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International Adoptees and Hepatitis B Virus Infection-Reply

MARGARET K. HOSTETTER, MD; DANA E. JOHNSON, MD, PHD
Am J Dis Child. 1990;144(5):523-524. doi:10.1001/archpedi.1990.02150290017014.
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In Reply.—The letter from Dr Murray

raises several important issues regarding screening and counseling for HBV infections in internationally adopted children. Dr Murray and his colleagues are to be congratulated for the screening program they have initiated in young infants who are placed for adoption through the Holt agency in Seoul, South Korea.1 However, not all infants are adopted at 3 to 4 months of age; indeed, in our study of international adoptees from Korea, India, and Central/South America, the mean age at adoption was 17.3 months, with a median age of 7 months, a time at which passively transferred maternal antibodies should have waned.2 As Dr Murray points out, a small percentage of HBV-infected children were missed by testing for the HBsAg alone.1 Our experience was of even more concern in that more than 50% of our patients with HBV infections would have been misdiagnosed had only

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