The Role of Vaccination Status Information in Evaluation of Children Arriving from the former Soviet

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The Role of Vaccination Status Information in
Evaluation of Children Arriving from the former
Soviet Union

• ALLA GORDINA, MD, FAAP
• Pediatric and Adolescent Medicine,
• International Adoptions Medical Support Services
• East Brunswick, NJ, USA

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Dr. Gordina is up to date on her vaccinations.

• Hepatitis B - 11.15.1991
• - 12.20.1991
• - 05.22.1992
• Hepatitis A - 10.09.1997
• - 04.15.1998
• IPV - 10.09.1997
• Td - 03.16.2003
• Measles - Immune
• Mumps - Immune
• Rubella - Immune
• Varicella - Immune

What about you?
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THE TALE OF TWO BABIES

• Two families are seen for the first time
  after their arrival from the former Soviet Union

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THE TALE OF TWO BABIES

• Baby A

• Baby B

• Past Medical history for both babies
• Birth weight 2800 gr, Apgar score 7/8
• Perinatal encephalopathy, late effects syndrome
  of hyperexitability seen by neurologist
  recently on nootrops and calming teas receiving
  massages
• Disbacteriosis, subcompensated
• All immunizations are up to date, done according
  to the standard vaccination schedule

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THE TALE OF TWO BABIES

• Baby A
• Home grown

• Baby B
• Adopted

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THE TALE OF TWO BABIES

• Baby A
• Home grown

• Baby B
• Adopted
• Re-immunize

PRESENT RECOMMENDATIONS ON FURTHER VACCINATIONS
Accept all records, start catch-up vaccinations
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POST-ADOPTION TESTINGPROTOCOL

• Routine post-adoption bloodwork (CBC,
  chemistry, lead, HIV 1/2, Hepatitis B and C,
  etc..)
• Mantoux testing
• Stool testing (including Giardia antigen)
• Post-vaccination evaluations

Red Book, the Report of the Committee on
Infectious Diseases, AAP, 26th edition, 2003
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Post-vaccination evaluations (for children
over 12-15 months of age)

• Polio 1,2,3 neutralizing antibodies
• Diphtheria antibodies
• Tetanus antibodies
• If Diphtheria Ab and Tetanus Ab are positive,and
  Pertussus vaccinations are documented, Pertussus
  immunity is to be taken on faith.
• Measles, Mumps, Rubella, and Varicella
• HBSAb (done with the hepatitis panel)

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Re-vaccination

• Recommended in any case of questionable or
  uncertain vaccination status
• Warning regarding the limitation of the amount of
  tetanus vaccinations (up to 6 by the age 4)
• Warning regarding higher possibility of incidence
  and severity of adverse reactions in people with
  high concentration of Tetanus antibodies because
  of multiple doses of Tetanus vaccine
• No evidence indicates that administration
  ofvaccines to already immune recipients can be
  harmful.

Red Book, the Report of the Committee on
Infectious Diseases, AAP, 26th edition, 2003
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Re-vaccination

• Are we hurting
• the HURT CHILD?

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OBJECTIVE

• To review the recent changes in vaccination
  practices in republics of the FSU
• To compare vaccination practices in adoptive and
  home-grown children
• To determine levels of immunity to the
  vaccine-preventable diseases in children born in
  the FSU
• To review the rationale for testing of children
  adopted from the FSU

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MATERIALS AND METHODS INCLUSION CRITERA

• Immunization records review
• All children, born in the former Soviet Union and
  seen in this office between 07.1996 and 07.2003,
  who had at least one round of DPT/DT vaccination
  before arrival to the United States (633)
• Post-adoption testing review
• Preliminary review of 20 of available records
• 38 consecutive patients who had their
  post-adoption blood work done in the LabCorp
  laboratory between 01.2002 and 07.2004.
• All chilren were tested for all antigens they
  were immunized with, regardless of the age at the
  time of adoption and the amount of vaccines they
  received in the country of origin

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• LK, born 05.1991,
• homegrown,
• in the US since 1999
• US vaccination record
• DTaPs 5, last 1993
• DT 1, 1993
• OPV/IPV 5, last 1993
• MMR - 2, 1992 and 1997

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• Problems with the translation
• 5 DTaPs ( not approved in Ukraine even today)
• 6 Tetanus containing vaccines by 30 mo of age
• No school doses of DT and OPV (6 yo)
• 2 MMRs had to be 2 Measles and 1 Mumps
• No BCG status noted had to have 2 (or 1 BCG and
  () Mantoux test)

