To the Editor: On 1 November 2005, the Australian states and territories introduced quadrivalent, pentavalent or hexavalent vaccines for childhood immunisations. This simplifies vaccination for young children, but may impair the ability of health services to provide primary immunisation for refugees over the age of 8 years.

The Australian refugee and humanitarian program targets refugees from many countries that have poor primary health infrastructure. In the 2004–05 financial year intake, at least 75% of the 12 096 entrants under the offshore resettlement program came from countries that had immunisation coverage rates below 50% in the 1990s.1,2 Adolescents and adults from these countries generally have patchy vaccination histories and no records. According to Australian guidelines, they warrant full catch-up vaccination, often involving a primary vaccination course.3

Primary vaccination against tetanus, diphtheria and pertussis requires three doses of vaccine. The dose of diphtheria toxoid in vaccines for children or adults over 8 years of age is significantly lower than in early childhood preparations because of potential adverse effects. In 2004, the conjugated pertussis–adult diphtheria–tetanus vaccine for adolescents (Boostrix, GlaxoSmithKline) was introduced to the immunisation schedule to provide boosters against pertussis, diphtheria and tetanus. However, Boostrix has no proven efficacy for primary vaccination against pertussis and is not recommended for adolescents and adults who have no primary cover against pertussis.3,4 As monovalent pertussis vaccine is not available, refugees over the age of 8 years cannot be provided with a primary vaccination course against pertussis.

Adult diphtheria–tetanus vaccination (ADT) is the most-used primary vaccine for refugees over the age of 8 years. After the introduction of Boostrix, many state and territory health departments reduced their supply of ADT to immunisation providers. Some refugee health services have attempted to meet demand for ADT by collating individual doctors’ stocks provided under the Emergency Drug (Doctors Bag) supplies section of the federally-funded Pharmaceutical Benefits Scheme, which provides for up to 15 doses of ADT per month. But this is a cumbersome and unsustainable strategy. Some jurisdictions, such as the Australian Capital Territory, supply ADT directly to refugee health service providers.

All the new polyvalent childhood vaccines include inactivated polio vaccine. Unless states and territories procure monovalent polio vaccine, primary vaccination against polio for people over 8 years will remain inadequate.

People from refugee backgrounds warrant the same level of protection against vaccine-preventable diseases as other Australians. The level of protection may be reduced by failure to provide suitable vaccines. We encourage state and territory health departments to stock sufficient vaccines for adult and adolescent refugees, including ADT and monovalent inactivated polio vaccine. We also recommend that the Australian Technical Advisory Group on Immunisation provide detailed advice on the needs of refugees when crafting immunisation guidelines.