Getting your child tested for TB is one of the most important things you can do to ensure your child's health after homecoming. Tuberculosis is an infectious disease that commonly affects the lungs of an infected person, but can infect any part of the body. It is very common in Ethiopia, which means our kids are ALL at high risk for having been exposed to TB.

TB is spread through the air when an infected person coughs. It first settles in the lungs. As the disease progresses it can spread to other parts of the body. People with TB are most likely to spread it to people they spend time with every day.

Adoptive families need to test their kids for TB exposure twice-- first, immediately after homecoming, and again 3-6 months after arrival. The second test is necessary because it is possible that a child could be exposed just as the child left Ethiopia and a test immediately on homecoming might not yet show exposure. I personally know half a dozen families whose kids tested negative on homecoming, then tested positive 6 or 8 months later.

Kids will probably have been tested for TB in Ethiopia as well, but there is no guarantee that a child won't get exposed after the test was done there. Also, TB tests done in countries outside the U.S. are not made from standardized materials and may be of poor quality. It is extremely important to get your child tested after homecoming.

TB testing (also known as PPD testing) consists of injecting a tiny amount of liquid just under the skin on the forearm, then waiting 48 hours and checking for a red, raised mosquito-bite-like reaction. If the test is non-reactive or negative, get your child retested after 3-6 months home, and then you're done.

If the test is positive, it is essential that your child gets two things: first, a chest x-ray to check for signs of active TB, and then 9 months of treatment with a medication called Isoniazid.

If a child tests positive but has a negative chest x-ray, he is considered to have latent TB. People with latent TB do not feel sick, do not have any symptoms, and cannot spread TB. However, they may develop active TB at some time in the future, so it is essential to take medicine to avoid developing active TB.

Occasionally a pediatrician will see a positive reaction to the TB test with a negative chest x-ray and attribute it to the fact that the child had a BCG vaccine in Ethiopia. However, the expert literature is very clear that if a child from an at-risk country like Ethiopia shows a reaction, treatment with INH Isoniazid is the safest course of action anyway.

Several years ago, a family from my agency had an infant who tested mildly positive, but had a clear chest x-ray. Her pediatrician thought it was because she had received the BCG vacine, and opted to wait and see without giving her medication. Unfortunately, the child died three months later of TB that had spread throughout her whole body. TB is NOT something you take chances with.

Having said that, please don't be terrified for your whole family if your child tests positive. A child with latent TB can NOT give another family member TB. Only someone with active TB can pass it on to someone else. And even in the case of active TB, children rarely pass TB on to other people because they don't cough hard enough to send the germs as far as adults.

However, if your child tests positive, it is wise to get other traveling family members tested too, since both of you may have been exposed while in Ethiopia. One final note: please keep in mind that although this is correct information to the best of my knowledge, it does NOT replace real true medical advice.

Additional resources
The Orphan Doctor – Jane Aronson

American Thoracic Society -- Tuberculosis in
Adults and Children.
About.com -- Tuberculosis facts for parents