A CPSP Survey on Canadian Paediatricians

1
A CPSP Survey on Canadian Paediatricians
Experience and Knowledge about the Risks of
Infectious Diseases in Children Adopted
Internationally ML Lawson1, L Auger2, C
Baxter3, JF Chicoine4, TJ Clifford1, S Kahaler5,
R Kugelmass6, S Kuhn7, M Naus8, A Simone9, C Hui1
Background
Results
Limitations of Survey
Qn How many internationally adopted (IA)
children have you seen over the past 2 years?

• 672 CPSP participants responded (27)
• Analyses were restricted to the 403 respondents
  (60) who had seen an internationally adopted
  (IA) child within the previous 2 years.

Canadian families have been adopting children
internationally at increasing rates over the last
10 years with over 2000 international adoptions
annually. Most of these children come from
countries and/or social situations with increased
risks for specific infectious diseases acquired
at birth or in the first years of life and where
routine immunization is incomplete or
inadequate.

• Only 27 of CPSP participants responded but this
  is consistent with the response rate to other
  one-time CPSP surveys.
• Survey was unable to distinguish between primary
  care/consulting paediatricians and paediatric
  subspecialists.
• The number of confirmed cases is likely
  underestimated as the survey did not include
  family physicians, however the survey method
  could not exclude duplicate reporting.
• The incidence for these infectious diseases
  could not be calculated because denominator data
  was not available.

Respondents Knowledge About Screening for
Infectious Diseases in IA Children
gt10
lt 5
Objective
5-10
2003 AAP Red Book Recommendations CPSP Survey Respondents
Hepatitis B Screen all IA children HBsAg, HBsAb, HBcAb on arrival Consider retesting in 6 months 79 would screen all IA children on arrival only 25 would include HBcAb 25 would retest
Hepatitis C Screen IA children from specific high-risk countries HCVAb on arrival Retesting not required 71 would screen all IA children on arrival 21 would retest
HIV Screen all IA children HIV Elisa or PCR on arrival Consider retesting in 6 months 73 would screen all IA children on arrival 37 would retest
Syphilis All IA children VDRL, RPR, ART or MHA-TP, FTA-ABS on arrival 67 would screen all IA children on arrival
TB Screen all IA children PPD within 3 months of arrival ( CXR if symptomatic or PPD ve) If PPD negative child is malnourished, consider repeat PPD in 2-3 months PPD is indicated even if child had previous BCG 71 would screen all IA children on arrival 95 would screen with PPD 37 also do CXR 35 would retest 35 would not do PPD if child had received BCG
Materials Methods
To determine the experience of Canadian
paediatricians with children adopted
internationally and their knowledge about current
recommendations for screening for infectious
diseases.
Discussion

• The majority of Canadian paediatricians are
  seeing children who were adopted internationally.
• Their practice and knowledge about screening for
  high-risk infectious diseases is suboptimal as is
  their knowledge about how to determine who needs
  revaccination.
• These gaps in knowledge and practice may be
  leading to under-detection of conditions such as
  HIV, hepatitis B and C and inadequate
  immunization putting these children and their
  contacts at risk.
• AAP recommendations are largely consensus based.
  Further research is required to develop
  evidence-based recommendations for children
  adopted internationally and to determine their
  risk for specific infectious diseases.

Confirmed Cases
Hepatitis B 30
Hepatitis C 4
HIV 3
Syphilis 4
TB Infection 111
Methods

• In September 2005, a one-time survey on
  international adoption was sent to the 2500
  participants of the Canadian Paediatric
  Surveillance Program (CPSP) to determine the
  following
• Whether Canadian paediatricians had experience
  with caring for children adopted internationally,
• Whether they had screened these children for
  specific high-risk infectious diseases and if
  they had, the number of confirmed cases they had
  seen,
• Their knowledge about the method of screening for
  these disease, including method and timing of
  testing, and
• Their knowledge and experience with evaluating
  immunization records of children adopted
  internationally and whether revaccination was
  indicated.

total cases seen by all respondents over
previous 2 years
Respondents Knowledge About Revaccination of IA
Children who were Previously Vaccinated

• Revaccination of IA children whose adoption
  records showed previous vaccination
• 77 sometimes, 17 always, 6 never
• Factors affecting respondents decision to
  revaccinate
• 86 would examine quality of records
• 66 would consider childs country of origin
• 46 would consider childs age
• 34 would consider overall state of childs
  health
• 25 would do serologic testing

Investigators Affiliation
1Childrens Hospital of Eastern Ontario
2Montreal Childrens Hospital 3 Royal Alexandra
Hospital, Edmonton 4CHU Sainte-Justine,
Montreal 5Vancouver 6Montreal 7Calgary 8BC
Centre for Disease Control 9Trillium Health
Centre, Mississauga
The authors gratefully acknowledge the support of
the CPSP Staff and the participating
paediatricians from across Canada.