Should you revaccinate your internationally adopted child?
Can immunization records from orphanages be relied upon, given that vaccinations in third-world nations often are not on par with accepted standards?
To revaccinate or not is a very heated and emotional decision that all adoptive parents need to face with the help of their general pediatrician. While the safest and most accurate way is to revaccinate every child regardless of immunization records, this method unfortunately does not sit well with many parents. I believe that each case needs to be evaluated on an individual basis.
There are many reasons why physicians in the U.S. do not want to accept the immunization records for internationally adopted children. In this article I will try to elaborate on these concerns and explain my personal approach to vaccinations.
- Inadequate background medical records. Children who are adopted internationally either lived in orphanages or are now placed in the foster care system. There may be many prior placements for this child, and the medical records may not be forwarded with that child. In some cases, a child may have been placed in an orphanage at an older age and vaccinations may have occurred prior to placement; these records are not forwarded.
- Immunocompromised children. Children who grow up in foreign orphanages usually have a weakened immune status. This condition occurs because of the poor living conditions, malnutrition of the child, and lack of medications to treat simple illness. Because of their weakened immune system, these children may not be able to mount an adequate immune response to the vaccine. The sequence of vaccination boosters may not have been given appropriately, hence not mounting an immune response to the vaccine.
Other reasons why these children may not mount an immune response is as follows:
- Factitious immunization practices.
- Use of outdated vaccines.
- Poorly stored and improperly handled vaccinations.
- Biologically impotent vaccinations because of poor manufacturing, transport, and storage. Without proper cold storage for these vaccines, there is no guarantee of their effectiveness.
- Vaccines could be expired, making them completely ineffective.
- Improper vaccine schedule for primary and secondary series.
Much of this information presented comes from experience with children adopted many years ago in the eighties to early nineties. Since then, orphanages have changed for the better. In the times that we live in now, most people care about children and try to advocate for them. Orphanages, especially in the Eastern European countries, are now better staffed and supplied, and health care is now available. Granted, it is not at the level that we have here in the U.S.A, but it has greatly improved. Shortfalls do exist, however. If the child lives in the main city of a particular country, funding is available; however, if they live somewhere on the outskirts, you can be sure that healthcare is limited and may even be nonexistent.
My personal approach to vaccinations is as follows:
- If the parents are agreeable to just restating all vaccinations, I will provide them.
- If parents are afraid of vaccinations, I will draw serologic studies and see if the child mounted an immune response. I will complete the vaccination program as indicated under the AAP catch-up schedule.
- In a very limited number of cases, I may opt to just continue with the vaccine schedule from where they left off, provided a number of criteria are met:
- Child’s growth and health parameters are perfect.
- Vaccine record appears to be valid, with dates and manufactures and absolutely no suspicion of foul play.
- All blood work is normal.
- The parents agree with this program.
- I have seen multiple children with the same health condition from the same orphanage.
While the revaccination decision can be pretty emotional for parents because of extra shots, realistically– even in children who got some vaccines overseas– they did not get a lot of them. Vaccines generally encountered on the medical record are only for Hepatitis B, DTP, and Polio. Many times they do not even have the complete series; I would need to give them booster vaccines anyway. I rarely ever see the HIB, MMR, Chicken Pox, or the new Prevnar vaccines.
While the revaccination controversy does certainly exist, I feel that it is somewhat over-publicized. Vaccines are good things to have. They prevent many of the deadly childhood illness that many young doctors today here in the U.S. may never have seen.
There are many people out there that have many personal stories related to the side effects of vaccinations. Some of these people are advocates against mass vaccination in the U.S.A. I respect their decisions, and all that I can do as a physician is try to educate them. I never try to forcefully impose a doctor’s belief and the standard of care on them. It is really good for their general health that most everyone around them is already vaccinated.
I know that today, because of mass vaccination in the U.S., our children rarely die illness that may have affected them if they were to remain in the orphanages, such as Polio, Pertusis, HIB, and Meningitis, just to name a few.