As families collect the mounds of paperwork to prepare for international adoption, some prospective parents find ways in which to prepare themselves for parenthood. Besides reading books about parenting, taking a class on infant CPR, fixing up the child's room, cleaning out the garage and attic, and meeting other parents through support groups, there are some unexpected ways to better anticipate the travel abroad by protecting yourself now for exposures that may occur when you travel.
Most trips to adopt internationally last no more than three weeks. Even so, during that short time new parents are exposed to a myriad of infectious diseases that are rare in most parts of the United States, due to better health conditions in the U.S. It makes sense to be prepared and to be protected while you travel, rather than risking that you will be significantly ill just as you become a new parent. Some of the recommended vaccines require multiple doses spread out over up to six months to confer full immunity. If families prepare to travel before they have a referral, there is less concern about all that needs to be done once they have a date to travel abroad.
It is recommended that all adults and children traveling abroad to developing nations have an updated panel of all routine immunizations, as well as additional ones that are necessary just for travel.
For all adults traveling internationally, it is recommended that they have three Hepatitis B vaccines to fully protect them from acquiring Hepatitis B. This disease, which is spread in manners similar to HIV, is contagious through blood and body fluids, particularly sexual transmission. Testing for children still in the country of their birth is not reliable, and some children who have tested negative abroad have tested positive once in the U.S. Family members have then been needlessly exposed. All newborns in this country begin this series of shots shortly after birth, and many states now require the full series of shots for school entry. Adults employed in occupations with the risk of exposure to body fluids (particularly health care workers) should be already vaccinated through their place of employment. The vaccine is given three times, the second one at one month after the first dose, and the third shot four to six months after the first dose. Although the risk of exposure for families while traveling is probably low, this is an important vaccine that should be given in the event of an accidental exposure to an adult or child with Hepatitis B, especially if that child becomes a member of your family (since it may take more than four months for an adult to become immune from the vaccine).
Families who travel abroad are also at significant risk of contacting Hepatitis A, another form of hepatitis that is preventable by a vaccine. This disease is much more contagious than is Hepatitis B, and is spread through contaminated water, contaminated food, or the mouth or fecal excretions of a person infected with this virus. Thus, it can be communicated by sharing food, drinking unsafe water (ice in drinks, as well as water that is not boiled or bottled), eating food washed in unsafe water (including lettuce, uncooked vegetables and unpeeled fruits), and even by changing the diaper of an infected infant without using good hand washing. This vaccine is effective for a short term if given one month prior to travel abroad. If multiple trips are planned, it is suggested that an individual have a booster 6 to 12 months after the initial dose, as this will avoid the need for a repeat booster prior to all future trips. This vaccine should not be given to children less than two years of age. The Hepatitis A vaccine has replaced the need for the gamma-globulin shot, which was formerly given to most adults prior to international travel.
Although wild type polio has been eradicated in North America (some vaccine acquired polio has been seen from the polio vaccine that is given by mouth in individuals who have a compromised immune system), polio is still seen in developing nations. It is recommended that all adults traveling to a developing nation receive an inactivated polio vaccine (IPV) to lessen the risk of acquiring polio abroad. This should be done even if the polio vaccine was given during childhood, as it will serve as a booster dose. The oral polio vaccine (OPV) should not be given to adults because of the risk of acquiring polio from the vaccine itself in individuals whose immunity may have waned. If children are traveling abroad for adoption, they should also receive an additional dose of the polio vaccine, preferably as IPV. This means that they should have a total of five doses of polio vaccine by age 4 rather than the recommended four doses. Adults that receive a booster before travel do not routinely need a dose before each trip.
Diphtheria and tetanus are still seen in other countries. Adults are reminded to have a Td booster every ten years to give continuing protection against these diseases. If an injury that is at risk for tetanus occurs more than five years after one's tetanus shot, a booster is needed at that time. Since none of us can predict what injuries may occur while we are abroad, it is recommended that adults have a tetanus shot booster if it has been more than five years since the last shot. This lessens the chance that a tetanus shot may be needed while overseas.
Measles, mumps and rubella are childhood illnesses that were
once common, and have lessened in frequency due to the MMR vaccine, now
given during childhood. Due to several outbreaks of measles in children
returning from China, the recommentations have been updated as of 5/2004:
Born before 1957: likely had disease, so no vaccines officially
recommended. If you are unsure, immune compromised or want to be certain,
an antibody level (rubeola titer, not rubella, which is the GERMAN
measles) can be drawn.
Born after 1957: TWO doses of the live virus measles vaccine or an antibody level (as above) to demonstrate immunity. There was a killed virus vaccine given in the early 1960's, and this likely did not give long term immunity. My recommendation is for families to be certain that they are immune,(via the two doses of the vaccine or blood test) and if not immune then get the vaccine. The vaccine has a certain percentage of failure to the measles component, so that's why the two doses are recommended. The second dose catches the people who missed making antibody the first time.
For children traveling: CDC recommendations include a dose of MMR (Measles/Mumps/Rubella) at 12-15 months. A second dose (for vaccine failure) is given at 4-6 years old. If a child has not received the second dose prior to travel to China (such as a child between 1-6 years old), it can easily be given earlier. The timing of the second dose is very arbitrary and not necessarily related to any medical reason. In fact, the two doses can be given as closely as 6 weeks apart.
There is now an effective shot to protect against chicken pox, which can cause significant illness in adults. The shot, given in two doses (the second 6 weeks after the first), is thought to be fairly protective against this disease, lessening the illness if an individual does acquire chicken pox. A blood test can be done if an adult's history is unclear, although the shot is not harmful if given in someone who had the disease and did not know it. This shot, as well as the MMR, should not be given in pregnant women.
For individuals traveling during the fall and winter months, it is recommended that they have the influenza vaccine which is offered each fall.
The recommendations regarding malaria prophylaxis vary depending upon the length of the visit, the ultimate destination (particularly rural versus urban), and the hours of exposure (whether you will be out after dark). Given that most adoption trips are relatively short in length, many doctors do not recommend that you take these medications, which have significant side effects, and must be taken for long time prior to travel, during the trip itself, as well as upon return home. For updates about malaria, it is suggested that you contact the CDC Malaria Hotline at (404) 332-4555, the CDC automated fax line at (404) 332-4565 or the CDC web site http://www.cdc.gov.
There are also vaccines for cholera, typhoid and yellow fever, but these are not univerally recommended for all international travelers due to expense, side effects, low availability, and mostly the low risk of exposure in most travel for international adoption. Again, for information about the particular area of the world where you will be traveling, contact the CDC at the above numbers or through the International Traveler's Hotline at (404) 332-4559. Many cities also have an international travel center with physicians who are knowledgable about travel abroad.
By Deborah A. Borchers, M.D., F.A.A.P.
Please reprint at will, permission is not necessary for families, health care professionals or social workers. This information is provided for adoptive parents, according to the current guidelines of the Centers for Disease Control and the American Academy of Pediatrics. It is intended to encourage prospective adoptive parents to immunize early, but not to take the place of a primary care physician familiar with each family member. All immunizations should be given by trained medical personnel in a health care setting. Dr. Borchers is a general pediatrician and adoption medicine specialist in Cincinnati Ohio, and may be reached at 513/753-2820.
Written August 25, 1998, revised May 8, 2000.
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