TB Procedures
The CDC is responsible for the new TB testing procedures, and they are supposedly rolling them out to the various consulates around the world, with the intent to make sure children with active TB do not come into the U.S.
They rolled the new guidelines out in Ethiopia in March, you can find the guidelines here: http://ethiopia.usembassy.gov/tb_testing.html
I believe these guidelines will be the same for each country, with the location of the clinic/hospital being the only difference.
My understanding of this is:
If the skin test is negative then you get the child’s visa and go home. If it shows positive then an x-ray must be done.
If the x-ray is clear then you get the child’s visa and go home. If it is not clear then a “sputum test” is done, and that culture can take 8 weeks to show or not show TB.
If the culture does not show TB then you get the child’s visa and go home. If it shows TB then the child has to stay in country to be medicated. The embassy site says six months, but I believe it is 9 months to a year of medication, perhaps they figure the child isn’t contagious anymore at 6 months? I don’t know. I just know that they say six months.
What does this mean for families? Even if the skin test shows positive then the x-ray probably won’t delay travel as long as the x-ray is clear. If you do the exam on Monday and they observe it on Wednesday, surely they can do the x-ray Wednesday as well?
But, if the x-ray shows something then you’re stuck in country another two months. And, if the culture shows TB then your child (and, I’m assuming, at least one parent) must remain in country for another six months – for a total of 8 months after adoption.
What percentage of babies will have active TB? A very very small percentage. In the decade or so I’ve been involved with adoptions from China I’ve heard of one travel group who came home with children who had active TB (some of the travel group, not all). I have heard of hundreds (maybe more) of children who had a reaction to the skin test and were put on meds, but that was for inactive/latent TB, with a clear chest x-ray.
It appears the CDC is just trying to keep children who are infectious from coming into the country, not children with latent TB. They estimate that less than 10 children a year will require the six month stay in Ethiopia.
It also appears that some agencies have started having the children in Ethiopia tested before the family travels. That way the family doesn’t get into a situation where they can’t bring their child home for 2 to 8 months. I do not know if that option is possible in China.
Realistically speaking, this is yet another stressor in an already stressful situation, but the odds are that most families will only make it to the skin test or the x-ray stage and will not have to stay for the culture or the medication phases.
June 2nd, 2009 at 7:12 pm
The embassy in Ethiopia does test all the children over 2 years old before the families travel. The difference is, Ethiopia adoptions are finalized before families travel. Families show up in Ethiopia and go to their embassy appointments within 2-3 days of arrival(most cases) and then leave 2 days after the appointment. Since the adoptions are finalized before travel this allows the embassy to process the child’s exit medical exam before the families arrives, everthing is done before a family even arrives in Ethiopia.
June 2nd, 2009 at 8:11 pm
Aren’t they only testing the children between ages 2 and 14? Are they doing any TB testing with children under 2?
June 2nd, 2009 at 8:36 pm
I am not a pro at this but why don’t they just do the testing when they send out your TA approval? It usually takes approximately 8 weeks by the time you travel and all your plans are set (at least for China Adoptions). That would make more sense. I think the government is just making it harder and harder for the adoption process. What Next? We are already looking at a five year wait for our regular adoption process. Or so that is what we have been told since our LID is in 08. We will see how March 06 progresses in the upcoming months. I have been told that they received the most dossiers in China from Jan thru March 06 (over two thousand). That is one factor causing the slow down.
June 2nd, 2009 at 8:40 pm
Thanks for clarifying. It does sound like an additional stress, but not too bad. My son had a positive skin and blood test, but negative chest x-ray so I asked the doctor a lot about TB. Most young children cannot cough hard enough to dislodge the bacteria enough to transmit the disease even if it is active, so that would make most sputum tests negative. Perhaps that is why they do not test children under 2? Or are babies included too? I am surprised that you have to wait 6 months after starting meds as our pediatrician said if by chance our son had active TB he would have to be on medication for a few WEEKs before he would no longer be contagious.
June 2nd, 2009 at 9:21 pm
To clarify the question about duration of treatment:
A child with an abnormal chest xray and TB in their sputum has active tuberculosis and in are considered contagious. That is treated with multiple medications over 6 months.
A child with a positive TB test (the blood test is obviously better than the skin test in children who have received the BCG vaccine like most children in China) but normal chest xray often have latent TB, which means they have been exposed and may have small numbers of TB bacteria hiding out in their body, but it is not causing an active infection. Those children are not contagious and are usually treated with 9 months of one medication to irradicate the latent TB.
