Immigrant health ndash immunisation
November 2016
Georgie Paxton
Outline
bull New intakes
bull New screening ndash offshore and onshore
bull New challenges ndash No Jab No Pay
2001 Somali
2013 BVE CD
2008 Karen Chin
2012 Iran
Afghan
2006 Other
African
2005 Sudan
2016
SyrianIraqi
2014 Held
2015 Held
Nauru
httpdataunhcrorgsyrianrefugeesregionalphp
Victorian settlement
bull Expect ~4000 + component regular intake
bull 85 linked
bull Current communities NSW (60) and Vic (rest)
bull High proportion children
bull 50 total = children
bull 17 total = lt4y
bull 21 total = 4-11y
68 linked ndash 202 visa
AMES Australia quarterly HSS statistics ndash July ndash September 2016
NSW
bull August ndash October 2016
bull 963 cases ndash 3513 individuals
bull 82 linked
bull 93 Iraqi and Syrian
bull 236 individuals aged gt 65y
Mitchell Smith NSW Refugee Health Service December 2016
Syrian health systems
bull 60 public hospitals out of service
bull 60-70 reduction pharmaceutical production
bull gt50 doctors have left (gt70 in parts)
bull Immunisation
bull Vaccination programs disrupted since 2011
bull 95 2010 -gt 45 2013
httpwwwrchorgauimmigranthealthclinicalsyrian-refugees
Immunisation schedule by country
httpappswhointimmunization_monitoringglobalsummaryschedules
Polio - Syria
bull WHO ndash outbreak 2013
bull 38 cases
bull Mostly young (lt2y) unimmunised
bull Serotype 1 sim envt strains Egypt Pakistan Israel
bull Nil in 2014
bull BUT Syrian opposition humanitarian arm lsquoAssistance Coordination Unitrsquo (ACU) reported 105 cases of acute flaccid paralysis
Polio
Measles
REFUGEE APPLICANT
ONSHORE
ASYLUM SEEKER
OFFSHORE
HUMANITARIAN ENTRANT
1) DETENTION HEALTH2) POST-RELEASE3) AT SUBSTANTIVE VISA
1) IME (MANDATED)2) DHC (VOLUNTARY)3) POST-ARRIVAL (VOL)
Departure Health Check (DHC) Humanitarian (Voluntary ndash 3d lt travel)
Exam parasite checkMalaria RDT and Rx if positive (location)
CXR and HIV if PHx TBAlbendazole ge 1 y
MMR 9m ndash 54y+- YF vaccine
+- Polio vaccineAx local conditions
+- Repeat IME
Immigration Medical Exam (IME) - all(Compulsory 3ndash12 m prior to travel)
HxExamTB screen 2-10y
CXR ge 11yHIV ge 15yFWTU ge 5y
HBsAg (pregURMHCW)
HCV (HCW)
Syphilis (Humanitarian)
OutcomesFitness to fly assessment
Alert (Red General)+- Health Undertaking
Character requirement
AustraliaPost arrival health screening
Voluntary
AUSCO
Outcomes+- Visa
Alert (Red General)Health Undertaking +- delay travel
Pre-departure health screen (offshore)
Syrian cohortsCombined IME and DHC
HxExam TB screen 2-10y ndash IGRA or TST
CXR ge 11yHIV ge 15yHBsAg (all)FWTU ge 5y
AlbendazoleFull 1st dose catch-up immunisations
Mental health screenDevelopment screen (lt5 y)
Offshore screening ndash Syrian and Iraqi cohorts
bull Immigration Medical Examination and DHC
bull Will include immunisation
bull Plan (11115 ndash Lebanon Turkey Jordan)bull lt10 years = MMR OPV penta (no hexa avail)
bull 10 years + = MMR OPV dTPa
bull Equivalent 1st dose catch-up
bull Challenges with information transfer
bull Difficulties sourcing MMR Jordan (and cases at the time)
OPV vs IPV
bull OPVbull Stopped Victoria 2005bull Excreted 6 weeks
bull Faecal specimen pick up
bull Highly effective immunity (95 3 doses) inc gutbull Prevents wild type infection
bull IPVbull Highly effective paralytic (99 3 doses) less gut
bull Can still get wild-type infection
bull Not recommended pregnancyBF
bull Seroconversion sl lower combination OPV and IPV (sero 3)
OPV only form available
httpswwwasidnetauresourcesclinical-guidelines
httprefugeehealthnetworkorgauengageimmunisation-working-group
April 2015 -httpparlinfoaphgovauparlInfosearchdisplaydisplayw3pquery=Id3A22media2Fpressrel2F377023622
No jab no pay - no plan for migrants
bull Prior to Jan 2016 upper age limit ACIR 7ybull Any child arrivingvaccinated after 7y ndash not on ACIR
bull Centrelink letters (all 27 of themhellip)
bull Establishing prior vaccinationbull Mobile populationsbull Many years agobull Lack of records
bull Duplicationsbull Appointmentsbull Serologybull Vaccines
bull Medical exemptions ndash GPs only
20m Hexa 13 13vPCV MMR-V 22 if had offshore Men C 11 DT-containing dose 4 and 5 IPV dose 4 and check HBV serol (sib infection)
3y MMR-V 22 if had offshore Hexa 13 no Hep B (infection) 13vPCV 11 Men C 11 will need DT-containing dose 4 and IPV dose 4
12 y dTpa 13 then dTnext 2 doses IPV 13 MMR-V 22 if had offshore Hep B adult formulation 12 MenC high school ndash HPV VV dTpa ndash factor in
7 y Hexa 13 no MMR (immune) VV 11 MenC 11 DT-containing dose 4
6 y no Hep B (infection) give DTPa 13 amp IPV 13 or hexa 13 MMR-V 22 MenC DT-containing dose 4
Any recordsAny serologyAny vaccinestimingHx varicellaSchedule changesAnything else ndash eg HH
Associated ACIR issues
bull Workloaddelaysbull Batch errorsbull Longer for offshore (3w)bull Faxed records (8w)
bull Catch-up incentives bull lt7y onlybull Not structured to support best practice
bull Specialist registrationbull Due-overdue rules hepatitis Bbull ACIR notification payment - quirks
httpsmygovaumygovcontenthtmlhelphtml
New challenges
bull Department Health
bull Proposal to broaden immunisation Humanitarian entrants
bull In accordance with NIP ndash where
bull Operationally feasible
bull Clinically relevant
bull Time allows
Concerns
bull Many countries
bull Many schedules
bull Supply issues
bull No process to transfer offshore to ACIRbull Reliant on paperwork
bull My thoughts ndash DT-containing polio MMRbull Use hexa or penta where available in lt 10y
bull 2nd 3rd set could be the same
New challenges
bull Numbers ndash and complexity of catch-up in context screening
bull ACIR -gt AIRbull Measurement subgroups
bull Asylum seekers ndash TPV
bull After end 2017 ndash catch-up vaccination fundings
bull Other migrant groups
Take home
bull Large number new arrivals ndash Northern regions
bull New offshore vaccination for Humanitarian entrantsbull Which may extend further
bull Paperwork is good (but not in ACIR)
bull Catch-up onshore still difficultbull Back to 202 visas
bull Immunisation policy ndash needs to consider migration
Acknowledgements
bull RCH Immunisation Service especially Sonja Elia for their assistance over many years
bull RCH Immigrant health team ndash Helen Milton Tatiana Polizzi Drs Andy Smith Shidan Tosif Hamish Graham Jane Standish Karen Kiang Sophie Oldfield Rowena Conroy Sanjay Patel Erin OrsquoRourke
bull Kirsten Gordon Yasmin Abubakar Sylvie Bui Hoang Jenny Kendrick our fabulous volunteers
bull Interpreting staff Amin Bhatat Mourteza Khorshidi Sabine MacDonald and many people over many years
bull RCH colleagues
bull RCH Executive and Melbourne Childrenrsquos Campus partners
bull Victorian Foundation for Survivors of Torture
bull Victorian Refugee Health Network
bull Department of Health Crystal Russell Pam Williams Martin Turnbull
bull Dr Mitchell Smith NSW Refugee Health
bull The children adolescents and families we see at RCH
Outline
bull New intakes
bull New screening ndash offshore and onshore
bull New challenges ndash No Jab No Pay
2001 Somali
2013 BVE CD
2008 Karen Chin
2012 Iran
