Physician: Orphanage Immunization Records

Can immunization records from orphanages be relied upon, given that vaccinations in third-world nations often are not on par with accepted standards?

To revaccinate or not is a very heated and emotional decision that all adoptive parents need to face with the help of their general pediatrician. While obviously, the safest and the most accurate way is to just revaccinate every child regardless of immunization records, this method unfortunately does not sit well with many parents; I feel that each case needs to be evaluated on an individual basis.

There are many reasons why physicians in the U.S.A do not want to accept the immunization records for internationally adopted children. In this article I will try to elaborate on these concerns, and explain my personal style to vaccinations.

1. Inadequate background medical records: Children that are adopted internationally either live in orphanages or are now placed in the foster care system. There may be many prior placements for this child and the medical record may not be forwarded with that child. In some cases, a child may have been placed in an orphanage at an older age, and vaccinations may have occurred prior to placement, and these records are not forwarded.
   
   
   
2. Immunocompromised children: Children that grow up in foreign orphanages usually have a weakened immune status. This condition occurs because of the poor living conditions, malnutrition of the child, and lack of medications to treat simple illness. Because of their weakened immune system, these children may not be able to mount an adequate immune response to the vaccine. The sequence of vaccination boosters may not have been given appropriately, hence not mounting an immune response to the vaccine.

Other reasons: why these children may not mount an immune response is as follows:

1. Factitious immunization practices
   
2. Use of outdated vaccines
   
3. Poorly stored and improperly handled vaccinations
   
4. Biologically impotent vaccinations because of poor manufacturing, transport and storage. Without the proper cold storage for these vaccines, there is no guarantee of their effectiveness.
5. Vaccines could be expired, making them completely ineffective.
6. Improper vaccine schedule for primary and secondary series.

Much of this information presented comes from experience with children adopted many years ago in the eighties to early nineties. Since then, orphanages have changed for the better. In the times that we live in now, most people care about children and try to advocate for them. Orphanages especially in the Eastern European countries are now better staffed, supplied, and health care is now available. Granted it is not at the level that we have here in the U.S.A, it has greatly improved improved. Shortfalls do exist however. If the child lives in the main city of a particular country, funding is available, but if they live somewhere on the outskirts, you could be sure that healthcare is limited and may even be nonexistent.

My personal approach to vaccinations is as follows:

1. If the parents are agreeable to just restating all vaccinations I will
   
2. If parents are afraid of vaccinations, I will draw serologic studies and see if the child mounted an immune response. I will complete the vaccination program as indicated under the AAP catch-up schedule.
3. In a very limited number of cases I may opt to just continue with the vaccine schedule from where they left off if a number of criteria are met:
   • Childs growth and health parameters are perfect
     
   • Vaccine record appears to be valid, with dates and manufactures, and absolutely no suspicion of foul play.
     
   • All blood work is normal
     
   • If the parents agree with this program
     
   • If I have had multiple children with the same health condition from the same orphanage.

While the revaccination decision can be pretty emotional for parents because of extra shots, realistically even in children who got some vaccines overseas, they did not get a lot of them. Vaccines generally encountered on the medical record are only the Hepatitis B, DTP and Polio. Many times they do not even have the complete series; I would need to give them booster vaccines anyway. I rarely ever see the HIB, MMR, Chickenpox or the new Prevnar vaccines.

The revaccination controversy does certainly exist; I feel that it is somewhat over publicized. Vaccines are good things to have. They prevent many of the deadly childhood illness that many young doctors today here in the U.S.A, may never have seen.

There are many people out there that have many personal stories related to the side effects of vaccinations. Some of these people are advocates against mass vaccination in the U.S.A. I respect their decisions and all that I can do as a physician is try to educate them. I never try to forcefully impose a doctor’s belief and the standard of care on them. It is really good for their general health that most everyone around them is already vaccinated.

I know that today, because of mass vaccination in the U.S.A, our children rarely die from these illness that may have affected them if they were to remain in the orphanages, such as Polio, Pertusis, HIB Meningitis just to name a few.

by George Rogu M.D.

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The information and advice provided is intended to be general information, NOT as advice on how to deal with a particular child's situation and or problem. If your child has a specific problem you need to ask your pediatrician about it - only after a careful history and physical exam can a medical diagnosis and/or treatment plan be made. This Web site does not constitute a physician-patient relationship.

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© George Rogu, M.D.