The CDC has released medical screening recommendations(www.cdc.gov) for U.S. physicians evaluating orphans who were evacuated from Haiti.
Under normal circumstances, internationally adopted children are required to have a medical examination in their country of origin. However, following the Jan. 12 earthquake, the Department of Homeland Security announced that Haitian orphans entering the United States will be allowed to bypass overseas medical screening.
The CDC said the health status of many Haitian orphans is poor. That country had a high prevalence of bacterial and protozoal diarrhea, hepatitis A, hepatitis E, typhoid fever, dengue fever, malaria, leptospirosis, tuberculosis and HIV before the earthquake.
The agency said medical screening, including medical history and physical examination, should be performed as soon as possible after a child arrives in the United States. The medical history should include
- a history of trauma;
- symptoms of communicable disease, such as fever, coryza, cough, rash, diarrhea or vomiting; and
- medical and surgical histories, including a medication history and any known chronic diseases.
The physical exam should include
- vital signs and assessment of hydration status;
- height, weight and head circumference, if age-appropriate;
- assessment of obvious injuries that may have resulted from trauma;
- heightened vigiliance for signs that may indicate underlying medical problems, such as heart disease or asthma; and
- an assessment of nutritional status.
Laboratory screening tests should include
- a complete blood cell count with red blood cell indices;
- HIV testing;
- a malaria smear (if symptomatic);
- a stool examination for ova and parasites;
- a stool examination for Giardia spp., Cryptosporidium, rotavirus antigen (if symptomatic), and Strongyloides serology, if eosinophilia is present;
- nontreponemal and treponemal serologic tests for syphilis;
- serologic testing for vaccine-preventable diseases; and
- tuberculin skin test or chest radiograph.
The incidence of tuberculosis in Haiti is one of the highest in the Western hemisphere, at 306 per 100,000, according to the CDC. The following categories of children should provide sputum specimens:
- those who have signs and symptoms of tuberculosis,
- those whose medical history suggests tuberculosis,
- those who have chest radiograph findings suspicious for the disease and
- those with HIV infection.
Children and adolescents adopted from Haiti should receive vaccines recommended(5 page PDF) by the CDC's Advisory Committee on Immunization Practices, or ACIP, and the AAFP.
Serologic testing for the surface antigen of the hepatitis B virus should be performed on all children to identify chronic infection. If serologic testing is not available and receipt of immunogenic vaccines cannot be ensured, immunization is recommended.
Adoptive parents, family members and other close contacts should ensure they are immunized or otherwise immune to hepatitis A virus infection before international travel to pick up the child. If this is not feasible, serologic testing of the orphan for hepatitis A IgM and IgG is recommended to identify current, recent or past infection. If a child has no evidence of previous infection, the child should be immunized against hepatitis A. If IgG tests positive, indicating past infection, immunization of the child is not necessary. If IgM is positive, indicating current or recent infection, all close contacts and family members should be immunized.
In addition to an initial medical exam, the CDC strongly recommends that children from Haiti have a comprehensive exam after they arrive at their final destination to evaluate other medical and developmental issues, including hearing and vision assessment, evaluation of growth and development, blood lead concentration, newborn screening and/or measurement of thyroid-stimulating hormone concentration, and examination for congenital anomalies.