Afghan
2006 Other
African
2005 Sudan
2016
SyrianIraqi
2014 Held
2015 Held
Nauru
httpdataunhcrorgsyrianrefugeesregionalphp
Victorian settlement
bull Expect ~4000 + component regular intake
bull 85 linked
bull Current communities NSW (60) and Vic (rest)
bull High proportion children
bull 50 total = children
bull 17 total = lt4y
bull 21 total = 4-11y
68 linked ndash 202 visa
AMES Australia quarterly HSS statistics ndash July ndash September 2016
NSW
bull August ndash October 2016
bull 963 cases ndash 3513 individuals
bull 82 linked
bull 93 Iraqi and Syrian
bull 236 individuals aged gt 65y
Mitchell Smith NSW Refugee Health Service December 2016
Syrian health systems
bull 60 public hospitals out of service
bull 60-70 reduction pharmaceutical production
bull gt50 doctors have left (gt70 in parts)
bull Immunisation
bull Vaccination programs disrupted since 2011
bull 95 2010 -gt 45 2013
httpwwwrchorgauimmigranthealthclinicalsyrian-refugees
Immunisation schedule by country
httpappswhointimmunization_monitoringglobalsummaryschedules
Polio - Syria
bull WHO ndash outbreak 2013
bull 38 cases
bull Mostly young (lt2y) unimmunised
bull Serotype 1 sim envt strains Egypt Pakistan Israel
bull Nil in 2014
bull BUT Syrian opposition humanitarian arm lsquoAssistance Coordination Unitrsquo (ACU) reported 105 cases of acute flaccid paralysis
Polio
Measles
REFUGEE APPLICANT
ONSHORE
ASYLUM SEEKER
OFFSHORE
HUMANITARIAN ENTRANT
1) DETENTION HEALTH2) POST-RELEASE3) AT SUBSTANTIVE VISA
1) IME (MANDATED)2) DHC (VOLUNTARY)3) POST-ARRIVAL (VOL)
Departure Health Check (DHC) Humanitarian (Voluntary ndash 3d lt travel)
Exam parasite checkMalaria RDT and Rx if positive (location)
CXR and HIV if PHx TBAlbendazole ge 1 y
MMR 9m ndash 54y+- YF vaccine
+- Polio vaccineAx local conditions
+- Repeat IME
Immigration Medical Exam (IME) - all(Compulsory 3ndash12 m prior to travel)
HxExamTB screen 2-10y
CXR ge 11yHIV ge 15yFWTU ge 5y
HBsAg (pregURMHCW)
HCV (HCW)
Syphilis (Humanitarian)
OutcomesFitness to fly assessment
Alert (Red General)+- Health Undertaking
Character requirement
AustraliaPost arrival health screening
Voluntary
AUSCO
Outcomes+- Visa
Alert (Red General)Health Undertaking +- delay travel
Pre-departure health screen (offshore)
Syrian cohortsCombined IME and DHC
HxExam TB screen 2-10y ndash IGRA or TST
CXR ge 11yHIV ge 15yHBsAg (all)FWTU ge 5y
AlbendazoleFull 1st dose catch-up immunisations
Mental health screenDevelopment screen (lt5 y)
Offshore screening ndash Syrian and Iraqi cohorts
bull Immigration Medical Examination and DHC
bull Will include immunisation
bull Plan (11115 ndash Lebanon Turkey Jordan)bull lt10 years = MMR OPV penta (no hexa avail)
bull 10 years + = MMR OPV dTPa
bull Equivalent 1st dose catch-up
bull Challenges with information transfer
bull Difficulties sourcing MMR Jordan (and cases at the time)
OPV vs IPV
bull OPVbull Stopped Victoria 2005bull Excreted 6 weeks
bull Faecal specimen pick up
bull Highly effective immunity (95 3 doses) inc gutbull Prevents wild type infection
bull IPVbull Highly effective paralytic (99 3 doses) less gut
bull Can still get wild-type infection
bull Not recommended pregnancyBF
bull Seroconversion sl lower combination OPV and IPV (sero 3)
OPV only form available
httpswwwasidnetauresourcesclinical-guidelines
httprefugeehealthnetworkorgauengageimmunisation-working-group
April 2015 -httpparlinfoaphgovauparlInfosearchdisplaydisplayw3pquery=Id3A22media2Fpressrel2F377023622
No jab no pay - no plan for migrants
bull Prior to Jan 2016 upper age limit ACIR 7ybull Any child arrivingvaccinated after 7y ndash not on ACIR
bull Centrelink letters (all 27 of themhellip)
bull Establishing prior vaccinationbull Mobile populationsbull Many years agobull Lack of records
bull Duplicationsbull Appointmentsbull Serologybull Vaccines
bull Medical exemptions ndash GPs only
20m Hexa 13 13vPCV MMR-V 22 if had offshore Men C 11 DT-containing dose 4 and 5 IPV dose 4 and check HBV serol (sib infection)
3y MMR-V 22 if had offshore Hexa 13 no Hep B (infection) 13vPCV 11 Men C 11 will need DT-containing dose 4 and IPV dose 4
12 y dTpa 13 then dTnext 2 doses IPV 13 MMR-V 22 if had offshore Hep B adult formulation 12 MenC high school ndash HPV VV dTpa ndash factor in
7 y Hexa 13 no MMR (immune) VV 11 MenC 11 DT-containing dose 4
6 y no Hep B (infection) give DTPa 13 amp IPV 13 or hexa 13 MMR-V 22 MenC DT-containing dose 4
Any recordsAny serologyAny vaccinestimingHx varicellaSchedule changesAnything else ndash eg HH
Associated ACIR issues
bull Workloaddelaysbull Batch errorsbull Longer for offshore (3w)bull Faxed records (8w)
bull Catch-up incentives bull lt7y onlybull Not structured to support best practice
bull Specialist registrationbull Due-overdue rules hepatitis Bbull ACIR notification payment - quirks
httpsmygovaumygovcontenthtmlhelphtml
New challenges
bull Department Health
bull Proposal to broaden immunisation Humanitarian entrants
bull In accordance with NIP ndash where
bull Operationally feasible
bull Clinically relevant
bull Time allows
Concerns
bull Many countries
bull Many schedules
bull Supply issues
bull No process to transfer offshore to ACIRbull Reliant on paperwork
bull My thoughts ndash DT-containing polio MMRbull Use hexa or penta where available in lt 10y
bull 2nd 3rd set could be the same
New challenges
bull Numbers ndash and complexity of catch-up in context screening
bull ACIR -gt AIRbull Measurement subgroups
bull Asylum seekers ndash TPV
bull After end 2017 ndash catch-up vaccination fundings
bull Other migrant groups
Take home
bull Large number new arrivals ndash Northern regions
bull New offshore vaccination for Humanitarian entrantsbull Which may extend further
bull Paperwork is good (but not in ACIR)
bull Catch-up onshore still difficultbull Back to 202 visas
bull Immunisation policy ndash needs to consider migration
Acknowledgements
bull RCH Immunisation Service especially Sonja Elia for their assistance over many years
bull RCH Immigrant health team ndash Helen Milton Tatiana Polizzi Drs Andy Smith Shidan Tosif Hamish Graham Jane Standish Karen Kiang Sophie Oldfield Rowena Conroy Sanjay Patel Erin OrsquoRourke
bull Kirsten Gordon Yasmin Abubakar Sylvie Bui Hoang Jenny Kendrick our fabulous volunteers
bull Interpreting staff Amin Bhatat Mourteza Khorshidi Sabine MacDonald and many people over many years
bull RCH colleagues
bull RCH Executive and Melbourne Childrenrsquos Campus partners
bull Victorian Foundation for Survivors of Torture
bull Victorian Refugee Health Network
bull Department of Health Crystal Russell Pam Williams Martin Turnbull
bull Dr Mitchell Smith NSW Refugee Health
bull The children adolescents and families we see at RCH
2001 Somali
2013 BVE CD
2008 Karen Chin
2012 Iran
Afghan
2006 Other
African
2005 Sudan
2016
SyrianIraqi
2014 Held
2015 Held
Nauru
httpdataunhcrorgsyrianrefugeesregionalphp
Victorian settlement
bull Expect ~4000 + component regular intake
bull 85 linked
bull Current communities NSW (60) and Vic (rest)
bull High proportion children
bull 50 total = children
bull 17 total = lt4y
