The American Academy of Pediatricians (AAP) maintains a list of doctors with a special interest in adoption.

Alabama Jennifer Nobles, MD, MPH, TM MCTR 201 1600 7th Ave South Birmingham, AL 35233-1711 Phone: 205-939-9585 E-mail: jnobles@peds.uab.edu

Alaska Sorry; there are no pediatricians listed for this state.

Arizona... more

Before we came home with Ella I had done some research and found a pediatrician specializing in International Adoption who practices just a few towns over from our own. My husband and I both use the same family practice and we decided that we would have Ella examined by the specialist first and then we would switch her over to our family practice. We have since changed our minds and decided to keep her at the specialist. Part of that decision is because we are comfortable with the level of care she has received and part of it is because we’re going... more

Last week I wrote about Ella’s positive ppd test and was agonizing over taking our doctor’s advice (to wait and retest her at fifteen months) or seeking treatment for her. My husband emailed the doctor and asked her to clarify some issues and we’ve decided to wait and retest her in about four months.

The main reason to hold off on treatment (unless it was necessary) is the toxicity of the treatment, and she may not even need it. Had she tested higher (her reaction was 5 mm) we would certainly go ahead and begin the prophylaxis treatment. Depending on what her test reveals at fifteen months, we’ll decide then.

I’m glad that I took some time to really think about it and to calm... more

Some other points that I am taking into consideration (the bolding is my own):

PPD Interpretation

Winthrop uses greater than or equal to 10 mm of induration as the cutoff for latent TB infection (LTBI) According to the Redbook 1997 this category is designed for children living in high-prevalence regions of the world 5 mm cutoff is used by a few experts

Infants and young children are more likely than older children and adults to develop life-threatening forms of TB

We also need to strongly consider the toxicity of the preventative treatment. The treatment... more

Even more from the Orphan Doctor:

Tuberculosis is quite common in countries all over the world, but especially in the former Soviet Union, Eastern Europe, China, Southeast Asia, India, and Central America. Tuberculosis can occur in the lungs and in many other organs of the body. Children contract TB from adults, not usually from other children. For children in orphanages, the staff who cares for them is usually the main source of infection. BCG vaccine (Bacille-Calmette-Guerin) is given to children early in life to help prevent TB, but it has a very limited effect. The BCG... more

More from the Orphan Doctor:

as published in the International Primer

The epidemiology of Tuberculosis abroad is well-understood. The high prevalence countries are Mexico, the Philippines, Vietnam, Cambodia, India, China, Haiti, South Korea, and the former Soviet Union. Children living in orphanages abroad are the unwitting victims of this disease. They are exposed to adult caretakers with active tuberculosis who are living and working in the orphanage and have no access to medical care. Caretakers in orphanages are often ill for weeks and months without any medical attention... more

The Orphan Doctor website has a lot of good information on this topic. Here's one article:

Children adopted from abroad are special in a way neither their delighted adoptive parents nor their pediatricians may have guessed, experts say. For several reasons, they're at a particularly heightened risk for tuberculosis. For one thing, too many American pediatricians mistakenly believe that the BCG vaccine - which is administered routinely in almost all countries except the United States - means that children either don't need to get a PPD skin test or that the test won't be valid,... more

Commonwealth Adoptions has this to say:

Tuberculosis (tb) is quite common in many countries. It is not unknown in the United States but the numbers seem to be declining. The Center for Disease Control and Prevention reported 15,078 cases in the US in 2002.

Most countries now give children the BCG vaccine, which often leaves a small but visible scar at the site of immunization (often the upper arm). Children who have had this vaccine may get a positive reaction to a skin test (Mantoux) but it is generally smaller in size and duration. This test must be administered and “read”... more

I'm going to post some of the articles/information sheets that I found on the topic of positive ppd tests in kids who were adopted internationally.

The first is from Winthrop University Hospital's International Adoption Program:

Q: If my child has a positive skin test for tuberculosis (positive PPD) does that mean my child has tuberculosis?

A: A positive PPD means the child has been infected with Mycobacterium tuberculosis, the bacterium that causes tuberculosis. However, this does not mean the child is sick or has tuberculosis disease. Infection... more

At Ella's regular doctor visit on Monday she received her two scheduled vaccinations and we did the ppd test for the first time. She had the BCG Tuberculosis (tb) vaccine in Viet Nam, so I ignorantly believed that her test would be positive because of the vaccine and we'd have nothing to worry about.

So I took her back to have the results read yesterday (Wednesday) and it was in fact positive. I kept telling the staff "she had the vaccine in Viet Nam" as they measured the reaction site and had me schedule an appointment to speak with the doctor.

Last night, armed with my trusty and much loved internet access, I began to research positive ppd tests in internationally adopted... more