In making its recommendation, ACIP considered the likelihood that a child adopted by parents in the United States might be actively infected with HAV and shedding virus at the time of adoption. During 1998-2008, approximately 18,000 children (range: 15,583 to 22,884) were adopted from foreign countries by families in the United States each year.* Approximately 99.8% of these children came from countries where hepatitis A is considered to be of high or intermediate endemicity,2 and approximately 85% of were aged <5 years. Country-specific policies pertaining to foreign adoption are changing constantly, leading to rapid changes in the numbers of international adoptees entering the United States from various countries. Although South Korea was the most common country of origin for adoptions in the United States in the early 1990s, Russia and China became prominent in international adoption in the late 1990s, and currently the largest numbers of adopted children come from Guatemala, China, Russia, and Ethiopia. The incidence of HAV infection is highest in these countries among children aged <5 years, when HAV infection is likely to be asymptomatic.