Sunday, October 10, 2010

Immigrant TB Testing

Yesterday, some friends of ours that adopted from Ukraine and are medical doctors, passed on some info to us that may be of value to those of you who also have adopted from Ukraine. We will be passing it on to our family doctor to see what he thinks about it. You can see this link for more info.
"[I] recently became aware of some new medical information that has affected my girls and I wanted to pass it on. I figured if it was new to me (I am suppose to know this stuff) then maybe you didn't know it either. Our children received a vaccine in Ukraine for Tb called BCG. It was suppose to protect them from Tb. It is not a good vaccine and doesn't work very well. That is why the US doesn't use it. My girls actually received it more than once. The real problem with the vaccine is that it turns the usual skin test (ppd) that we use here to test to see if someone has been exposed to Tb, useless. It has widely been assumed (until very recently ) that if you had BCG you should not even do a ppd skin test because it would always be positive and that would be a false positive and mean nothing. So the only way to test for Tb was to do a chest xray and that would show tif you had active Tb. There was no way to tell if you had just been exposed. So all of our children were required to have chest xrays before we left Ukraine to come to the US. Well, recently for some very strange reasons, I found out that those guidelines have changed. I am sending you a very good article that outlines the changes that you can print and bring to your doctors. The guidelines say that you should do a ppd and if it is positive then you should do a special Q. Gold blood test. If that is positive then the child should be treated for one year with a medicine called INH to prevent conversion in the future to active Tb. You see, many of our children, despite the vaccine have been exposed to Tb in Ukraine but have not yet developed active Tb. This is the stage when they are healthy and the Tb can be stopped from ever developing into active disease. The INH is not without risk but when they are young the risks are much smaller than when they are older. Also, the medicine must be taken regularly for one year to be affective and that is more likely to happen when they are still living in our homes under our care than when they are out on their own some day. Also, after talking to the head of Infection Disease at the Univ. of Iowa and at the Center of Disease Control, Atlanta they believe it should be done within 5 years of arriving to the US for best benefit. Only one of my daughters is positive by the blood test. So it doesn't mean that your children are positive, only that it is a possibility. It doesn't mean that they are sick. Just that they have a chance of becoming sick in the future (maybe many many years from now) but that it can be prevented if they are treated now. The state health department pays and provides the medicine. My daughter did need to have one more chest xray to prove that she still had no active disease before we could begin the treatment. If they had found any disease then they would have treated her with two medicines instead of only one. After the treatment no further treatment is ever needed again. I hope this helps. I was still working under the old model and so was our doctor. Pass this on to anyone that you think could benefit."


MoonDog said...

none of my kids had chest xrays leaving ukraine. 2 came home exactly a year ago. 4 came home 2 months ago. the little russian didt get one either 6 years ago.

Alan said...

Ours didn't either. I suppose the medical check for the Embassy didn't feel it was necessary.

Carlin said...

In the Ukraine one of our three children tested positive for TB. We were told to get a chest xray when we got home. Within a couple weeks the CDC in Utah contacted us and had us retest all three children. All three tested positive for TB. All three had to have chest xrays, all were clear. All three of our children had received the BCG shot in the orphanage.
They told us about the Quantiferon Gold blood test, but the government wouldn't cover it where we had already had the standard TB test (they said they would have covered it if we had requested it instead of the TB test). Who knows, but the blood test was 450 dollars a child (our insurance ended up covering it, we had to beg and show documents of everything we had had done). In the end two of our children were positive and one negative. The two who were positive were on Isoniazid for 9 months. They didn't have any side effects from the meds, but we were also told that the older you are when you take the meds the greater probablity you'll be sick on them. We then recieved a certificate stating they had gone through the treatment (and told they would always test positive so they need to show the paper instead of having a TB test or they could end up doing the treatment again).
Get the TB test, if it's negative your good, if not there are options. The government did pay for the 9 months of medications (after our 25$ copay). Just happy to have it behind us now. We have met two other families who have done the blood test (one positive one negative, both had had positive TB skin tests).

Healy Family said...

We brought our daughters home from Ukraine on 9-15-2009 and the very next week had them in for physicals. Both of their Tb tests were positive and then we immediately had the chest xrays as well - both were clear. We were issued the Isoniazid for 9 months as well, also at the expense of the health department who sent it right to the docs office for us to pick up. no cost and no copay. my friend who worked at the health department at the time said that since Tb is a public health issue the medication is issued for no charge. the girls were 10 and 11 when they started the Isoniazid and also took for 9 months with no knows side effects. This was such interesting information on the blog - thank you for passing it along!