Wednesday, October 28, 2009

Adoptive Families Magazine "A TB Regulation Victory"

Adoptive Families magazine December 2009 issue, Adoptalk New and Notes section, article “A TB Regulation Victory” contains several misleading statements.

The article can be accessed here

Tuberculosis screening criteria and regulations are complex.

The statement “The regulations held adopted children to a higher standard than children born to American parents in another country, or even to tourists” has two flaws.

The first flaw implies that the 2007 TB screening guidelines to obtain an immigrant visa no longer differentiate between guidelines for children adopted internationally by US citizens and children screened in the US. The September 18 CDC updates are minor tweaks to practical screening steps for children aged two to ten years. The regulations still require screening that goes above and beyond screening for TB in children born in the US.

The second flaw is the implication that adopted children should not be held to a higher standard than children born to American parents. PEAR’s Position on Tuberculosis Management in International Adoptees, page 2 at describes why adoptees who have been in institutional care should be held to a higher standard. The excerpted passage:

“Children born to American citizens abroad are not and never have been in the same patient population as international adoptees. Differences in international adoptees include use of BCG vaccine, malnutrition, poor hygienic living conditions, institutional settings, being exposed to adult caregivers with TB, and being exposed in their communities to adults with TB and HIV. As a whole, children being adopted from these circumstances have a huge disparity of immune status compared to children born to American citizens abroad. Worse, this point deliberately misleads prospective parents away from the very real problem: the potential of foreign-born children residing in orphanages in high-prevalence TB countries having latent TB, active TB or MDR-TB, and the impact this will have not only on the child, but the adoptive family, and the community once the child has immigrated.

The last paragraph of the article misleads the reader to believe that the waiver process used by the adoptive family was something unique or added after advocacy on September 18, 2009. It actually was built in to the original 2007 TB screening guidelines. PEAR’s Position on Tuberculosis Management in International Adoptees, page 2, describes the waiver process. The excerpted passage:

“The CDC guidelines include a Class A waiver for immigrants with active TB. This waiver allows the parent to opt to bring a child with active TB to the US as long as specific conditions are met. Conditions include a US doctor and state health officer signing the waiver to take responsibility for treatment of the child, the child reporting to the doctor or health facility upon arrival to the US for appropriate treatment, parental agreement to comply with the entire therapy, and parental acknowledgement of financial burden of treatment. The CDC technical instructions addendum that is dated September 18, 2009 includes further details of the Class A waiver system and electronic tracking to ensure complete TB treatment.”

We want to remind the public that that removing country of origin screening removes the safeguard to US citizens. In addition, such a policy shift would put the burden on the adoptive family to infer the necessity of the testing and subsequent cost of possible treatment, which was likely not a planned adoption expense.

The recently-completed survey by PEAR shows that only 37 percent of the 486 international adoptive parent respondents used an International Adoption Clinic or provider with international adoption expertise post-adoption. Only 57 percent of the adoptive parent respondents had their child tested with the Mantoux TB screening test post-adoption

Ethics, Transparency, Support
~ What All Adoptions Deserve.

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