Pediatrics

Predictors of Mycobacterium tuberculosis Infection in International Adoptees Anna M. Mandalakas, H. Lester Kirchner, Sandra Iverson, Mary Chesney, Mary Jo Spencer, Angela Sidler and Dana Johnson Pediatrics 2007;120;e610-e616 DOI: 10.1542/peds.2006-2817

The online version of this article, along with updated information and services, is located on the World Wide Web at:http://www.pediatrics.org/cgi/content/full/120/3/e610

PEDIATRICS is the official journal of the American Academy of Pediatrics. A monthly publication, it has been published continuously since 1948. PEDIATRICS is owned, published, and trademarked by the American Academy of Pediatrics, 141 Northwest Point Boulevard, Elk Grove Village, Illinois, 60007. Copyright © 2007 by the American Academy of Pediatrics. All rightsreserved. Print ISSN: 0031-4005. Online ISSN: 1098-4275.

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ARTICLE

Predictors of Mycobacterium tuberculosis Infection in International Adoptees
Anna M. Mandalakas, MDa, H. Lester Kirchner, PhDa, Sandra Iverson, MS, RN, CPNPb, Mary Chesney, MS, RN, CPNPb, Mary Jo Spencer, BSN, RN, CPNPb, Angela Sidler, MDb, Dana Johnson, MD, PhDb
aDepartment of Pediatrics, Case Western Reserve University, Cleveland, Ohio; bDepartment of Pediatrics, University of Minnesota, Minneapolis, Minnesota

The authors have indicated they have no financial relationships relevant to this article to disclose.

ABSTRACT
OBJECTIVE. The objective of this study was to measure the factors that are associated

with Mycobacterium tuberculosis infectionin international adoptees.
METHODS. A retrospective chart review was conducted on 880 international adoptees
www.pediatrics.org/cgi/doi/10.1542/ peds.2006-2817 doi:10.1542/peds.2006-2817
Key Words tuberculin test, malnutrition, tuberculosis, adoption, immigrants, pediatrics Abbreviations TST—tuberculin skin test BCG— bacille Calmette-Guerin ´ OR— odds ratio CI— confidence interval aOR—adjustedodds ratio PPD—purified protein derivative
Accepted for publication Jun 30, 2007 Address correspondence to Anna M. Mandalakas, MD, 11100 Euclid Ave, Cleveland, OH 44106-7052. E-mail: amm13@po.cwru.edu PEDIATRICS (ISSN Numbers: Print, 0031-4005; Online, 1098-4275). Copyright © 2007 by the American Academy of Pediatrics

who presented to the International Adoption Clinic at the University ofMinnesota between 1986 and 2001. Five tuberculin units of purified protein derivative were placed intradermally on the left forearm. The largest diameter of induration was measured in millimeters between 48 and 72 hours. Nutritional status was assessed using anthropometric measures at initial screening. Data on age, birth country, and year of adoption were assessed.
RESULTS. Adoptees (mean age: 26months; range: 1–200 months; 62% female) came

from 33 birth countries. Twenty-eight percent and 5% had evidence of chronic and acute malnutrition, respectively. Twelve percent had evidence of M tuberculosis infection. The odds of M tuberculosis infection increased 7% for each subsequent year during the period studied, increased 142% with each additional year of age for children 24 months of age atbaseline screening, and increased 15% with each additional year of age for children 24 months of age at the time of evaluation. Tuberculin skin test induration response was not associated with nutritional status or birth region.
CONCLUSIONS. Our study demonstrated a high prevalence of M tuberculosis infection

and malnutrition in internationally adopted children, placing them at considerable riskfor progression to tuberculosis disease. These findings also support current guidelines recommending completion of tuberculin screening immediately after adoption.

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HE NUMBER OF children who were adopted internationally increased dramatically in the past 2 decades. Since 1990, the United States has issued...