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.

Yesterday, we visited my dear friend and her brand new daughter who had just been born 12 hours prior to our visit. She still had that new baby smell on her!

I chatted with her mom and she told me that she couldn’t wait to get out of the hospital so she could get back on track. I just smiled. I know that feeling?somewhat. Due to the fact that I delivered with midwives, I was always home within 12 hours of the birth except for the birth of our last child. The midwife new I had very little family support and that my ex husband was not much help either. She let me stay at the birthing center for 3 days after the birth of my fourth child. I could have stayed longer, but due to an approaching ice storm, I chose to leave on the third day instead of risking driving my newborn home on icy roads.

I have to admit that while I was very excited to get home, I felt much better prepared to conquer the tasks and responsibilities waiting for me at home after being able to rest for 3 days. I say rest because constantly being monitored 24 hours a day isn’t very restful.

Everyone seems to have different ideas on this issue. I’d encourage you to do what is best for you. If you have a choice (sometimes you don’t have a choice – either your insurance company doesn’t cover for maternity stays after 24 hours or you or the baby are very sick), it’s best to make your decision carefully.

Should you stay as long as you are able to stay, or leave at the first chance you get? Here are some things to consider:

• How is the baby doing? – If he or she is struggling with weight gain, having trouble nursing, or looking yellow, you may want to stay extra time.
• Do you have Step B? – You may want to stay longer so that the staff can monitor your child to see that he or she doesn’t develop complications as a result of this.
• How was your birth? – If you have a traumatic experience, you may need extra time for your body to heal.
• How is the weather? – I know of women who have decided to leave the hospital early because there was a mandatory evacuation of their area due to a hurricane that was approaching. I’ve also known women who, under the same circumstances, chose to stay with their infants in a hospital that had made accommodations to deal with such a natural event.
• Do you have family support? – If your family is supportive, or you have a large circle of supportive friends, you may be able to get help during those first few exhausting days.
• Do you have other children? – If you have a large, young family to tend to, rest as much as you can after the birth of your baby.

I am not sure what my friend will decide. Her family lives locally and they are incredibly supportive of her and her young family. She is healthy and her birth was uneventful. Her daughter is doing well and gaining weight as she should. I won’t be too surprised if I get the phone call today announcing that they’ve returned home.

Do you have any recommendations for new moms? Should you stay where you delivered you child as long as possible—or should you go home as quickly as you can?