Ask the Doctor: Immunizations

Our medical expert explains how to ensure adopted children have the immunity they need when medical records are inaccurate, or incomplete.

Immunization records for adopted children

Q: We don’t know whether our recently adopted child’s immunization record is accurate. Also, shes missing several immunizations. What should we do?


A: It is often difficult, or even impossible, to be sure that a child adopted internationally or from the U.S. foster-care system was adequately protected against childhood diseases.

Immunization records may be incomplete and/or inaccurate; vaccinations may have been given at too young an age to ensure immunity; or a child may have received out-of-date or unrefrigerated vaccines. Children adopted from foster care may have seen multiple providers — possibly in different states — or visited doctors only for emergency care. Without routine checkups, a child could have missed multiple recommended immunizations.

Whatever the situation, the medical consensus is clear: It is critical to take action to ensure your child’s immunity.

In the face of an uncertain vaccination history, physicians generally take one of three approaches, depending on parents’ preferences and a child’s adoption history: one, repeat all immunizations; two, check antibody levels and vaccinate as necessary; or three, a combination of the two, depending on the child’s circumstances.

Each approach has its pros and cons, so parents must make the decision that makes sense to them. Because various insurance companies treat the question of reimmunization differently, cost will inevitably be a factor. Check your insurance coverage before discussing the options with your physician.


For the most part, children can be reimmunized without undue effects. Because of this, many physicians choose to disregard a child’s immunization record, starting vaccinations again from the beginning and giving the number of doses appropriate to the child’s age.

This course of action is often taken in cases when a vaccine isn’t mentioned in the child’s record or was given at the wrong age. In addition, some physicians discount any immunizations that were given outside the U.S. (with the exception of those given to children in South Korea or Guatemala, countries where health care is thought to be comparable to that of the U.S.).

Checking Antibody Levels (Titers)

This option involves determining the child’s current immunity status by checking antibody levels, also known as titers, from a blood sample.

For parents who are cautious about immunization, checking antibody levels provides an alternative to reimmunizing across the board, though some children may be hesitant about procedures where blood is drawn.

When a child’s immunization record clearly shows dates for vaccines administered, parents can still check antibodies for most of the basic vaccinations, including polio, hepatitis A and B, measles/mumps/rubella (MMR), and diphtheria/tetanus/pertussis (DTaP). If antibodies can be verified, a child simply receives booster shots as needed. If the levels don’t correspond to the vaccination record, the child can be reimmunized.

Checking antibody levels is particularly useful for children adopted from the foster care system; their records may be incomplete or missing, but their vaccinations-to-date have probably followed the recommended U.S. schedule.

Tailoring the Approach

Depending on the child’s adoption history, physicians may tailor their recommendation by combining approaches. Some physicians reimmunize all children who are under a year old at the time of placement, but check titers for children adopted at older ages. Others reimmunize with certain vaccines, but check titers to decide about others. For example, the DTaP inoculation can leave young patients with sore arms, so some physicians check titers to see if they can avoid repeating it.

Discuss your options with your physician to find your family’s best fit. For the most up-to-date information about immunization, download the complete U.S. schedule for recommended and catch-up vaccines.

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