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International adoption: Infectious disease aspects

Author
Mary Allen Staat, MD, MPH
Section Editor
Morven S Edwards, MD
Deputy Editor
Mary M Torchia, MD

INTRODUCTION

Each year thousands of children immigrate to the United States through international adoption. Internationally adopted children are at increased risk for common infectious diseases such as tuberculosis, intestinal parasites, skin infections, and infestations because they come from resource-poor countries where these conditions are common.

The infectious disease aspects of international adoption will be discussed here. Immunization of international adoptees and their close contacts and general issues related to adoption are discussed separately. (See "International adoption: Immunization considerations" and "Adoption: An overview".)

EPIDEMIOLOGY

Since 1999, more than 250,000 children have immigrated to the United States through international adoption [1]. The number of international adoptions peaked at nearly 23,000 in 2004 and has declined since then (figure 1) [2].

In 2015, 5648 children were adopted internationally from 88 countries [3]. The majority of children came from China (42 percent). More than 100 children were adopted from each of 12 other countries, including Ethiopia, South Korea, Ukraine, and Uganda. The full list is available from the Bureau of Consular Affairs at the United States Department of State [2].

In 2015, most international adoptees (54 percent) were <5 years of age at the time of adoption, but only 0.6 4 percent were <1 year of age [2], compared with 2003 when 87 percent of children were <5 years of age and 56 percent were <1 year of age. Since 2003, there has been a steady decline in children ≤1 years of age available for adoption [4], and nearly all of the children available and adopted from China have special medical or developmental needs.

                     

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