Medical Issues

Medical Tests for New Intercountry Arrivals

Take this list of tests to your doctor upon the arrival of your internationally adopted child

Children entering Canada from overseas may not have been tested for hepatitis, tuberculosis, syphilis or parasitic infections. As well, some children may not have been immunized, children have arrived in Canada with the above conditions.

Medical Disease Screening

It is recommended that all children have age-appropriate screening test, including an evaluation for anemia, visual and hearing impairments and assessment of growth and development.

Families should provide the family doctor with as much information as is known about their child.


Unless there is clear, written documentation of prior immunization, it is sensible to begin a routine immunization schedule for children not immunized in early infancy (Health Canada: Canadian Immunization Guide, 4th Edition, 1993). There is little risk in inadvertently repeating immunizations.

Internationally adopted children should receive these tests:

  • Complete blood count and red cell indices
  • Blood lead level
  • Serology for Syphilis
  • Hepatitis B profile to include hepatitis B surface antigen and antibodies to hepatitis B surface and antigen**
  • Hepatitis C
  • HIV-1
  • Stool sample for ova and parasites***
  • PPD (mantoux) &chest X ray (if not already done)
  • Urinalysis

** If your child is found to be a carrier of hepatitis B, you and your family should be immunized.

*** Intestinal parasites are common in many parts of the world. They may not be causing your child symptoms, but knowing their presence will help prevent transmission to others. If your child has loose stools, other tests may be appropriate.

Hepatitis B

Please review the informative letter to parents developed by Dr. Margaret Lawson, volunteer medical consultant with The Children’s Bridge adoption agency. The letter was written to assist adoptive parents to understand the issues around Hepatitis B. Dr. Lawson is a paediatrician at the Children’s Hospital of Eastern Ontario (CHEO) in Ottawa, specializing in pediatric endocrinology (hormone problems in children). In writing this letter, Dr. Lawson obtained assistance from the infectious disease department at CHEO.

Although the likelihood of Hepatitis B infection is relatively remote, this letter sets out preventive precautions that families should consider and discuss with their doctor. For further information, you may also want to read the article on Hepatitis B published in the March 2002 Children’s Bridge Newsletter.


Thank you to the following people for their assistance with this information:

  • Dr. Dana Johnson, Prof. Of Pediatrics, International Adoption Clinic, University of Minnesota
  • Dr. Simon Dobson, Pediatric Specialist in Infectious Diseases, Children’s Hospital in Vancouver, B.C
  • Dr. Elinor Ames, Prof. Psychology Dept. Simon Fraser University

Health Concerns while Travelling

Food & drink

All water should be regarded as being a potential health risk. Water used for drinking, brushing teeth or making ice should have first been boiled or otherwise sterilised. Contaminated tap water contains a high prevalence of gastrointestinal infections. The water supply in St Petersburg especially has been linked to giardiasis. Milk is pasteurised and dairy products are safe for consumption. Only eat well-cooked meat and fish, preferably served hot. Pork, salad and mayonnaise may carry increased risk. Vegetables should be cooked and fruit peeled.

Other risks

Dysentery is common throughout the country. Hepatitis A occurs. Widespread outbreaks of diphtheria have been reported. Consult a doctor regarding inoculation before travelling to Russia. Tick-borne typhus has been reported from east and central Siberia. Tick-borne encephalitis and Lyme disease occur in forested areas throughout the Russian Federation. Vaccination is advisable. Outbreaks of Japanese Encephalitis have been reported from the southeast. Leishmaniasis occurs in the south, and in 1999 an outbreak of Crimean-Congo haemorrhagic fever occurred in the area north of Stravapol. Outbreaks of meningitis have been reported from Volgograd.

Rabies is present and increasing. For those at high risk, vaccination before arrival should be considered. If you are bitten, seek medical advice without delay. For more information consult the Health appendix.

Health care

The highly developed health service provides free medical treatment for all citizens. If a traveller becomes ill during a booked tour, emergency treatment is free, with small sums to be paid for medicines and hospital treatment. If a longer stay than originally planned becomes necessary because of the illness, the visitor has to pay for all further treatment. This can be very expensive; air evacuation can cost up to £80,000. All visitors are strongly advised to have full medical cover that includes medical evacuation. It is advisable to take a supply of medicines that are likely to be required (check first that they may be imported legally). A reciprocal health care agreement is in operation between the UK and Russia, allowing citizens to receive free treatment. Private medical care can be expensive.