Volume 186 - Issue 6
Immunisation coverage in refugee children
Authors: Kylee J Parsons, Maggi Osbourn, David N Durrheim and Murray T Webber
Med J Aust 2007; 186 (6): 323. || doi: 10.5694/j.1326-5377.2007.tb00916.x
Published online: 19 March 2007
Published online: 19 March 2007
To the Editor: Refugees are a particularly marginalised group, often originating from countries where immunisation coverage is low.1 As vaccine-preventable diseases such as hepatitis B and measles are endemic in both their countries of origin and the countries in which they spend time in displaced persons camps, the potential burden of disease for refugees is greater than for Australians.2 It is important to determine whether our health systems provide refugees with access to optimal health care, including vaccines.
From May 2004, refugee families arriving in Newcastle, New South Wales, have attended the Newcastle Refugee Clinic, where, with the assistance of interpreters, health screening is provided and catch-up vaccination regimens are commenced according to the Australian Standard Vaccination Schedule.3 Vaccines administered are documented in an appropriate personal health record. All age-appropriate vaccines are registered with the Australian Childhood Immunisation Register (ACIR). Families are provided with a copy of the catch-up schedule and, through interpreters, are advised to complete their vaccination schedule through a general practitioner. In NSW, general practices can obtain free vaccines for refugees through public health units.
In March and April 2006, there was an outbreak of measles in NSW. A review of ACIR records of refugee children seen over the previous 12 months (May 2005 to April 2006) at our clinic showed that, of the 35 children aged under 7 years, all were overdue for subsequent vaccinations, and only two children had received any additional vaccines after their Refugee Clinic visit. By contrast, vaccination coverage for all children in the Greater Newcastle area is high, and exceeds 90% for scheduled vaccines. Older members of refugee families also required additional vaccines, highlighting concerns that refugee families are not attending general practices for this basic preventive health care measure. While the reasons for this are unclear and need further research, it is likely that multiple factors, including lack of knowledge of the health system, lack of transport, no local government or community vaccination services, and lack of bulk billing by general practices, all play a role. Further, a number of local general practices have closed their books and do not accept new patients.
Consequently, catch-up vaccination sessions were conducted at the Refugee Clinic, and transport was provided. Home visits were conducted for families unable to attend these clinics. Seventy-seven people were vaccinated and 209 vaccine doses administered.
A thorough assessment of refugees for important medical and psychological conditions is merited soon after they arrive in Australia.4 It is also essential that early access to general practice is secured for continuity of care and completion of vaccination. It is the responsibility of all — the Department of Immigration and Citizenship, contracted resettlement organisations, proposers, public health services and general practitioners — to ensure that vaccinations are accessible to newly arrived refugees. We believe they deserve the same protection against vaccine-preventable diseases as other Australians.
References
- World Health Organization, UNICEF, World Bank. State of the world’s vaccines and immunization. New York: UNICEF, 2002. 0_CBBIFCGG
- Schwarzwald H. Illnesses among recently arrived immigrated children. Semin Pediatr Infect Dis 2005; 16: 78-83. 0_CBBFFFCJ
- National Health and Medical Research Council. Australian immunisation handbook. 8th ed. Canberra: NHMRC, 2003: 43. 0_CBBDBABG
- Smith MM. Refugees in Australia: changing faces, changing needs. Med J Aust 2006; 185: 587-588. 0_CBBEFHIE
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