bull 21 total = 4-11y
68 linked ndash 202 visa
AMES Australia quarterly HSS statistics ndash July ndash September 2016
NSW
bull August ndash October 2016
bull 963 cases ndash 3513 individuals
bull 82 linked
bull 93 Iraqi and Syrian
bull 236 individuals aged gt 65y
Mitchell Smith NSW Refugee Health Service December 2016
Syrian health systems
bull 60 public hospitals out of service
bull 60-70 reduction pharmaceutical production
bull gt50 doctors have left (gt70 in parts)
bull Immunisation
bull Vaccination programs disrupted since 2011
bull 95 2010 -gt 45 2013
httpwwwrchorgauimmigranthealthclinicalsyrian-refugees
Immunisation schedule by country
httpappswhointimmunization_monitoringglobalsummaryschedules
Polio - Syria
bull WHO ndash outbreak 2013
bull 38 cases
bull Mostly young (lt2y) unimmunised
bull Serotype 1 sim envt strains Egypt Pakistan Israel
bull Nil in 2014
bull BUT Syrian opposition humanitarian arm lsquoAssistance Coordination Unitrsquo (ACU) reported 105 cases of acute flaccid paralysis
Polio
Measles
REFUGEE APPLICANT
ONSHORE
ASYLUM SEEKER
OFFSHORE
HUMANITARIAN ENTRANT
1) DETENTION HEALTH2) POST-RELEASE3) AT SUBSTANTIVE VISA
1) IME (MANDATED)2) DHC (VOLUNTARY)3) POST-ARRIVAL (VOL)
Departure Health Check (DHC) Humanitarian (Voluntary ndash 3d lt travel)
Exam parasite checkMalaria RDT and Rx if positive (location)
CXR and HIV if PHx TBAlbendazole ge 1 y
MMR 9m ndash 54y+- YF vaccine
+- Polio vaccineAx local conditions
+- Repeat IME
Immigration Medical Exam (IME) - all(Compulsory 3ndash12 m prior to travel)
HxExamTB screen 2-10y
CXR ge 11yHIV ge 15yFWTU ge 5y
HBsAg (pregURMHCW)
HCV (HCW)
Syphilis (Humanitarian)
OutcomesFitness to fly assessment
Alert (Red General)+- Health Undertaking
Character requirement
AustraliaPost arrival health screening
Voluntary
AUSCO
Outcomes+- Visa
Alert (Red General)Health Undertaking +- delay travel
Pre-departure health screen (offshore)
Syrian cohortsCombined IME and DHC
HxExam TB screen 2-10y ndash IGRA or TST
CXR ge 11yHIV ge 15yHBsAg (all)FWTU ge 5y
AlbendazoleFull 1st dose catch-up immunisations
Mental health screenDevelopment screen (lt5 y)
Offshore screening ndash Syrian and Iraqi cohorts
bull Immigration Medical Examination and DHC
bull Will include immunisation
bull Plan (11115 ndash Lebanon Turkey Jordan)bull lt10 years = MMR OPV penta (no hexa avail)
bull 10 years + = MMR OPV dTPa
bull Equivalent 1st dose catch-up
bull Challenges with information transfer
bull Difficulties sourcing MMR Jordan (and cases at the time)
OPV vs IPV
bull OPVbull Stopped Victoria 2005bull Excreted 6 weeks
bull Faecal specimen pick up
bull Highly effective immunity (95 3 doses) inc gutbull Prevents wild type infection
bull IPVbull Highly effective paralytic (99 3 doses) less gut
bull Can still get wild-type infection
bull Not recommended pregnancyBF
bull Seroconversion sl lower combination OPV and IPV (sero 3)
OPV only form available
httpswwwasidnetauresourcesclinical-guidelines
httprefugeehealthnetworkorgauengageimmunisation-working-group
April 2015 -httpparlinfoaphgovauparlInfosearchdisplaydisplayw3pquery=Id3A22media2Fpressrel2F377023622
No jab no pay - no plan for migrants
bull Prior to Jan 2016 upper age limit ACIR 7ybull Any child arrivingvaccinated after 7y ndash not on ACIR
bull Centrelink letters (all 27 of themhellip)
bull Establishing prior vaccinationbull Mobile populationsbull Many years agobull Lack of records
bull Duplicationsbull Appointmentsbull Serologybull Vaccines
bull Medical exemptions ndash GPs only
20m Hexa 13 13vPCV MMR-V 22 if had offshore Men C 11 DT-containing dose 4 and 5 IPV dose 4 and check HBV serol (sib infection)
3y MMR-V 22 if had offshore Hexa 13 no Hep B (infection) 13vPCV 11 Men C 11 will need DT-containing dose 4 and IPV dose 4
12 y dTpa 13 then dTnext 2 doses IPV 13 MMR-V 22 if had offshore Hep B adult formulation 12 MenC high school ndash HPV VV dTpa ndash factor in
7 y Hexa 13 no MMR (immune) VV 11 MenC 11 DT-containing dose 4
6 y no Hep B (infection) give DTPa 13 amp IPV 13 or hexa 13 MMR-V 22 MenC DT-containing dose 4
Any recordsAny serologyAny vaccinestimingHx varicellaSchedule changesAnything else ndash eg HH
Associated ACIR issues
bull Workloaddelaysbull Batch errorsbull Longer for offshore (3w)bull Faxed records (8w)
bull Catch-up incentives bull lt7y onlybull Not structured to support best practice
bull Specialist registrationbull Due-overdue rules hepatitis Bbull ACIR notification payment - quirks
httpsmygovaumygovcontenthtmlhelphtml
New challenges
bull Department Health
bull Proposal to broaden immunisation Humanitarian entrants
bull In accordance with NIP ndash where
bull Operationally feasible
bull Clinically relevant
bull Time allows
Concerns
bull Many countries
bull Many schedules
bull Supply issues
bull No process to transfer offshore to ACIRbull Reliant on paperwork
bull My thoughts ndash DT-containing polio MMRbull Use hexa or penta where available in lt 10y
bull 2nd 3rd set could be the same
New challenges
bull Numbers ndash and complexity of catch-up in context screening
bull ACIR -gt AIRbull Measurement subgroups
bull Asylum seekers ndash TPV
bull After end 2017 ndash catch-up vaccination fundings
bull Other migrant groups
Take home
bull Large number new arrivals ndash Northern regions
bull New offshore vaccination for Humanitarian entrantsbull Which may extend further
bull Paperwork is good (but not in ACIR)
bull Catch-up onshore still difficultbull Back to 202 visas
bull Immunisation policy ndash needs to consider migration
Acknowledgements
bull RCH Immunisation Service especially Sonja Elia for their assistance over many years
bull RCH Immigrant health team ndash Helen Milton Tatiana Polizzi Drs Andy Smith Shidan Tosif Hamish Graham Jane Standish Karen Kiang Sophie Oldfield Rowena Conroy Sanjay Patel Erin OrsquoRourke
bull Kirsten Gordon Yasmin Abubakar Sylvie Bui Hoang Jenny Kendrick our fabulous volunteers
bull Interpreting staff Amin Bhatat Mourteza Khorshidi Sabine MacDonald and many people over many years
bull RCH colleagues
bull RCH Executive and Melbourne Childrenrsquos Campus partners
bull Victorian Foundation for Survivors of Torture
bull Victorian Refugee Health Network
bull Department of Health Crystal Russell Pam Williams Martin Turnbull
bull Dr Mitchell Smith NSW Refugee Health
bull The children adolescents and families we see at RCH
httpdataunhcrorgsyrianrefugeesregionalphp
Victorian settlement
bull Expect ~4000 + component regular intake
bull 85 linked
bull Current communities NSW (60) and Vic (rest)
bull High proportion children
bull 50 total = children
bull 17 total = lt4y
bull 21 total = 4-11y
68 linked ndash 202 visa
AMES Australia quarterly HSS statistics ndash July ndash September 2016
NSW
bull August ndash October 2016
bull 963 cases ndash 3513 individuals
bull 82 linked
bull 93 Iraqi and Syrian
bull 236 individuals aged gt 65y
Mitchell Smith NSW Refugee Health Service December 2016
Syrian health systems
bull 60 public hospitals out of service
bull 60-70 reduction pharmaceutical production
bull gt50 doctors have left (gt70 in parts)