June 2nd, 2009 at 11:30 pm
This is such a stressful thought. Not to mention the added cost of staying in China an extra 6 months or more.
Why can’t the children be tested, etc when they are deemed paper ready by the orphanages and cleared for adoption by CCAA? It seems so much more practical and logical to clear the children BEFORE adoption than after adoption.
June 3rd, 2009 at 12:30 am
Our agency was told by the ACIVU that they are only testing children ages 2-14. So, no, not infants. And it also sounds like the consulate is advocating for the tests to be done in the orphanages prior to adoption, so hopefully that will change according to our agency.
June 3rd, 2009 at 12:35 am
My question. The amount of reaction of the skin test could be indictative of the TB shot they got at some earlier point. If it reads less than 10MM will a chest xray be needed? Almost all kids are going to show something on the skin test cause a TB shot is given before age 1.
The question is if you are referred a 22 month old and it takes 3 months to travel will they have gotten to the test before travel?
If they were diagnosed at home would they be quaranteened to the house during the 9 month treatment? If not why can’t they travel home and continue treatment home? Why can’t they have the blood test since they were all given the vaccine for TB?
Sounds like a wonderful precaution but a problem. Heaven help us from well intended processes.
June 3rd, 2009 at 7:25 am
Who can afford $$ to stay up to 6 months, if your child has TB…it would be great if they would test these children as soon as they are match for adoption..giving them time to take care of the matter before the parent arrives. But it sounds like it’s not going to happen that way.
Praying for a speed up!
Teresa
LID 4/03/06
June 3rd, 2009 at 8:01 am
Does anyone know if another batch was posted to the special needs list last night/today?
June 3rd, 2009 at 8:17 am
I’d love to know more about the blood test that is being mentioned. My child tested positive for TB in the skin test and xray was clear. She is now on 9 months of antibiotics. If there is another way to check if she tested positive only due to the BCG shot – I would love to do that. The health dept here in my county/state did not tell me about any kind of blood test.
June 3rd, 2009 at 8:37 am
While it’s difficult to criticize the CDC attempting to protect the public from TB, which is making an ugly comback, I think it unfortunate AP’s have yet another hoop to jump through in order to bring their children home. Hopefully each country will be able to perform the testing before families travel.
BTW, we were told the INH treatment does not eradicate the TB bacteria from the body. It reduces the chances of contracting the active disease, but does not eliminate it.
June 3rd, 2009 at 9:07 am
We are at the very early stages of this announcement. There are too many really bad consequences if a child has already been placed in the arms of the parent(s) and then told they must remain in the country for 6-9 months. That is simply unrealistic on so many levels.
Because the tests would come back after the adoption process has been legalized, the CCAA can’t require the child to be placed back in foster care or the orphanage. Can adoptive parent(s) then obtain a visa for such an extended (6 month) stay? Additionally, that would probably bankrupt us.
For all those reasons, I have to believe that someone in the CCAA will determine that the ONLY option is to provide testing for children before TAs and probably before actual referrals.
Lastly, RQ says that “…the odds are that most families will only make it to the skin test or the x-ray stage and will not have to stay for the culture or the medication phases.” I’m a numbers guy. I think I would like to see real numbers so that the “odds” can be properly assessed.
June 3rd, 2009 at 9:41 am
Has there actually been a fatality of someone contracting TB from an adopted child?
June 3rd, 2009 at 9:58 am
I was a TB nurse for our counties public health department, the county I worked in is our state’s capital and we have a significant population of Hispanics. Quite often folks who have recieved the BCG will have what appears to be a postive skin reaction. A red welt, we would actually measure the raised welt and not the area that was ‘red’ in color. If the measurement was outside of what was considered ‘normal’ for people who had received the BCG than an Xray was ordered, especially if you were symptomatic. Often the Xray was clear or showed scarring from a period where the person may have been exposed to TB, but was not actively contagious.
TB is very contagious and with our global world, I can see why there is a percaution. As a TB nurse I had to go to your house everyday for 9 months and watch you take the medication. I have incidences where people w/ active contagious TB were not compliant and they were forced to be in the hospital.
June 3rd, 2009 at 10:24 am
dbm Says: “I’m a numbers guy. I think I would like to see real numbers so that the “odds” can be properly assessed.”
They are easy enough to look up online.
According to the State Department, last year there were 3,909 adoptions from China and 1,725 adoptions from Ethiopia.
