The Advisory Committee on Immunization Practices met in Atlanta on Wednesday, Feb 25. The committee makes recommendations to the Centers for Disease Control and Prevention. Among the latest recommendations: the Hepatitis-A vaccine for people who come in contact with international adoptees.

Dr. Cindy Weinbaum, a medical epidemiologist with the CDC, said the recommendations cover adoptions from countries with a high or intermediate infection risk. “That includes most of the world. All that (it) excludes is North America, Western Europe, Australia, New Zealand and Japan,” she said. The disease is unfortunately common among children coming from the four top countries of origin for children being adopted by US families. Those are China, Russia, Guatemala and Ethiopia.

Formerly, only parents who were traveling to such countries were recommended for the vaccine. Now, the suggestion includes people such as grandparents and babysitters–anyone who will have close contact with an international adoptee withing 60 days of his or her arrival in the U.S. The average incubation for the disease is 28 days, but it can be longer, and young children often show only very mild symptoms, thereby increasing the risk to unsuspecting adults. And children adopted from other countries usually have not had a vaccination.

Even though these children only cause 3% (at the highest estimate) of Hep-A infections every year, federal officials state that the results can be tragic–especially since they are both foreseeable and preventable. The latest of these cases involved a 51-year old woman who became critically ill after exposure to her internationally adopted grandchildren. Weinbaum cited there were about 20 recent cases.

Hepatitis A is a highly contagious liver infection caused by a virus. It is typically spread through feces (in other words, be careful with the diapers!). Symptoms can include fever, jaundice, nausea and vomiting. It is usually more severe in adults, and can be fatal.

The vaccine is given in two doses. The first one should be administered as soon as an adoption is planned. The second would ideally be given two weeks before the child’s arrival. It is an expensive vaccine, by some standards ($140). But considering that international adoptions often cost between $20,000 and $40,000 (according to Dr. Weinbaum), it’s not a lot of money in the big scheme of things.

This recommendation follows the news last summer of many false-negative tuberculosis tests in international adoptees. For some reason, the children did not show positive results for three months. Similarly, young children with hepatitis-A don’t often show signs of jaundice, an indicator for the infection.

Today is International Literacy Day. It also marks the 5^th year of United Nations Literacy Decade 2003 to 2012. The initiative started in January 2003 by a resolution of the UN General Assembly after endorsement at the 2000 Dakar World Education Forum. Improving literacy is also one of the “Millenium Development Goals” of the United Nations Development Program.

One of the main targets of the literacy initiative is to “achieve universal primary education”, that is, ensure that children everywhere, boys and girls alike, will be able to complete a full course of primary schooling by 2015. Children, especially girls, are especially threatened by illiteracy. According to the World Bank, about 130 million? school-aged children are not attending school, most in developing countries. Two-thirds of these are girls. Worldwide, more than 880 million adults are illiterate and two-thirds of these are women.

It is highly important that literacy among girls and women be improved, considering a woman’s role in the education and upbringing of her children.

I’ve talked to many moms and this seems to be a dreaded event in most households. If only there were a smooth, painless, and accident-less transition between the convenience of diapers and using the potty. Unfortunately, there isn’t, and the whole potty-training business still makes parents anxious even with books, and gadgets galore in the U.S. What are the trends around the world?

Germany Parents introduce the potty between 16 mos. and 2 yrs.old, but are lax on a timeline. The children are allowed to go at their own pace. Most are fully trained by age 3.

Cuba Children are potty trained much earlier, by 1 or 1.5 years old. This is most likely because children almost always exclusively use cloth diaper since disposable diapers are expensive. Since children feel wet and uncomfortable more readily than those absorbent disposables, they are more open to “doing their business” in the toilet.

England There is a fierce debate between the older generations on the issue of potty training. The older generation think children should start their training as early as 6 mos. While the younger generation prefer to start much later, at around 2 years old. Again, older generation used cloth diapers, and had more children closer in age. The younger generation have fewer children, spaced further apart, and have the luxury of time to keep them in their nappies. However, some young moms don’t wait until 2 yrs. old and prefer to start at 6-9 mos. like the older generation did. I was surprised to see my friend’s baby, the same age as my daughter, using her “potty” at 9 mos.!

India & China It is customary in both countries to start the process very early. They condition the child to associate a sssshhhh or similar noise with potty training as young as a few months old, while holding them over the toilet. Also, most parents do not use a child’s version of the potty, but go straight to the big throne, so to speak. As a result, children are independent in their bathroom trips as young as 2, making use of the customary split in their pants to make things even easier. I have also heard of anecdotes where some children are held in the streets to go poop. Right now, western influence is slowly introducing diapers to the Chinese, so we’ll see if this practice survives the western assault.

United States Pediatricians advise parents to watch for signs that the child is ready for training like watching mom/dad with interest when they go to the bathroom, understanding what the potty is for, etc. However, the same method that is prevalent in India and China is being advocated by a few parents here and books are now available explaining the process.