus vaccinated 2 months earlier, HIV-infected, chronically ill, or under treatment with immunosuppressive agents were excluded. TST was considered the dependent variable. Independent variables were gender, age, geographical origin, BCG scar, nutritional status, immune status, and intestinal parasites infestation.

RESULTS

One thousand seventy-four children were included, 69.6 % are female; their origin includes China (34.7 %), Latin America (20.8 %), India/Nepal (19.4 %), Eastern Europe (15.7 %), and Africa (9.3 %). BCG scar was present in 79 % of children. Mantoux = 0 mm in 84.4 %, <10 mm in 4.1 %, and ≥10 mm in 11.4 %. Only two variables, age and BCG scar, influenced TST result. Risk of a TST false-positive due to BCG disappears 3 years after vaccine administration.

CONCLUSIONS

A history of BCG vaccination at birth does not interfere with TST results in children >3 years old. Under 3 years of age, BCG does interfere with and may cause a false-positive TST result. In these cases, the use of interferon-gamma release assays (IGRAs) is recommended. If IGRAs are not available or when results are indeterminate, ignoring the antecedent of the vaccine is recommended.

Factors associated with protective antibody levels to vaccine preventable diseases in internationally adopted children

To determine which factors are predictive of protective antibody against vaccine-preventable diseases in internationally adopted children, we evaluated 562 children with serologic testing for at least one vaccine antigen before receiving a US vaccination. Vaccination status was defined as the number-of-doses recorded and as the presence of an up-to-date and valid record according to the American Academy of Pediatrics and the Advisory Committee on Immunization Practices guidelines. The number-of-doses recorded was the best predictor of protective antibody. These findings suggest that other options for immunization verification guidelines for internationally adopted children should be considered by policy makers.

Serologic testing to verify the immune status of internationally adopted children against vaccine preventable diseases

Definitive immunization guidelines for internationally adopted children are lacking. We examined whether these children had serologic evidence of protection against vaccine-preventable diseases. For children with ≥3 vaccine doses, overall protection was high for diphtheria (85%), tetanus (95%), polio (93%), hepatitis B (77%), and Hib (67%). For children ≥12 months of age with ≥1 dose of measles, mumps, or rubella vaccines, 95%, 72%, and 94% were immune, respectively. Children without immunization documentation had lower immunity. Serologic testing was useful in verifying the immunization status in internationally adopted children with and without documentation of immunizations.

[Diagnosis of tuberculosis in pediatrics. Consensus document of the Spanish Society of Pediatric Infectology (SEIP) and the Spanish Society of Pediatric Pneumology (SENP)]

Tuberculosis is one of the most important health problems worldwide. There are an increased number of cases, including children, due to different reasons in developed countries. The most likely determining cause is immigration coming from high endemic areas. Measures to optimize early and appropriate diagnosis of the different forms of tuberculosis in children are a real priority. Two Societies of the Spanish Pediatric Association (Spanish Society of Pediatric Infectology and Spanish Society of Pediatric Pneumology) have agreed this Consensus Document in order to homogenize diagnostic criteria in pediatric patients.

Measles risk groups in Spain: implications for the European measles-elimination target

The European Region has set itself the goal of eliminating measles by 2010. Incidence has increased in recent years. This study sought to investigate outbreaks in Spain in the period 2005-2007, in order to identify measles-vulnerable groups and compare Spain to other European countries which have also had measles outbreaks. The pattern observed for Spain proved different to that of other European countries, i.e., whereas young adults and infants aged under 15 months were affected in Spain, children aged under 9 years comprised the predominant group in other European countries. Measles cases in Spain reflect low coverage when vaccination began, a pattern that could be repeated in neighbouring countries. Vaccination efforts should thus be targeted at vulnerable groups, namely: young adults; health professionals; travelling communities; and adopted infants and foreigners from countries with important pockets of susceptibles.