Intercountry (International) Adoption Health Guidance

Each year, parents in the United States adopt more than 5,000 children from all over the world. Adopting a child is a wonderful and exciting event for families. The health of the child who has been adopted is one of many issues that parents need to address during the process of intercountry adoption, also known as international adoption.

Children born in other areas of the world may have different health problems from those of children raised in the United States. Children may have been exposed to vaccine-preventable diseases that are rare in the United States. Some children are adopted from countries with high rates of diseases, such as tuberculosis, hepatitis, and HIV/AIDS. For all these reasons, knowing as much as possible about a child’s health will help parents get the right treatment and care for their child. Ensuring that children who have been adopted are healthy will also help prevent the spread of disease in families and communities in the United States.

Before You Travel Overseas to Bring Your Child Home

CDC recommends that you try to collect health information about your child who has been adopted before you travel to bring him or her home. Any available medical and vaccination records should be shared and discussed with your medical provider here in the United States so that they can be better prepared once your child arrives.

Many vaccine-preventable diseases are more common in the countries of origin of children who have been adopted from other countries. Therefore, family members traveling to pick up the child, as well as close contacts of the child in the United States (e.g., other family members, babysitters) should make sure they are fully vaccinated according to the recommendations of the Advisory Committee on Immunization Practices (ACIP). CDC’s Travelers’ Health homepage has more information on vaccines you may need and other healthy travel tips.

Overseas Medical Exam Process

The medical examination process for your child who has been adopted begins overseas with a visit to a panel physician. A panel physician is a Department of State-designated medical doctor who performs medical exams overseas for immigrants (including children who have been adopted from other countries), refugees, and migrants coming into the United States. Panel physicians, who are located in many countries in the world, must refer to CDC guidelines (technical instructions) on medical exams. Panel physicians are trained in the technical instructions that CDC provides.

The purpose of the overseas medical exam is to identify applicants, including children who have been adopted, with Class A conditions. Children with these conditions must be treated or get a waiver before they can get a visa to come to the United States.

The visa medical exam differs from a normal physical that you may be used to. The visa medical exam includes:

• a physical exam
• a series of vaccines
• a screening for tuberculosis/TB (skin test/chest x-ray examination)
• a blood test for syphilis (not routinely done for children under 15 unless there is reason to suspect infection)

Once the medical exam is completed, the panel physician will give you a sealed packet containing the medical exam forms. When you arrive in the United States, give the sealed packet to the Customs and Border Protection (CBP) officer. The CBP officer is an immigration official who will process your paperwork when you first enter the United States. During the medical exam, you should ask for an extra copy of the medical exam forms and give them to your child’s medical provider in the United States. Children should also receive a medical exam once they enter the United States.

Vaccinations

Vaccinations are an important part of the overseas medical examination. The Immigration and Nationality Act requires that all immigrant visa applicants, including children who have been adopted, show proof of having received certain vaccinations named in the law, as well as others recommended by the Advisory Committee on Immunization Practices, before they may be granted an immigrant visa. Vaccination requirements depend on the age of your child. The age-appropriate vaccinations your child may require can be found in the vaccination schedules for children. Some children who have been adopted can receive an affidavit to have their vaccinations delayed until after they arrive in the United States. Children who receive an affidavit must receive the required vaccines once they arrive in the United States. For more information, please see the affidavit [PDF – 1 page].

Finding a Medical Provider in the United States

Once you have brought your child into the United States, you need to find a medical provider with whom you feel comfortable taking your child for medical care. CDC encourages parents to schedule their child’s medical visit within a few weeks of arrival. Your child’s first medical visit in the United States will be more detailed than his or her visa medical exam. Since the visa medical exam only screens for certain diseases, it may not give you a complete picture of your child’s health. The first U.S. medical exam will help you find out about any other health issues your child may have and allow for timely treatment, if needed.

During your child’s first medical visit in the U.S., the doctor may*:

• Check growth and development
• Test hearing and vision
• Screen for these diseases, if needed:
  • HIV/AIDS
  • Syphilis
  • Hepatitis B
  • Illnesses caused by parasites
  • Tuberculosis

*For more information on your child’s first medical visit, refer to the CDC Yellow Book.

