Immigrants and refugees

Immunisation for immigrants and refugees, as covered in the Immunisation Handbook 2017.

Note: The following information is an extract from the Immunisation Handbook 2017.

Immigrants and refugees

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 the 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 Eligibility section.

Children who have been previously immunised in low-income country may have received BCG, three doses of DTwP and oral polio vaccine (and/or IPV) 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, HepB, MMR or VV. Many countries, including European countries, do not have HepB 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). The programme may require modification for any documented doses: only clearly documented doses should be considered as given.

Details of immunisation schedules of other countries can be found on the World Health Organization website. See also the Recommendations for Comprehensive Post-Arrival Health Assessment for People from Refugee-like Backgrounds (2016 edition), available on the Australasian Society for Infectious Diseases website.

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.

Suspected TB must be appropriately investigated. If individuals 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 TB who:

  • will be living in a house or family/whānau with a person with either current TB or a history of TB
  • have one or both parents or household members or carers who within the last five years lived for a period of six months or longer in countries with a rate ≥40 per 100,000
  • during their first five years will be living for three months or longer in a country with a rate ≥40 per 100,000 (see Appendix 8 for a list of the high-incidence countries).

Hepatitis B

If a member of an immigrant or refugee family is found to have chronic HBV 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 HBV 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.

Varicella

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

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