The Centers for Disease Control and Prevention issued a health advisory urging families who adopt children from Ethiopia to make sure all family members are vaccinated for hepatitis A, which is endemic throughout the African continent.
The advisory, issued July 19 via the CDC's Clinician Outreach and Communication Activity (COCA) Listserv, said the agency had received an undisclosed number of reports of hepatitis A (HAV) in adults and children “linked” to children adopted from Ethiopia. “Other household members and caregivers of children adopted from Ethiopia should consider being vaccinated before adopted children are brought to the United States,” the advisory warned.
Most children younger than the age of 6 years do not get sick from hepatitis A virus infection, but they can spread it to older children and adults, who often become ill, the CDC says. Symptoms usually last up to 2 months, but there is no chronic disease. Older persons and those with chronic liver disease can have more serious illness. Overall mortality is 0.3%, but it is 1.8% in those aged 50 years and older.
If adopted children, household members, or others who have been in contact with them are experiencing symptoms of hepatitis A (fatigue, abdominal pain, loss of appetite, nausea, jaundice), they should contact a physician.
Persons exposed to hepatitis A who have not previously been immunized should contact their physician or local health department to see if they should receive an immunization or immunoglobulin that might prevent illness, the CDC said.
According to the U.S. Department of State, Ethiopia in 2003 was the 15th most common source country for foreign adoptions; in 2006, it was 5th. (See graphic.) Last year, Ethiopia accounted for 732 (4%) of 20,679 foreign adoptions overall into the United States.
The CDC also urged persons who were traveling to Ethiopia or other areas with a high incidence of hepatitis A to be vaccinated against the disease before travel.
According to the World Health Organization, Africa as a whole is considered to have “very high” endemicity of hepatitis A, and most hepatitis A patients on the continent are younger than 5 years. Most adults in endemic countries, however, are immune to the disease. (The report is available at www.who.int/csr/disease/hepatitis
In August 2004, a group of 351 European tourists visiting Egypt contracted the disease (Euro. Surveill. 2006;11:37–9).
A study in 1990 also found a higher than expected incidence of the disease among missionaries in sub-Saharan Africa (Am. J. Trop. Med. Hyg. 1990:43:527–33). An earlier study found that 84% of Ethiopians were positive for hepatitis A surface antigen (Am. J. Epidemiol. 1986;123:344–51).
“The Centers for Disease Control also recommends that all children [at least] 1 year of age receive the hepatitis A vaccine,” the advisory noted. This is part of the U.S. Childhood and Adolescent Immunization Schedule.
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