bull Immunisation
bull Vaccination programs disrupted since 2011
bull 95 2010 -gt 45 2013
httpwwwrchorgauimmigranthealthclinicalsyrian-refugees
Immunisation schedule by country
httpappswhointimmunization_monitoringglobalsummaryschedules
Polio - Syria
bull WHO ndash outbreak 2013
bull 38 cases
bull Mostly young (lt2y) unimmunised
bull Serotype 1 sim envt strains Egypt Pakistan Israel
bull Nil in 2014
bull BUT Syrian opposition humanitarian arm lsquoAssistance Coordination Unitrsquo (ACU) reported 105 cases of acute flaccid paralysis
Polio
Measles
REFUGEE APPLICANT
ONSHORE
ASYLUM SEEKER
OFFSHORE
HUMANITARIAN ENTRANT
1) DETENTION HEALTH2) POST-RELEASE3) AT SUBSTANTIVE VISA
1) IME (MANDATED)2) DHC (VOLUNTARY)3) POST-ARRIVAL (VOL)
Departure Health Check (DHC) Humanitarian (Voluntary ndash 3d lt travel)
Exam parasite checkMalaria RDT and Rx if positive (location)
CXR and HIV if PHx TBAlbendazole ge 1 y
MMR 9m ndash 54y+- YF vaccine
+- Polio vaccineAx local conditions
+- Repeat IME
Immigration Medical Exam (IME) - all(Compulsory 3ndash12 m prior to travel)
HxExamTB screen 2-10y
CXR ge 11yHIV ge 15yFWTU ge 5y
HBsAg (pregURMHCW)
HCV (HCW)
Syphilis (Humanitarian)
OutcomesFitness to fly assessment
Alert (Red General)+- Health Undertaking
Character requirement
AustraliaPost arrival health screening
Voluntary
AUSCO
Outcomes+- Visa
Alert (Red General)Health Undertaking +- delay travel
Pre-departure health screen (offshore)
Syrian cohortsCombined IME and DHC
HxExam TB screen 2-10y ndash IGRA or TST
CXR ge 11yHIV ge 15yHBsAg (all)FWTU ge 5y
AlbendazoleFull 1st dose catch-up immunisations
Mental health screenDevelopment screen (lt5 y)
Offshore screening ndash Syrian and Iraqi cohorts
bull Immigration Medical Examination and DHC
bull Will include immunisation
bull Plan (11115 ndash Lebanon Turkey Jordan)bull lt10 years = MMR OPV penta (no hexa avail)
bull 10 years + = MMR OPV dTPa
bull Equivalent 1st dose catch-up
bull Challenges with information transfer
bull Difficulties sourcing MMR Jordan (and cases at the time)
OPV vs IPV
bull OPVbull Stopped Victoria 2005bull Excreted 6 weeks
bull Faecal specimen pick up
bull Highly effective immunity (95 3 doses) inc gutbull Prevents wild type infection
bull IPVbull Highly effective paralytic (99 3 doses) less gut
bull Can still get wild-type infection
bull Not recommended pregnancyBF
bull Seroconversion sl lower combination OPV and IPV (sero 3)
OPV only form available
httpswwwasidnetauresourcesclinical-guidelines
httprefugeehealthnetworkorgauengageimmunisation-working-group
April 2015 -httpparlinfoaphgovauparlInfosearchdisplaydisplayw3pquery=Id3A22media2Fpressrel2F377023622
No jab no pay - no plan for migrants
bull Prior to Jan 2016 upper age limit ACIR 7ybull Any child arrivingvaccinated after 7y ndash not on ACIR
bull Centrelink letters (all 27 of themhellip)
bull Establishing prior vaccinationbull Mobile populationsbull Many years agobull Lack of records
bull Duplicationsbull Appointmentsbull Serologybull Vaccines
bull Medical exemptions ndash GPs only
20m Hexa 13 13vPCV MMR-V 22 if had offshore Men C 11 DT-containing dose 4 and 5 IPV dose 4 and check HBV serol (sib infection)
3y MMR-V 22 if had offshore Hexa 13 no Hep B (infection) 13vPCV 11 Men C 11 will need DT-containing dose 4 and IPV dose 4
12 y dTpa 13 then dTnext 2 doses IPV 13 MMR-V 22 if had offshore Hep B adult formulation 12 MenC high school ndash HPV VV dTpa ndash factor in
7 y Hexa 13 no MMR (immune) VV 11 MenC 11 DT-containing dose 4
6 y no Hep B (infection) give DTPa 13 amp IPV 13 or hexa 13 MMR-V 22 MenC DT-containing dose 4
Any recordsAny serologyAny vaccinestimingHx varicellaSchedule changesAnything else ndash eg HH
Associated ACIR issues
bull Workloaddelaysbull Batch errorsbull Longer for offshore (3w)bull Faxed records (8w)
bull Catch-up incentives bull lt7y onlybull Not structured to support best practice
bull Specialist registrationbull Due-overdue rules hepatitis Bbull ACIR notification payment - quirks
httpsmygovaumygovcontenthtmlhelphtml
New challenges
bull Department Health
bull Proposal to broaden immunisation Humanitarian entrants
bull In accordance with NIP ndash where
bull Operationally feasible
bull Clinically relevant
bull Time allows
Concerns
bull Many countries
bull Many schedules
bull Supply issues
bull No process to transfer offshore to ACIRbull Reliant on paperwork
bull My thoughts ndash DT-containing polio MMRbull Use hexa or penta where available in lt 10y
bull 2nd 3rd set could be the same
New challenges
bull Numbers ndash and complexity of catch-up in context screening
bull ACIR -gt AIRbull Measurement subgroups
bull Asylum seekers ndash TPV
bull After end 2017 ndash catch-up vaccination fundings
bull Other migrant groups
Take home
bull Large number new arrivals ndash Northern regions
bull New offshore vaccination for Humanitarian entrantsbull Which may extend further
bull Paperwork is good (but not in ACIR)
bull Catch-up onshore still difficultbull Back to 202 visas
bull Immunisation policy ndash needs to consider migration
Acknowledgements
bull RCH Immunisation Service especially Sonja Elia for their assistance over many years
bull RCH Immigrant health team ndash Helen Milton Tatiana Polizzi Drs Andy Smith Shidan Tosif Hamish Graham Jane Standish Karen Kiang Sophie Oldfield Rowena Conroy Sanjay Patel Erin OrsquoRourke
bull Kirsten Gordon Yasmin Abubakar Sylvie Bui Hoang Jenny Kendrick our fabulous volunteers
bull Interpreting staff Amin Bhatat Mourteza Khorshidi Sabine MacDonald and many people over many years
bull RCH colleagues
bull RCH Executive and Melbourne Childrenrsquos Campus partners
bull Victorian Foundation for Survivors of Torture
bull Victorian Refugee Health Network
bull Department of Health Crystal Russell Pam Williams Martin Turnbull
bull Dr Mitchell Smith NSW Refugee Health
bull The children adolescents and families we see at RCH
Victorian settlement
bull Expect ~4000 + component regular intake
bull 85 linked
bull Current communities NSW (60) and Vic (rest)
bull High proportion children
bull 50 total = children
bull 17 total = lt4y
bull 21 total = 4-11y
68 linked ndash 202 visa
AMES Australia quarterly HSS statistics ndash July ndash September 2016
NSW
bull August ndash October 2016
bull 963 cases ndash 3513 individuals
bull 82 linked
bull 93 Iraqi and Syrian
bull 236 individuals aged gt 65y
Mitchell Smith NSW Refugee Health Service December 2016
Syrian health systems
bull 60 public hospitals out of service
bull 60-70 reduction pharmaceutical production
bull gt50 doctors have left (gt70 in parts)
bull Immunisation
bull Vaccination programs disrupted since 2011
bull 95 2010 -gt 45 2013
httpwwwrchorgauimmigranthealthclinicalsyrian-refugees
Immunisation schedule by country
httpappswhointimmunization_monitoringglobalsummaryschedules
Polio - Syria
bull WHO ndash outbreak 2013
bull 38 cases
bull Mostly young (lt2y) unimmunised
bull Serotype 1 sim envt strains Egypt Pakistan Israel
bull Nil in 2014
bull BUT Syrian opposition humanitarian arm lsquoAssistance Coordination Unitrsquo (ACU) reported 105 cases of acute flaccid paralysis