Your child must also get vaccines if he or she did not receive them overseas. Parents are required to get their children vaccinated within 30 days of arrival.

Your child’s medical provider may also want to learn about your child’s medical history. If you have any forms or papers with details about your child’s medical background, bring them to the first visit.

If you are looking for a medical provider, you may want to consider pediatricians who focus on treating children who have been adopted from other countries. They tend to have more experience with medical conditions seen in children adopted overseas.

Class A Conditions

Class A conditions are illnesses of public health importance that prohibit a person from entering the United States. Many children who have been adopted come from countries where Class A conditions are more common than in the United States.

Class A conditions include:

• Tuberculosis
• Syphilis
• Gonorrhea
• Hansen’s Disease (Leprosy)
• Mental Disorders (with Associated Harmful Behavior)
• Substance Abuse

The diseases in the following two categories are also Class A conditions:

• Quarantinable diseases designated by any Presidential Executive Order: cholera, diphtheria, infectious tuberculosis, plague, smallpox, yellow fever, viral hemorrhagic fevers, severe acute respiratory syndromes, and novel influenza (e.g., pandemic flu).
• Events that are reportable as a public health emergency of international concern to the World Health Organization under the International Health Regulations of 2005: polio, smallpox, SARS, novel/pandemic influenza (flu), and other public health emergencies of international concern.

The Class A condition that is most relevant for children who have been adopted from other countries is tuberculosis (TB). In 2007 CDC updated the TB technical instructions for panel physicians to improve TB screening. TB is a disease that is caused by bacteria which are spread from person to person through the air. Tuberculosis is considered infectious (active) when the TB bacteria overcome the defenses of the body and begin to multiply. People with active TB can spread TB bacteria to others. Most TB can be treated with antibiotics.

For information on TB screening for children who have been adopted from other countries, please visit the Intercountry (International) Adoption Tuberculosis Frequently Asked Questions (FAQs).

Waiver Process

In certain instances, waivers can be granted so that a child with a Class A condition can enter the United States. A waiver request may also be filed on religious or moral grounds (for vaccinations only). CDC’s role in the waiver process is only to review and provide an opinion. The final decision to approve or deny a waiver is made by U.S. Citizenship and Immigration Services (USCIS) in the Department of Homeland Security (DHS).

Here is the process to apply for a waiver:

• If a child is found to have a Class A condition, parents should talk to the panel physician and the U.S. Consulate to find out if it is possible to get a waiver.

You cannot apply for a waiver before the child is found to have an inadmissible condition. Thus, all tests must be completed and read by the panel physician before a class can be assigned.

• Parents will have to complete a waiver request form (Form I-601) with USCIS.

* Finding a U.S. doctor or health-care provider is a vital step in the waiver process. You must list the doctor who will treat your child in the United States on the I-601 Form, and the I-601 Form must be completed and signed by the doctor. For children with TB, you must contact your state or local health department; the health department must complete the I-601 waiver. They can tell you if they will be able to treat the child. They may not agree to treat your child until they get all the medical forms about his or her case.

• The panel physician will send the child’s medical forms to the U.S. Consulate (American Embassy).
• The I-601 will be sent to USCIS, and then USCIS will send the I-601 to CDC for review.
• CDC will check the I-601 and medical forms to make sure they are correct and complete.
• CDC will then provide an opinion to USCIS about the case.
• USCIS will make the final decision to approve or deny the waiver. This decision will be reported to the U.S. Consulate and CDC.
• USCIS will tell the parents whether the waiver was granted. If the waiver is granted, the child will receive a visa.

More Information

For more information about CDC’s role in intercountry (international) adoptions, please contact:

Immigrant and Refugee Health Branch
Division of Global Migration Health
National Center for Emerging and Zoonotic Infectious Diseases

Centers for Disease Control and Prevention
1600 Clifton Road, NE, MS E-03
Atlanta, Georgia, USA 30333
CDC INFO: 1-800-CDC-INFO (232-4636)
TTY: 1-888-232-6348