Preventing infectious diseases during and after international adoption
Families of internationally adopted children face risks associated with travel if they pick up their children overseas. Unlike other travelers, they also face risks because of close contact with a child with uncertain infection and vaccination status. Tuberculosis organisms, hepatitis C virus, hepatitis B virus, and measles virus have been transmitted from adopted children to family and community members. Intestinal parasites, Bordetella pertussis, and other infectious disease agents can also be transmitted. Some of these infections may be inapparent or may not manifest in adopted children until many years after the adoption. Increased attention to preventive measures for family members and early diagnosis of infectious diseases in adopted children can reduce transmission of the organisms causing these infections. Those providing health care to families planning international adoption should know about standard pretravel advice, as well as the spectrum of possible infections in adopted children, so that they can protect the health of the travelers and family members and close friends who will welcome the new child into the home.
Publication Name: Annals of Internal Medicine
Social vulnerability and death by infection
The serious threat posed to public health by infectious disease may best be combatted by initiatives that take into account underlying social factors that make humans susceptible to disease. A recent study showing the disproportionate occurrence of tuberculosis, AIDS and death among substance abusing welfare clients in New York City indicates the social dimension of disease transmission. Synergy between tuberculosis and AIDS, overcrowded living conditions, and limited access to health care are some factors making infectious disease particularly potent among the poor. The impact of these health problems may be felt beyond the indigent groups most affected. Drug-resistant tuberculosis, the ability of tuberculosis to spread in any closed room, and the heterosexual transmission of HIV from intravenous drug users are some major causes for concern. The specific targeting of vulnerable populations for disease prevention, as exemplified by needle exchange programs or aggressive tuberculosis case finding and treatment, has shown promise and should continue to be an effective approach.
Publication Name: The New England Journal of Medicine
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