Polio
Measles
REFUGEE APPLICANT
ONSHORE
ASYLUM SEEKER
OFFSHORE
HUMANITARIAN ENTRANT
1) DETENTION HEALTH2) POST-RELEASE3) AT SUBSTANTIVE VISA
1) IME (MANDATED)2) DHC (VOLUNTARY)3) POST-ARRIVAL (VOL)
Departure Health Check (DHC) Humanitarian (Voluntary ndash 3d lt travel)
Exam parasite checkMalaria RDT and Rx if positive (location)
CXR and HIV if PHx TBAlbendazole ge 1 y
MMR 9m ndash 54y+- YF vaccine
+- Polio vaccineAx local conditions
+- Repeat IME
Immigration Medical Exam (IME) - all(Compulsory 3ndash12 m prior to travel)
HxExamTB screen 2-10y
CXR ge 11yHIV ge 15yFWTU ge 5y
HBsAg (pregURMHCW)
HCV (HCW)
Syphilis (Humanitarian)
OutcomesFitness to fly assessment
Alert (Red General)+- Health Undertaking
Character requirement
AustraliaPost arrival health screening
Voluntary
AUSCO
Outcomes+- Visa
Alert (Red General)Health Undertaking +- delay travel
Pre-departure health screen (offshore)
Syrian cohortsCombined IME and DHC
HxExam TB screen 2-10y ndash IGRA or TST
CXR ge 11yHIV ge 15yHBsAg (all)FWTU ge 5y
AlbendazoleFull 1st dose catch-up immunisations
Mental health screenDevelopment screen (lt5 y)
Offshore screening ndash Syrian and Iraqi cohorts
bull Immigration Medical Examination and DHC
bull Will include immunisation
bull Plan (11115 ndash Lebanon Turkey Jordan)bull lt10 years = MMR OPV penta (no hexa avail)
bull 10 years + = MMR OPV dTPa
bull Equivalent 1st dose catch-up
bull Challenges with information transfer
bull Difficulties sourcing MMR Jordan (and cases at the time)
OPV vs IPV
bull OPVbull Stopped Victoria 2005bull Excreted 6 weeks
bull Faecal specimen pick up
bull Highly effective immunity (95 3 doses) inc gutbull Prevents wild type infection
bull IPVbull Highly effective paralytic (99 3 doses) less gut
bull Can still get wild-type infection
bull Not recommended pregnancyBF
bull Seroconversion sl lower combination OPV and IPV (sero 3)
OPV only form available
httpswwwasidnetauresourcesclinical-guidelines
httprefugeehealthnetworkorgauengageimmunisation-working-group
April 2015 -httpparlinfoaphgovauparlInfosearchdisplaydisplayw3pquery=Id3A22media2Fpressrel2F377023622
No jab no pay - no plan for migrants
bull Prior to Jan 2016 upper age limit ACIR 7ybull Any child arrivingvaccinated after 7y ndash not on ACIR
bull Centrelink letters (all 27 of themhellip)
bull Establishing prior vaccinationbull Mobile populationsbull Many years agobull Lack of records
bull Duplicationsbull Appointmentsbull Serologybull Vaccines
bull Medical exemptions ndash GPs only
20m Hexa 13 13vPCV MMR-V 22 if had offshore Men C 11 DT-containing dose 4 and 5 IPV dose 4 and check HBV serol (sib infection)
3y MMR-V 22 if had offshore Hexa 13 no Hep B (infection) 13vPCV 11 Men C 11 will need DT-containing dose 4 and IPV dose 4
12 y dTpa 13 then dTnext 2 doses IPV 13 MMR-V 22 if had offshore Hep B adult formulation 12 MenC high school ndash HPV VV dTpa ndash factor in
7 y Hexa 13 no MMR (immune) VV 11 MenC 11 DT-containing dose 4
6 y no Hep B (infection) give DTPa 13 amp IPV 13 or hexa 13 MMR-V 22 MenC DT-containing dose 4
Any recordsAny serologyAny vaccinestimingHx varicellaSchedule changesAnything else ndash eg HH
Associated ACIR issues
bull Workloaddelaysbull Batch errorsbull Longer for offshore (3w)bull Faxed records (8w)
bull Catch-up incentives bull lt7y onlybull Not structured to support best practice
bull Specialist registrationbull Due-overdue rules hepatitis Bbull ACIR notification payment - quirks
httpsmygovaumygovcontenthtmlhelphtml
New challenges
bull Department Health
bull Proposal to broaden immunisation Humanitarian entrants
bull In accordance with NIP ndash where
bull Operationally feasible
bull Clinically relevant
bull Time allows
Concerns
bull Many countries
bull Many schedules
bull Supply issues
bull No process to transfer offshore to ACIRbull Reliant on paperwork
bull My thoughts ndash DT-containing polio MMRbull Use hexa or penta where available in lt 10y
bull 2nd 3rd set could be the same
New challenges
bull Numbers ndash and complexity of catch-up in context screening
bull ACIR -gt AIRbull Measurement subgroups
bull Asylum seekers ndash TPV
bull After end 2017 ndash catch-up vaccination fundings
bull Other migrant groups
Take home
bull Large number new arrivals ndash Northern regions
bull New offshore vaccination for Humanitarian entrantsbull Which may extend further
bull Paperwork is good (but not in ACIR)
bull Catch-up onshore still difficultbull Back to 202 visas
bull Immunisation policy ndash needs to consider migration
Acknowledgements
bull RCH Immunisation Service especially Sonja Elia for their assistance over many years
bull RCH Immigrant health team ndash Helen Milton Tatiana Polizzi Drs Andy Smith Shidan Tosif Hamish Graham Jane Standish Karen Kiang Sophie Oldfield Rowena Conroy Sanjay Patel Erin OrsquoRourke
bull Kirsten Gordon Yasmin Abubakar Sylvie Bui Hoang Jenny Kendrick our fabulous volunteers
bull Interpreting staff Amin Bhatat Mourteza Khorshidi Sabine MacDonald and many people over many years
bull RCH colleagues
bull RCH Executive and Melbourne Childrenrsquos Campus partners
bull Victorian Foundation for Survivors of Torture
bull Victorian Refugee Health Network
bull Department of Health Crystal Russell Pam Williams Martin Turnbull
bull Dr Mitchell Smith NSW Refugee Health
bull The children adolescents and families we see at RCH
68 linked ndash 202 visa
AMES Australia quarterly HSS statistics ndash July ndash September 2016
NSW
bull August ndash October 2016
bull 963 cases ndash 3513 individuals
bull 82 linked
bull 93 Iraqi and Syrian
bull 236 individuals aged gt 65y
Mitchell Smith NSW Refugee Health Service December 2016
Syrian health systems
bull 60 public hospitals out of service
bull 60-70 reduction pharmaceutical production
bull gt50 doctors have left (gt70 in parts)
bull Immunisation
bull Vaccination programs disrupted since 2011
bull 95 2010 -gt 45 2013
httpwwwrchorgauimmigranthealthclinicalsyrian-refugees
Immunisation schedule by country
httpappswhointimmunization_monitoringglobalsummaryschedules
Polio - Syria
bull WHO ndash outbreak 2013
bull 38 cases
bull Mostly young (lt2y) unimmunised
bull Serotype 1 sim envt strains Egypt Pakistan Israel
bull Nil in 2014
bull BUT Syrian opposition humanitarian arm lsquoAssistance Coordination Unitrsquo (ACU) reported 105 cases of acute flaccid paralysis
Polio
Measles
REFUGEE APPLICANT
ONSHORE
ASYLUM SEEKER
OFFSHORE
HUMANITARIAN ENTRANT
1) DETENTION HEALTH2) POST-RELEASE3) AT SUBSTANTIVE VISA
1) IME (MANDATED)2) DHC (VOLUNTARY)3) POST-ARRIVAL (VOL)
Departure Health Check (DHC) Humanitarian (Voluntary ndash 3d lt travel)
Exam parasite checkMalaria RDT and Rx if positive (location)
CXR and HIV if PHx TBAlbendazole ge 1 y
MMR 9m ndash 54y+- YF vaccine
+- Polio vaccineAx local conditions
+- Repeat IME
Immigration Medical Exam (IME) - all(Compulsory 3ndash12 m prior to travel)
HxExamTB screen 2-10y
CXR ge 11yHIV ge 15yFWTU ge 5y
HBsAg (pregURMHCW)
HCV (HCW)
Syphilis (Humanitarian)
OutcomesFitness to fly assessment
Alert (Red General)+- Health Undertaking
