title: Evaluating acceptability and completeness of overseas immunization records of internationally adopted children.
abstract: BACKGROUND
  Increasing numbers of families in the United States are adopting children who were born in other countries. Appropriate immunization of internationally adopted children provides a challenge to pediatricians who must evaluate documentation of vaccines administered overseas and fulfill the recommended US childhood immunization schedule. The acceptability of vaccinations received outside the United States was addressed by the Advisory Committee on Immunization Practices in 1994, but few population-based studies assessing these vaccinations have been reported.
  
  
  METHODS
  We performed a retrospective cohort study of 504 children who were adopted from other countries and evaluated in 1997 and 1998. Our goal was to determine the acceptability of overseas vaccinations for meeting US immunization requirements. We assessed immunization records for both valid documentation of receipt of vaccine and comparability with the recommended US schedule. We also determined the number of children who were up to date (UTD) for diphtheria-tetanus-pertussis, polio, hepatitis B, and measles-mumps-rubella vaccines under the US schedule.
  
  
  RESULTS
  The children's mean age at initial US evaluation was 19 months; 71% were girls, and most (88%) had resided in orphanages. They were adopted from 16 countries, most frequently from China (48%) and Russia (31%). Thirty-five percent (178) of children had overseas immunization records, 167 (94%) of which were considered valid. Most children with valid records (112 [67%] of 167) were UTD for 1 or more vaccine series under the US schedule.
  
  
  CONCLUSIONS
  The majority (65%) of internationally adopted children had no written records of overseas immunizations. Among the 178 children with documented overseas immunizations, 167 (94%) had valid records and some vaccine doses that were acceptable and UTD under the US schedule. Additional research and more specific guidance in the most cost-effective approaches to evaluation of overseas vaccinations are needed to ensure appropriate state-side vaccination and to improve the health of these children and their communities.
authors.affiliation: Division of HIV/AIDS-Surveillance and Epidemiology, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA. jzs1@cdc.gov
authors.forename: Joann M
authors.initials: JM
authors.lastname: Schulte
authors.forename: Susan
authors.initials: S
authors.lastname: Maloney
authors.forename: Jane
authors.initials: J
authors.lastname: Aronson
authors.forename: Pablo
authors.initials: P
authors.lastname: San Gabriel
authors.forename: Juyan
authors.initials: J
authors.lastname: Zhou
authors.forename: Lisa
authors.initials: L
authors.lastname: Saiman
mesh_terms: D000300:Adoption / Q000208:ethnology / Q000331:legislation & jurisprudence*; D015331:Cohort Studies; D015721:Diphtheria-Tetanus-Pertussis Vaccine / Q000008:administration & dosage; D004641:Emigration and Immigration / Q000331:legislation & jurisprudence*; D005260:Female; D006291:Health Policy; D006801:Humans; D017589:Immunization Programs / Q000331:legislation & jurisprudence / Q000592:standards*; D007115:Immunization Schedule; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D022542:Measles-Mumps-Rubella Vaccine / Q000008:administration & dosage; D008499:Medical Records / Q000592:standards*; D023321:Poliovirus Vaccines / Q000008:administration & dosage; D012189:Retrospective Studies; D014481:United States
chemical_list: D015721:Diphtheria-Tetanus-Pertussis Vaccine; D022542:Measles-Mumps-Rubella Vaccine; D023321:Poliovirus Vaccines