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• LK, born 05.1991
• Ukrainian
• vaccination records
• 2 BCGs, last 1998
• PPD (-) annually
• 3 DPTs , last 1993
• 3 DTs, last 1997
• 8 OPVs, last 1997
• Measles 1992, 1997
• Mumps 1993

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Findings in vaccination records, suggestive of
inaccurate completion and/or translation

• 1. Vaccines, presently not approved/ not
  routinely used in the country of origin (DTaP,
  IPV, Prevnar, Varivax)
• 2. Vaccines, not routinely available in the
  country of origin at the time of vaccination (H.
  Flu., MMR, Rubella, Hepatitis B before 1997)
• 3. Vaccination schedule not approved in the
  country of origin (DTP after 4 years of age,
  first DPT at 2 months of age, DPT given before
  BCG)

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Findings in vaccination records, suggestive of
inaccurate completion and/or translation

• 4. Vaccinations given before the actual birth
  date or on major local holidays
• 5. Timely vaccinations given to a reportedly sick
  child
• (active treatment for perinatal
  encephalopathy, chronic diseases asthma,
  kidney problems, etc.)
• 6. Not specified type of vaccination and/or
  testing (DPT vs. DT MMR vs. Measles, Mumps,
  and/or Rubella BCG vs. Mantoux test)
• 7. Acceptance of the 4th and 5th OPV doses at 18
  and 24 months of age as the equivalent of the 4th
  IPV dose in the US schedule

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IMMUNIZATION RECORDS REVIEW QUALITY OF DPT
VACCINATION
DT vaccine/- DPT
DPT vaccine only
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Review of patients with no immunity to
Diphtheria
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Review of patients under 15 months of age
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Review of patients (twins) with less then 3 DPT
vaccines given
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CONCLUSIONS

• The quality of translations of vaccination
  records done either through the government
  agencies or privately, continues to be very poor.
  
• Vaccination records of adopted children are
  usually translated more accurately, than the
  records of their homegrown peers.
• There is a noticeable trend towards improving of
  the vaccination practices in children born after
  1993 in the republics of the FSU.

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CONCLUSIONS

• The records of adoptive children indicate better
  vaccination practices.
• Preliminary data shows good protective immunity
  levels for tetanus and diphtheria in adopted
  children
• Low levels of pertussus immunity in adopted
  children are worrisome and require further
  investigation.

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CONCLUSIONS

• Testing for tetanus and diphtheria immunity can
  not be used to determine immunity to pertussus.
• There is a potential risk of higher
  susceptibility to Pertussus and other
  vaccine-preventable diseases in immigrant and
  adopted children, arriving from the countries of
  the FSU.
• Review of immunization records of children, born
  in the FSU for the possibility of inconsistencies
  has to be an important part of any record
  evaluation regardless of the social status of the
  child (adopted vs. homegrown) and the time spent
  in the US.

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THE TALE OF TWO BABIES

• Two families
• are seen for the first time
• after their arrival from the former Soviet
  Union

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THE TALE OF TWO BABIES

• Baby A

• Baby B

• Past Medical history for both babies
• Birth weight 2800 gr, Apgar score 7/8
• Perinatal encephalopathy, late effects
  syndrome of hyperexitability last time seen by
  neurologist recently on nootrops and calming
  teas receiving massages
• Disbacteriosis, subcompensated on probiotics
• All immunizations are up to date, according
  to the standard vaccination schedule

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THE TALE OF TWO BABIES

• Re-vaccination
• Recommended in any case of questionable
  vaccination records
• Warning regarding limitation of the amount of
  tetanus vaccinations (up to 6 by the age 4)
• Warning regarding higher possibility of
  incidence and severity of adverse reactions in
  people with high concentration of Tetanus
  antibodies because of multiple doses of Tetanus
  vaccine
• No evidence indicates that administration
  ofvaccines to already immune recipients can be
  harmful.

Red Book, the Report of the Committee on
Infectious Diseases, AAP, 26th edition, 2003
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THE TALE OF TWO BABIES

• Baby A
• Home grown

• Baby B
• Adopted

REVIEW vaccination records and past medical
history EVALUATE immunity status if in
doubt VACCINATE for protection rather then for
the protocol