Character requirement
AustraliaPost arrival health screening
Voluntary
AUSCO
Outcomes+- Visa
Alert (Red General)Health Undertaking +- delay travel
Pre-departure health screen (offshore)
Syrian cohortsCombined IME and DHC
HxExam TB screen 2-10y ndash IGRA or TST
CXR ge 11yHIV ge 15yHBsAg (all)FWTU ge 5y
AlbendazoleFull 1st dose catch-up immunisations
Mental health screenDevelopment screen (lt5 y)
Offshore screening ndash Syrian and Iraqi cohorts
bull Immigration Medical Examination and DHC
bull Will include immunisation
bull Plan (11115 ndash Lebanon Turkey Jordan)bull lt10 years = MMR OPV penta (no hexa avail)
bull 10 years + = MMR OPV dTPa
bull Equivalent 1st dose catch-up
bull Challenges with information transfer
bull Difficulties sourcing MMR Jordan (and cases at the time)
OPV vs IPV
bull OPVbull Stopped Victoria 2005bull Excreted 6 weeks
bull Faecal specimen pick up
bull Highly effective immunity (95 3 doses) inc gutbull Prevents wild type infection
bull IPVbull Highly effective paralytic (99 3 doses) less gut
bull Can still get wild-type infection
bull Not recommended pregnancyBF
bull Seroconversion sl lower combination OPV and IPV (sero 3)
OPV only form available
httpswwwasidnetauresourcesclinical-guidelines
httprefugeehealthnetworkorgauengageimmunisation-working-group
April 2015 -httpparlinfoaphgovauparlInfosearchdisplaydisplayw3pquery=Id3A22media2Fpressrel2F377023622
No jab no pay - no plan for migrants
bull Prior to Jan 2016 upper age limit ACIR 7ybull Any child arrivingvaccinated after 7y ndash not on ACIR
bull Centrelink letters (all 27 of themhellip)
bull Establishing prior vaccinationbull Mobile populationsbull Many years agobull Lack of records
bull Duplicationsbull Appointmentsbull Serologybull Vaccines
bull Medical exemptions ndash GPs only
20m Hexa 13 13vPCV MMR-V 22 if had offshore Men C 11 DT-containing dose 4 and 5 IPV dose 4 and check HBV serol (sib infection)
3y MMR-V 22 if had offshore Hexa 13 no Hep B (infection) 13vPCV 11 Men C 11 will need DT-containing dose 4 and IPV dose 4
12 y dTpa 13 then dTnext 2 doses IPV 13 MMR-V 22 if had offshore Hep B adult formulation 12 MenC high school ndash HPV VV dTpa ndash factor in
7 y Hexa 13 no MMR (immune) VV 11 MenC 11 DT-containing dose 4
6 y no Hep B (infection) give DTPa 13 amp IPV 13 or hexa 13 MMR-V 22 MenC DT-containing dose 4
Any recordsAny serologyAny vaccinestimingHx varicellaSchedule changesAnything else ndash eg HH
Associated ACIR issues
bull Workloaddelaysbull Batch errorsbull Longer for offshore (3w)bull Faxed records (8w)
bull Catch-up incentives bull lt7y onlybull Not structured to support best practice
bull Specialist registrationbull Due-overdue rules hepatitis Bbull ACIR notification payment - quirks
httpsmygovaumygovcontenthtmlhelphtml
New challenges
bull Department Health
bull Proposal to broaden immunisation Humanitarian entrants
bull In accordance with NIP ndash where
bull Operationally feasible
bull Clinically relevant
bull Time allows
Concerns
bull Many countries
bull Many schedules
bull Supply issues
bull No process to transfer offshore to ACIRbull Reliant on paperwork
bull My thoughts ndash DT-containing polio MMRbull Use hexa or penta where available in lt 10y
bull 2nd 3rd set could be the same
New challenges
bull Numbers ndash and complexity of catch-up in context screening
bull ACIR -gt AIRbull Measurement subgroups
bull Asylum seekers ndash TPV
bull After end 2017 ndash catch-up vaccination fundings
bull Other migrant groups
Take home
bull Large number new arrivals ndash Northern regions
bull New offshore vaccination for Humanitarian entrantsbull Which may extend further
bull Paperwork is good (but not in ACIR)
bull Catch-up onshore still difficultbull Back to 202 visas
bull Immunisation policy ndash needs to consider migration
Acknowledgements
bull RCH Immunisation Service especially Sonja Elia for their assistance over many years
bull RCH Immigrant health team ndash Helen Milton Tatiana Polizzi Drs Andy Smith Shidan Tosif Hamish Graham Jane Standish Karen Kiang Sophie Oldfield Rowena Conroy Sanjay Patel Erin OrsquoRourke
bull Kirsten Gordon Yasmin Abubakar Sylvie Bui Hoang Jenny Kendrick our fabulous volunteers
bull Interpreting staff Amin Bhatat Mourteza Khorshidi Sabine MacDonald and many people over many years
bull RCH colleagues
bull RCH Executive and Melbourne Childrenrsquos Campus partners
bull Victorian Foundation for Survivors of Torture
bull Victorian Refugee Health Network
bull Department of Health Crystal Russell Pam Williams Martin Turnbull
bull Dr Mitchell Smith NSW Refugee Health
bull The children adolescents and families we see at RCH
AMES Australia quarterly HSS statistics ndash July ndash September 2016
NSW
bull August ndash October 2016
bull 963 cases ndash 3513 individuals
bull 82 linked
bull 93 Iraqi and Syrian
bull 236 individuals aged gt 65y
Mitchell Smith NSW Refugee Health Service December 2016
Syrian health systems
bull 60 public hospitals out of service
bull 60-70 reduction pharmaceutical production
bull gt50 doctors have left (gt70 in parts)
bull Immunisation
bull Vaccination programs disrupted since 2011
bull 95 2010 -gt 45 2013
httpwwwrchorgauimmigranthealthclinicalsyrian-refugees
Immunisation schedule by country
httpappswhointimmunization_monitoringglobalsummaryschedules
Polio - Syria
bull WHO ndash outbreak 2013
bull 38 cases
bull Mostly young (lt2y) unimmunised
bull Serotype 1 sim envt strains Egypt Pakistan Israel
bull Nil in 2014
bull BUT Syrian opposition humanitarian arm lsquoAssistance Coordination Unitrsquo (ACU) reported 105 cases of acute flaccid paralysis
Polio
Measles
REFUGEE APPLICANT
ONSHORE
ASYLUM SEEKER
OFFSHORE
HUMANITARIAN ENTRANT
1) DETENTION HEALTH2) POST-RELEASE3) AT SUBSTANTIVE VISA
1) IME (MANDATED)2) DHC (VOLUNTARY)3) POST-ARRIVAL (VOL)
Departure Health Check (DHC) Humanitarian (Voluntary ndash 3d lt travel)
Exam parasite checkMalaria RDT and Rx if positive (location)
CXR and HIV if PHx TBAlbendazole ge 1 y
MMR 9m ndash 54y+- YF vaccine
+- Polio vaccineAx local conditions
+- Repeat IME
Immigration Medical Exam (IME) - all(Compulsory 3ndash12 m prior to travel)
HxExamTB screen 2-10y
CXR ge 11yHIV ge 15yFWTU ge 5y
HBsAg (pregURMHCW)
HCV (HCW)
Syphilis (Humanitarian)
OutcomesFitness to fly assessment
Alert (Red General)+- Health Undertaking
Character requirement
AustraliaPost arrival health screening
Voluntary
AUSCO
Outcomes+- Visa
Alert (Red General)Health Undertaking +- delay travel
Pre-departure health screen (offshore)
Syrian cohortsCombined IME and DHC
HxExam TB screen 2-10y ndash IGRA or TST
CXR ge 11yHIV ge 15yHBsAg (all)FWTU ge 5y
AlbendazoleFull 1st dose catch-up immunisations
Mental health screenDevelopment screen (lt5 y)
Offshore screening ndash Syrian and Iraqi cohorts
bull Immigration Medical Examination and DHC
bull Will include immunisation
bull Plan (11115 ndash Lebanon Turkey Jordan)bull lt10 years = MMR OPV penta (no hexa avail)
bull 10 years + = MMR OPV dTPa
bull Equivalent 1st dose catch-up
bull Challenges with information transfer
bull Difficulties sourcing MMR Jordan (and cases at the time)
