Epidemiology

Hepatitis A infection risk in foreign-born adoptees, their contacts

Last Updated: 2011-07-11 14:02:23 -0400 (Reuters Health)

By Dave Levitan

NEW YORK (Reuters Health) - Foreign-born adopted children are often infected with hepatitis-A, and transmission can occur among both direct and secondary contacts even when the child is asymptomatic, a new study has found.

"Parents, families and other close contacts of adoptees from places where hepatitis A is endemic should be aware of the risk of hepatitis A and how it is spread," said Kristin Sweet, an epidemiologist with the Minnesota Department of Health in St. Paul who led the study.

"A key message is that infants may not have symptoms of hepatitis A, but can still spread the disease," she said in an e-mail to Reuters Health

In her state, one of every ten cases of hepatitis A between 2007 and 2009 was linked with internationally adopted children, she and her colleagues reported online July 4 in Pediatrics.

In their review of data on adoptee-associated hepatitis A cases in Minnesota in those years, Sweet's group found 21 who were infected. The median age of infected children was 11 months. Sixteen were adopted from Ethiopia, three from Guatemala, and two from Liberia.

Hepatitis A is endemic in the 20 most common countries of birth for adoptees, the researchers note.

Only two of the 21 hepatitis A cases were found because of symptoms. Twelve others were identified through routine screening of adoptees from endemic areas; five were found after reported hepatitis A cases led to routine follow-up; and the other two were identified by routine screening at a public health clinic.

Altogether there were 170 patients with hepatitis A in Minnesota during the study period, with 10 cases explained by contact with infected adopted children. Eight of the 10 cases had direct contact with an adoptee infected with hepatitis A, and the other two were infected by someone else who had been in contact with an infected adoptee. Only one of the 10 cases had contact with a symptomatic infected adoptee.

Sweet said that the number of infected adoptees was surprising, and that clinicians need to be aware of the risk of hepatitis A in these adoptees. "Children who are found to be positive for total anti-HAV should be tested for IgM anti-HAV, PEP (post-exposure prophylaxis) should be considered for the adoptee's close contacts," she and the researchers conclude.

SOURCE: http://bit.ly/nEcwoK

Pediatrics 2011.