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.