OPV vs IPV
bull OPVbull Stopped Victoria 2005bull Excreted 6 weeks
bull Faecal specimen pick up
bull Highly effective immunity (95 3 doses) inc gutbull Prevents wild type infection
bull IPVbull Highly effective paralytic (99 3 doses) less gut
bull Can still get wild-type infection
bull Not recommended pregnancyBF
bull Seroconversion sl lower combination OPV and IPV (sero 3)
OPV only form available
httpswwwasidnetauresourcesclinical-guidelines
httprefugeehealthnetworkorgauengageimmunisation-working-group
April 2015 -httpparlinfoaphgovauparlInfosearchdisplaydisplayw3pquery=Id3A22media2Fpressrel2F377023622
No jab no pay - no plan for migrants
bull Prior to Jan 2016 upper age limit ACIR 7ybull Any child arrivingvaccinated after 7y ndash not on ACIR
bull Centrelink letters (all 27 of themhellip)
bull Establishing prior vaccinationbull Mobile populationsbull Many years agobull Lack of records
bull Duplicationsbull Appointmentsbull Serologybull Vaccines
bull Medical exemptions ndash GPs only
20m Hexa 13 13vPCV MMR-V 22 if had offshore Men C 11 DT-containing dose 4 and 5 IPV dose 4 and check HBV serol (sib infection)
3y MMR-V 22 if had offshore Hexa 13 no Hep B (infection) 13vPCV 11 Men C 11 will need DT-containing dose 4 and IPV dose 4
12 y dTpa 13 then dTnext 2 doses IPV 13 MMR-V 22 if had offshore Hep B adult formulation 12 MenC high school ndash HPV VV dTpa ndash factor in
7 y Hexa 13 no MMR (immune) VV 11 MenC 11 DT-containing dose 4
6 y no Hep B (infection) give DTPa 13 amp IPV 13 or hexa 13 MMR-V 22 MenC DT-containing dose 4
Any recordsAny serologyAny vaccinestimingHx varicellaSchedule changesAnything else ndash eg HH
Associated ACIR issues
bull Workloaddelaysbull Batch errorsbull Longer for offshore (3w)bull Faxed records (8w)
bull Catch-up incentives bull lt7y onlybull Not structured to support best practice
bull Specialist registrationbull Due-overdue rules hepatitis Bbull ACIR notification payment - quirks
httpsmygovaumygovcontenthtmlhelphtml
New challenges
bull Department Health
bull Proposal to broaden immunisation Humanitarian entrants
bull In accordance with NIP ndash where
bull Operationally feasible
bull Clinically relevant
bull Time allows
Concerns
bull Many countries
bull Many schedules
bull Supply issues
bull No process to transfer offshore to ACIRbull Reliant on paperwork
bull My thoughts ndash DT-containing polio MMRbull Use hexa or penta where available in lt 10y
bull 2nd 3rd set could be the same
New challenges
bull Numbers ndash and complexity of catch-up in context screening
bull ACIR -gt AIRbull Measurement subgroups
bull Asylum seekers ndash TPV
bull After end 2017 ndash catch-up vaccination fundings
bull Other migrant groups
Take home
bull Large number new arrivals ndash Northern regions
bull New offshore vaccination for Humanitarian entrantsbull Which may extend further
bull Paperwork is good (but not in ACIR)
bull Catch-up onshore still difficultbull Back to 202 visas
bull Immunisation policy ndash needs to consider migration
Acknowledgements
bull RCH Immunisation Service especially Sonja Elia for their assistance over many years
bull RCH Immigrant health team ndash Helen Milton Tatiana Polizzi Drs Andy Smith Shidan Tosif Hamish Graham Jane Standish Karen Kiang Sophie Oldfield Rowena Conroy Sanjay Patel Erin OrsquoRourke
bull Kirsten Gordon Yasmin Abubakar Sylvie Bui Hoang Jenny Kendrick our fabulous volunteers
bull Interpreting staff Amin Bhatat Mourteza Khorshidi Sabine MacDonald and many people over many years
bull RCH colleagues
bull RCH Executive and Melbourne Childrenrsquos Campus partners
bull Victorian Foundation for Survivors of Torture
bull Victorian Refugee Health Network
bull Department of Health Crystal Russell Pam Williams Martin Turnbull
bull Dr Mitchell Smith NSW Refugee Health
bull The children adolescents and families we see at RCH
NSW
bull August ndash October 2016
bull 963 cases ndash 3513 individuals
bull 82 linked
bull 93 Iraqi and Syrian
bull 236 individuals aged gt 65y
Mitchell Smith NSW Refugee Health Service December 2016
Syrian health systems
bull 60 public hospitals out of service
bull 60-70 reduction pharmaceutical production
bull gt50 doctors have left (gt70 in parts)
bull Immunisation
bull Vaccination programs disrupted since 2011
bull 95 2010 -gt 45 2013
httpwwwrchorgauimmigranthealthclinicalsyrian-refugees
Immunisation schedule by country
httpappswhointimmunization_monitoringglobalsummaryschedules
Polio - Syria
bull WHO ndash outbreak 2013
bull 38 cases
bull Mostly young (lt2y) unimmunised
bull Serotype 1 sim envt strains Egypt Pakistan Israel
bull Nil in 2014
bull BUT Syrian opposition humanitarian arm lsquoAssistance Coordination Unitrsquo (ACU) reported 105 cases of acute flaccid paralysis
Polio
Measles
REFUGEE APPLICANT
ONSHORE
ASYLUM SEEKER
OFFSHORE
HUMANITARIAN ENTRANT
1) DETENTION HEALTH2) POST-RELEASE3) AT SUBSTANTIVE VISA
1) IME (MANDATED)2) DHC (VOLUNTARY)3) POST-ARRIVAL (VOL)
Departure Health Check (DHC) Humanitarian (Voluntary ndash 3d lt travel)
Exam parasite checkMalaria RDT and Rx if positive (location)
CXR and HIV if PHx TBAlbendazole ge 1 y
MMR 9m ndash 54y+- YF vaccine
+- Polio vaccineAx local conditions
+- Repeat IME
Immigration Medical Exam (IME) - all(Compulsory 3ndash12 m prior to travel)
HxExamTB screen 2-10y
CXR ge 11yHIV ge 15yFWTU ge 5y
HBsAg (pregURMHCW)
HCV (HCW)
Syphilis (Humanitarian)
OutcomesFitness to fly assessment
Alert (Red General)+- Health Undertaking
Character requirement
AustraliaPost arrival health screening
Voluntary
AUSCO
Outcomes+- Visa
Alert (Red General)Health Undertaking +- delay travel
Pre-departure health screen (offshore)
Syrian cohortsCombined IME and DHC
HxExam TB screen 2-10y ndash IGRA or TST
CXR ge 11yHIV ge 15yHBsAg (all)FWTU ge 5y
AlbendazoleFull 1st dose catch-up immunisations
Mental health screenDevelopment screen (lt5 y)
Offshore screening ndash Syrian and Iraqi cohorts
bull Immigration Medical Examination and DHC
bull Will include immunisation
bull Plan (11115 ndash Lebanon Turkey Jordan)bull lt10 years = MMR OPV penta (no hexa avail)
bull 10 years + = MMR OPV dTPa
bull Equivalent 1st dose catch-up
bull Challenges with information transfer
bull Difficulties sourcing MMR Jordan (and cases at the time)
OPV vs IPV
bull OPVbull Stopped Victoria 2005bull Excreted 6 weeks
bull Faecal specimen pick up
bull Highly effective immunity (95 3 doses) inc gutbull Prevents wild type infection
bull IPVbull Highly effective paralytic (99 3 doses) less gut
bull Can still get wild-type infection
bull Not recommended pregnancyBF
bull Seroconversion sl lower combination OPV and IPV (sero 3)
OPV only form available
httpswwwasidnetauresourcesclinical-guidelines
httprefugeehealthnetworkorgauengageimmunisation-working-group
April 2015 -httpparlinfoaphgovauparlInfosearchdisplaydisplayw3pquery=Id3A22media2Fpressrel2F377023622
No jab no pay - no plan for migrants
bull Prior to Jan 2016 upper age limit ACIR 7ybull Any child arrivingvaccinated after 7y ndash not on ACIR
bull Centrelink letters (all 27 of themhellip)
