A Negative PPD Test and a New Email Address

July 20th, 2007

Ella’s second PPD test (for tuberculosis) came back negative this week!!! Many months ago she was tested and her result was 5 millimeters, which is viewed as a borderline reaction (depending on who you ask.) We had her tested as a precaution due to the prevalence of tuberculosis ( TB ) in Viet Nam. She had received one TB vaccination while she was there, and bears the scar on her upper arm to prove it. This vaccine is very common in Viet Nam and other countries in Asia. When her first test came back as a five, my husband and I were worried, but our doctor wasn’t too alarmed. She felt it would be best to wait a few months, let her immune system develop a little more and re-test her… [more]

TB/PPD Update

March 8th, 2007

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 down after first hearing that her test… [more]

TB/PPD Information 6

March 1st, 2007

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 of isoniazid prophylaxis is a nine month long treatment that requires testing of liver functions. The Orphan Doctor site says: Risk of INH hepatitis is very small in infants, children and adolescents (O’Brien… [more]

TB/PPD Information 5: Tuberculosis in Children Adopted from Abroad

March 1st, 2007

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 vaccine is used in all countries, except the Netherlands and the United States. You can recognize the vaccine site by a visible scar on most commonly the left upper arm. In order for physicians to… [more]

TB/PPD Information 4

March 1st, 2007

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 making the spread of TB easy. Orphans have poor nutrition leading to inevitable immunosuppression (decreased ability to fight infection) making them more susceptible to tuberculosis. The incubation period can be weeks, months, and even years. A child arrives in the U.S. well-appearing and… [more]

TB/PPD Information 3: International Adoptions Pose Extra TB Risk

March 1st, 2007

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, experts say. As a result, such children often fail to be screened. Failing to skin-test kids adopted from abroad "is a serious, serious problem," says Jane Aronson, MD, chief of pediatric infectious diseases, and director of… [more]

TB/PPD Information 2

March 1st, 2007

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” by a skilled medical person about 2-3 days later. Children who have been diagnosed with TB may have received a preventive medication called isoniazid (INH). The usual regimen is for 9… [more]

TB/PPD Information

March 1st, 2007

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 means the bacteria is present in the body; disease means the bacteria are now harming the body and causing symptoms. For tuberculosis, years might pass from the time of infection until the time disease develops in the lungs. We have found about 20% of… [more]

TB/ PPD Woes

March 1st, 2007

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 children. I was pleasantly surprised to find quite a… [more]