The CDC estimates less than 10 babies a year will have to stay for the medication phase.
But, TB is a lot more prevalent in Ethiopia than it is in China. Depending on which variables you plug into the WHO’s database, it’s either a quarter or a half as prevalent. If you put in “all forms” then it’s a quarter, but if you put in “reported cases” then it’s half.
But, another variable, how many are over two in Ethiopia vs China?
If the “above two” age is similar in both countries then I’d say that (rough estimate) between five and 15 babies a year in China will have to stay for the medication phase.
June 3rd, 2009 at 10:46 am
Hi
I read that Ethiopia is closing to some orphanges and they are advising people not to adopt there right now. Also, I read that Vietnam has too many abandoned babies right now. They can’t take care of all of them. I just don’t get it. Why is adoption so hard when there are so many children out there that need loving homes. We were looking at a 6 yr. wait with a 1-17-2007 LID.
WaitingforKatie08…who said the wait would be 5 yrs? I am just curious. I expected 6 with an early 2007 LID. My friend said it could take more than a yr. to get through Feb., March, April, and May 2007 because everyone rushed to get logged in before the rules changed. She dropped out because she expected almost 8 yrs. with a late 2008 LID.
June 3rd, 2009 at 10:55 am
wait4ever – one area of the country (3 orphanages) in Ethiopia is closed while an investigation takes place, I’ve been told the rest of the country is fine.
The State Department isn’t going to allow adoptions from
Vietnam because there are too many inconsistencies. Vietnam is supposed to be working to redo their adoption laws and procedures, but until that happens the USCIS is not going to give Visas to children who may not be orphans at all. I am glad the USCIS and State Department (via the consulates) are keeping an eye on these things. Yes, it’s sad there are kids who need families, but without oversight things like kidnapping and baby selling happen, and none of us want that, do we?
June 3rd, 2009 at 11:08 am
RQ, I promise, I’m looking and looking for this data, even before posting. I cannot locate the CDC estimate (<10 babies) that you have sited. In the Ethiopia post, it states that “Consular staff estimates fewer than 10 orphans per year will require this treatment.” (But that’s an estimate of adoptions from Ethiopia)
WHO held a conference in April regarding China/TB. I’m working through that data now:
http://www.who.int/tb_beijingmeeting/en/index.html
June 3rd, 2009 at 11:14 am
The WHO has worldwide numbers, here is the page you use to plug in the variables you want from their database:
http://apps.who.int/globalatlas/dataQuery/default.asp
Since I don’t know what numbers the CDC used to arrive at that “less than 10″ number, I don’t know what variables to plug into the WHO page, so I plugged several things in and everything came up with China being between a quarter to a half of the rate per 100,000 as Ethiopia is.
June 4th, 2009 at 12:53 pm
I find this quite concerning. My daughter had mild pneumonia when we adopted her. Under this new rule we might have been forced to remain in China.
We took our daughter to her U.S. pediatrician the day after arriving in the U.S., for a non-respiratory health condition. They gave her a TB skin test, which was positive (more than what you’d normally see just from BCG vaccine, they said). She immediately had a chest X-ray, which was abnormal, so they called the CDC who sent us straight to the isolation ward of the hospital. She was hospitalized for 3 days for testing. In the end, they concluded she had been exposed to TB (requiring 9 months of INH treatment) but not active TB. The chest X-ray had been abnormal due to the pneumonia, not TB. I shudder to think what might have happened under the new rule. There must be a better way.
P.S. By law my husband and I had to be tested and our case reported even though every physician agreed there was no possible way we could have been the source of the exposure. We were also told that young children cannot give TB to others, because when they cough the germs don’t get expelled far enough.
June 5th, 2009 at 7:32 am
I don’t get here much but heard about this thread and thought I’d respond. My daughter, home 11 months was just dx with latent TB and begins a 9 month regimen of INH. Her first PPD was negative which our IA doctor said is quite common due to nutritional deficiencies. 50% of those negative PPD’s will be positive when repeated 6-12 months later. Our repeat test was “very” positive but chest series confirmed that it is inactive. I suspect most children unless they have active TB won’t be affected by this change. I was told that children under 5 are most at risk to rapidly change from latent to active (within a few years) if they go without treatment whereas adults could take much longer. Of course this should be addressed early on with all children but it is important to ensure the well being and safety of everyone. Hopefully the diagnosis and treatment will increase everywhere making the chances of remaining in-country very slim.