Parents urged to verify immunization records of international adoptees

Nearly 250,000 children have been adopted into the United States in the last 15 years. Many spend their earliest months in resource-poor facilities in their birth countries, which can increase their risk for malnutrition and other complications. They are also more vulnerable to vaccine-preventable disease, which is why a revelation from a researcher at Case Western Reserve University School of Medicine is especially disconcerting.

A team led by Anna Maria Mandalakas, MD, MS, associate professor of pediatrics at the School of Medicine and chief of the Division of Pediatric Global Child Health—home of the Adoption Health Service at University Hospitals Rainbow Babies & Children's Hospital—found that immunization records of international adoptees are often inaccurate portrayals of a child's protection against disease.

Dr. Mandalakas and her team compared written vaccination records with the immunity present in the bodies of 465 children, primarily from Russia, China and Guatemala, specifically looking for antibodies to polio, diphtheria, tetanus, measles and hepatitis B. She found that for each disease, written vaccination records overestimated immunity. The team also discovered that many children showed immunity to certain diseases for which they had no record of receiving a vaccination, leading them to believe that some children gained immunity through natural exposure to the disease.

Dr. Mandalakas says there are many possible explanations for the inconsistent information— including less-than-potent vaccines, reduced immune response and inaccurate records.

"Some of these issues are administrative," she says. "Was the vaccine stored correctly? Was it given during the right time? Was it documented correctly?" She adds that other irregularities may reflect the child's lack of ability to respond effectively to the vaccines.

Dr. Mandalakas advises families adopting internationally to be aware of the vaccine-immunity disconnect, and plan accordingly. "We don't recommend accepting the written vaccination record as is; neither does the Centers for Disease Control and Prevention," she says. "Get as complete a record as possible from the birth country, and then discuss concerns with an adoption health specialist."