Contents

4 Immunisation of special groups

4.4 Immigrants and refugees

4.4.1 Introduction

Adults and children who enter New Zealand as refugees or immigrants will need an assessment of their documented vaccination status and an appropriate catch-up programme planned.

Regardless of their immigration and citizenship status, all children aged under 18 years are eligible to receive Schedule vaccines, and providers can claim the immunisation benefit for administering the vaccines (see the ‘Eligibility for publicly funded vaccines’ section in the Introduction to this Handbook). All children are also eligible for Well Child Tamariki Ora services, regardless of immigration and citizenship status. For more information about eligibility for publicly funded services, see the Ministry of Health website (www.health.govt.nz/eligibility).

Children who have been previously immunised in a developing country may have received BCG, three doses of DTwP and OPV in the first six months of life, and a dose of measles vaccine between 9 and 15 months of age. However, they are unlikely to have received Hib, pneumococcal or MMR vaccine. Many countries, including European countries, do not have hepatitis B vaccine included in their national childhood immunisation schedule. For immigrant children a catch-up immunisation plan may be needed.

If a refugee or immigrant has no valid documentation of vaccination, an age-appropriate catch-up programme is recommended (see Appendix 2). Documented vaccine doses should be taken into account when planning a catch-up programme that complies with the Schedule.

Details of immunisation schedules of other countries can be found at the WHO website (http://apps.who.int/immunization_monitoring/ globalsummary/schedules).

4.4.2 TuberculosisTop

Tuberculosis (TB) is an important public health problem for refugees and immigrants. Figures from the US show that approximately 1–2 percent of refugees are suffering from active TB on arrival, and about half have positive tuberculin skin tests. The number who have received BCG immunisation is unknown. In New Zealand there is a significant increasing trend in the number of TB cases in overseas-born people.

It is important that all refugee children with suspected TB be appropriately investigated. If they are known to have been recently exposed but tests are negative, they should be tested again three months later to identify recently acquired infection. Previous BCG immunisation should be considered when interpreting tuberculin skin test results (see chapter 20).

In New Zealand, the policy is to offer BCG vaccination to infants at increased risk of tuberculosis who:

4.4.3 Hepatitis BTop

The Pacific Islands and most of Asia (except Japan and India) are regions with a high prevalence of chronic hepatitis B infection. If a member of an immigrant or refugee family is found to have chronic hepatitis B infection, it is recommended that all the family be screened and immunisation offered to all those who are non-immune. Even if no one in the family has chronic hepatitis B infection, it is recommended that all children aged under 18 years be vaccinated against hepatitis B. See chapter 8 for more information and Appendix 2 for catch-up schedules.

4.4.4 VaricellaTop

People who have grown up in the tropics are less likely to have had chickenpox and may be non-immune adults. Because adult chickenpox can be severe, if there is no history of chickenpox, varicella vaccine should be offered (although it is currently not funded).