This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow P3Rs: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when P3Rs are posted
Right arrow Alert me if a correction is posted
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via CrossRef
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Schulte, J. M.
Right arrow Articles by Saiman, L.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Schulte, J. M.
Right arrow Articles by Saiman, L.
Related Collections
Right arrow Infectious Disease & Immunity
Right arrowRelated AAP Red Book topics:
Hepatitis B
Poliovirus Infections

PEDIATRICS Vol. 109 No. 2 February 2002, pp. e22

ELECTRONIC ARTICLE

Evaluating Acceptability and Completeness of Overseas Immunization Records of Internationally Adopted Children

Joann M. Schulte, DO*, Susan Maloney, MD, MHS{ddagger}, Jane Aronson, DO§, Pablo San Gabriel, MD, MPH||, Juyan Zhou, MPH, MS|| and Lisa Saiman, MD, MPH||

* Division of HIV/AIDS-Surveillance and Epidemiology, Centers for Disease Control and Prevention, Atlanta, Georgia
{ddagger} Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia
§ Department of Pediatrics, Winthrop University Hospital, Mineola, New York
|| Department of Pediatrics, Columbia University, College of Physicians and Surgeons, New York, New York

--> Background. Increasing numbers of families in the United States are adopting children who were born in other countries. Appropriate immunization of internationally adopted children provides a challenge to pediatricians who must evaluate documentation of vaccines administered overseas and fulfill the recommended US childhood immunization schedule. The acceptability of vaccinations received outside the United States was addressed by the Advisory Committee on Immunization Practices in 1994, but few population-based studies assessing these vaccinations have been reported.

Methods. We performed a retrospective cohort study of 504 children who were adopted from other countries and evaluated in 1997 and 1998. Our goal was to determine the acceptability of overseas vaccinations for meeting US immunization requirements. We assessed immunization records for both valid documentation of receipt of vaccine and comparability with the recommended US schedule. We also determined the number of children who were up to date (UTD) for diphtheria-tetanus-pertussis, polio, hepatitis B, and measles-mumps-rubella vaccines under the US schedule.

Results. The children’s mean age at initial US evaluation was 19 months; 71% were girls, and most (88%) had resided in orphanages. They were adopted from 16 countries, most frequently from China (48%) and Russia (31%). Thirty-five percent (178) of children had overseas immunization records, 167 (94%) of which were considered valid. Most children with valid records (112 [67%] of 167) were UTD for 1 or more vaccine series under the US schedule.

Conclusion. The majority (65%) of internationally adopted children had no written records of overseas immunizations. Among the 178 children with documented overseas immunizations, 167 (94%) had valid records and some vaccine doses that were acceptable and UTD under the US schedule. Additional research and more specific guidance in the most cost-effective approaches to evaluation of overseas vaccinations are needed to ensure appropriate state-side vaccination and to improve the health of these children and their communities.

Key Words: international adoption • immunization • vaccine-preventable disease

Abbreviations: WHO, World Health Organization • ACIP, Advisory Committee on Immunization Practices • INA, Immigration and Nationality Act • UTD, up to date • DTP, diphtheria-tetanus-pertussis • HB, hepatitis B • CI, confidence interval • RR, relative risk • ELISA, enzyme-linked immunosorbent assay

Received for publication Jul 19, 2001; Accepted Oct 1, 2001.