CDC Tuberculosis Rule Slows International Adoption The CDC now requires that internationally adopted children with TB be treated in their home countries. For 4-year-old Harper that meant two weeks in a Beijing hotel with her new parents, instead of a flight to her new home in Virginia.
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CDC Tuberculosis Rule Slows International Adoption

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CDC Tuberculosis Rule Slows International Adoption

CDC Tuberculosis Rule Slows International Adoption

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From NPR News, this is ALL THINGS CONSIDERED. I'm Melissa Block.


And I'm Robert Siegel.

There's always been a requirement that adult immigrants to the U.S. be tested for tuberculosis. They have to be cleared of the infection before they can enter the country. But the rule did not apply to immigrant children or adopted children.

The Centers for Disease Control and Prevention now wants internationally adopted children over the age of two to be tested for TB in their country of origin before they can enter the U.S. And in some countries, including Ethiopia and China, that means Americans are having to leave without the children they adopted.

NPR's Brenda Wilson reports.

BRENDA WILSON: Jay Scruggs and Candace Litchford spent the first weeks of this month in Beijing, getting to know a little 4-year-old girl they have adopted. They named her Harper.

Ms. CANDACE LITCHFORD: She loved to draw, and we're both architects so we spent a lot of time drawing. Just her getting used to us, us getting used to her. She has to learn how to trust us, you know? And she was willing to do all that. She was so trusting and loving. And by day three, I could not leave the hotel room without her by my side. If she saw me put my shoes on, she'd ran over and she'd put her shoes on, you know? With Jay, I think it took a little longer.

Mr. JAY SCRUGGS: She didn't really much care if I left.

(Soundbite of laughter)

WILSON: As they bonded with Harper, they were also filling out a lot of papers from the orphanage to prepare to leave China and bring her home.

Ms. LITCHFORD: Our translator had taken them home to translate. And when he came back the next day, in the translation, it said: This child has TB. Unfortunately, it was something that our agency missed.

WILSON: Harper wasn't coughing. She didn't appear to be sick. But because of the recent change in CDC rules, internationally adopted children over the age of two will not be granted a U.S. visa until they have been tested for tuberculosis and treated.

There is a waiver that would allow Harper to travel to the U.S. if the CDC determined she was no longer contagious. That meant, Candace says, Harper would have to undergo the same procedures that had already been conducted by Chinese doctors, only this time with doctors approved by the CDC.

Ms. LITCHFORD: She spent one month in the hospital on IV treatment. She was on treatment another month in the orphanage. But even so, the CDC is still requiring that she do these three supervised sputum cultures. And then you have to wait for 42 days for them to be processed.

WILSON: Jay and Candace had a child and jobs at home they had to get back to. They had to leave Harper in China.

The general consensus is that the vast majority of kids with TB aren't contagious because they don't have the violent coughs adults do that spread the disease. So children under 15 entering the U.S. weren't tested for TB.

But Dr. Ken Castro, head of the CDC's Division of TB Elimination, says there have been outbreaks of the disease in the U.S. among immigrants.

Dr. KEN CASTRO (Director, Centers for Disease Control and Prevention's Division of TB Elimination): These were usually children who lived in a household where the adult had tuberculosis. And not being able to identify them then resulted in the local health department having to deal with the consequences of having missed the diagnosis. Sometimes these children were in school, they had to investigate other schoolchildren.

Dr. JEFFREY STARKE (Director, Children's Tuberculosis Hospital): There is no hard-fast age cutoff. And the issue really is not the age of the patient. The issue is the kind of tuberculosis they have.

WILSON: Dr. Jeffrey Starke is the director of the Children's Tuberculosis Hospital in Houston. He says infectious TB in children is so rare they don't isolate the vast majority of the children with TB in their hospital.

Dr. STARKE: We know they're not contagious and we have lots of data, skin testing our own employees, for instance, knowing that no transmission of tuberculosis is occurring.

WILSON: Starke says the problem is that because children weren't tested, they weren't getting treated. But now, he thinks the CDC has gone too far.

Dr. STARKE: From the pendulum being way on the side of not providing children any services, it swung over to the side of making rules that are, in fact, preventing children from coming into the United States, children for whom it's completely safe. In fact, in their best interest that they be in the United States so they can be appropriately diagnosed and treated.

WILSON: In the meantime, visitors to the United States and children of any age born to Americans living outside of the U.S. are not screened for TB when they return. But adoptions of children in Ethiopia, the Philippines and China have been stalled because of the rule.

Dr. Martin Cetron, the CDC's director of Global Migration, says:

Dr. MARTIN CETRON (Director, Centers for Disease Control and Prevention's Division of Global Migration): It's not about exclusion. It's about finding TB cases that might not otherwise have been found until much later, when the disease might be worse in those children, when there might be drug resistance, when there might be risks of spread to others however small that may be.

WILSON: Dr. Cetron says the CDC intends to meet with adoption groups, parents and tuberculosis experts to come up with a smoother process.

But Candace Litchford says Harper is not going to understand why her parents went away for three weeks.

Ms. LITCHFORD: You can't explain government to a child. You can't explain CDC regulations to a child.

WILSON: NPR learned yesterday that the CDC has granted Harper a waiver. She's coming to the U.S. soon. But Harper received treatment. How the government will handle cases involving untreated children is less certain.

Brenda Wilson, NPR News.

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