bull Establishing prior vaccinationbull Mobile populationsbull Many years agobull Lack of records
bull Duplicationsbull Appointmentsbull Serologybull Vaccines
bull Medical exemptions ndash GPs only
20m Hexa 13 13vPCV MMR-V 22 if had offshore Men C 11 DT-containing dose 4 and 5 IPV dose 4 and check HBV serol (sib infection)
3y MMR-V 22 if had offshore Hexa 13 no Hep B (infection) 13vPCV 11 Men C 11 will need DT-containing dose 4 and IPV dose 4
12 y dTpa 13 then dTnext 2 doses IPV 13 MMR-V 22 if had offshore Hep B adult formulation 12 MenC high school ndash HPV VV dTpa ndash factor in
7 y Hexa 13 no MMR (immune) VV 11 MenC 11 DT-containing dose 4
6 y no Hep B (infection) give DTPa 13 amp IPV 13 or hexa 13 MMR-V 22 MenC DT-containing dose 4
Any recordsAny serologyAny vaccinestimingHx varicellaSchedule changesAnything else ndash eg HH
Associated ACIR issues
bull Workloaddelaysbull Batch errorsbull Longer for offshore (3w)bull Faxed records (8w)
bull Catch-up incentives bull lt7y onlybull Not structured to support best practice
bull Specialist registrationbull Due-overdue rules hepatitis Bbull ACIR notification payment - quirks
httpsmygovaumygovcontenthtmlhelphtml
New challenges
bull Department Health
bull Proposal to broaden immunisation Humanitarian entrants
bull In accordance with NIP ndash where
bull Operationally feasible
bull Clinically relevant
bull Time allows
Concerns
bull Many countries
bull Many schedules
bull Supply issues
bull No process to transfer offshore to ACIRbull Reliant on paperwork
bull My thoughts ndash DT-containing polio MMRbull Use hexa or penta where available in lt 10y
bull 2nd 3rd set could be the same
New challenges
bull Numbers ndash and complexity of catch-up in context screening
bull ACIR -gt AIRbull Measurement subgroups
bull Asylum seekers ndash TPV
bull After end 2017 ndash catch-up vaccination fundings
bull Other migrant groups
Take home
bull Large number new arrivals ndash Northern regions
bull New offshore vaccination for Humanitarian entrantsbull Which may extend further
bull Paperwork is good (but not in ACIR)
bull Catch-up onshore still difficultbull Back to 202 visas
bull Immunisation policy ndash needs to consider migration
Acknowledgements
bull RCH Immunisation Service especially Sonja Elia for their assistance over many years
bull RCH Immigrant health team ndash Helen Milton Tatiana Polizzi Drs Andy Smith Shidan Tosif Hamish Graham Jane Standish Karen Kiang Sophie Oldfield Rowena Conroy Sanjay Patel Erin OrsquoRourke
bull Kirsten Gordon Yasmin Abubakar Sylvie Bui Hoang Jenny Kendrick our fabulous volunteers
bull Interpreting staff Amin Bhatat Mourteza Khorshidi Sabine MacDonald and many people over many years
bull RCH colleagues
bull RCH Executive and Melbourne Childrenrsquos Campus partners
bull Victorian Foundation for Survivors of Torture
bull Victorian Refugee Health Network
bull Department of Health Crystal Russell Pam Williams Martin Turnbull
bull Dr Mitchell Smith NSW Refugee Health
bull The children adolescents and families we see at RCH
Syrian health systems
bull 60 public hospitals out of service
bull 60-70 reduction pharmaceutical production
bull gt50 doctors have left (gt70 in parts)
bull Immunisation
bull Vaccination programs disrupted since 2011
bull 95 2010 -gt 45 2013
httpwwwrchorgauimmigranthealthclinicalsyrian-refugees
Immunisation schedule by country
httpappswhointimmunization_monitoringglobalsummaryschedules
Polio - Syria
bull WHO ndash outbreak 2013
bull 38 cases
bull Mostly young (lt2y) unimmunised
bull Serotype 1 sim envt strains Egypt Pakistan Israel
bull Nil in 2014
bull BUT Syrian opposition humanitarian arm lsquoAssistance Coordination Unitrsquo (ACU) reported 105 cases of acute flaccid paralysis
Polio
Measles
REFUGEE APPLICANT
ONSHORE
ASYLUM SEEKER
OFFSHORE
HUMANITARIAN ENTRANT
1) DETENTION HEALTH2) POST-RELEASE3) AT SUBSTANTIVE VISA
1) IME (MANDATED)2) DHC (VOLUNTARY)3) POST-ARRIVAL (VOL)
Departure Health Check (DHC) Humanitarian (Voluntary ndash 3d lt travel)
Exam parasite checkMalaria RDT and Rx if positive (location)
CXR and HIV if PHx TBAlbendazole ge 1 y
MMR 9m ndash 54y+- YF vaccine
+- Polio vaccineAx local conditions
+- Repeat IME
Immigration Medical Exam (IME) - all(Compulsory 3ndash12 m prior to travel)
HxExamTB screen 2-10y
CXR ge 11yHIV ge 15yFWTU ge 5y
HBsAg (pregURMHCW)
HCV (HCW)
Syphilis (Humanitarian)
OutcomesFitness to fly assessment
Alert (Red General)+- Health Undertaking
Character requirement
AustraliaPost arrival health screening
Voluntary
AUSCO
Outcomes+- Visa
Alert (Red General)Health Undertaking +- delay travel
Pre-departure health screen (offshore)
Syrian cohortsCombined IME and DHC
HxExam TB screen 2-10y ndash IGRA or TST
CXR ge 11yHIV ge 15yHBsAg (all)FWTU ge 5y
AlbendazoleFull 1st dose catch-up immunisations
Mental health screenDevelopment screen (lt5 y)
Offshore screening ndash Syrian and Iraqi cohorts
bull Immigration Medical Examination and DHC
bull Will include immunisation
bull Plan (11115 ndash Lebanon Turkey Jordan)bull lt10 years = MMR OPV penta (no hexa avail)
bull 10 years + = MMR OPV dTPa
bull Equivalent 1st dose catch-up
bull Challenges with information transfer
bull Difficulties sourcing MMR Jordan (and cases at the time)
OPV vs IPV
bull OPVbull Stopped Victoria 2005bull Excreted 6 weeks
bull Faecal specimen pick up
bull Highly effective immunity (95 3 doses) inc gutbull Prevents wild type infection
bull IPVbull Highly effective paralytic (99 3 doses) less gut
bull Can still get wild-type infection
bull Not recommended pregnancyBF
bull Seroconversion sl lower combination OPV and IPV (sero 3)
OPV only form available
httpswwwasidnetauresourcesclinical-guidelines
httprefugeehealthnetworkorgauengageimmunisation-working-group
April 2015 -httpparlinfoaphgovauparlInfosearchdisplaydisplayw3pquery=Id3A22media2Fpressrel2F377023622
No jab no pay - no plan for migrants
bull Prior to Jan 2016 upper age limit ACIR 7ybull Any child arrivingvaccinated after 7y ndash not on ACIR
bull Centrelink letters (all 27 of themhellip)
bull Establishing prior vaccinationbull Mobile populationsbull Many years agobull Lack of records
bull Duplicationsbull Appointmentsbull Serologybull Vaccines
bull Medical exemptions ndash GPs only
20m Hexa 13 13vPCV MMR-V 22 if had offshore Men C 11 DT-containing dose 4 and 5 IPV dose 4 and check HBV serol (sib infection)
3y MMR-V 22 if had offshore Hexa 13 no Hep B (infection) 13vPCV 11 Men C 11 will need DT-containing dose 4 and IPV dose 4
12 y dTpa 13 then dTnext 2 doses IPV 13 MMR-V 22 if had offshore Hep B adult formulation 12 MenC high school ndash HPV VV dTpa ndash factor in
7 y Hexa 13 no MMR (immune) VV 11 MenC 11 DT-containing dose 4
6 y no Hep B (infection) give DTPa 13 amp IPV 13 or hexa 13 MMR-V 22 MenC DT-containing dose 4
Any recordsAny serologyAny vaccinestimingHx varicellaSchedule changesAnything else ndash eg HH
Associated ACIR issues
bull Workloaddelaysbull Batch errorsbull Longer for offshore (3w)bull Faxed records (8w)
bull Catch-up incentives bull lt7y onlybull Not structured to support best practice
bull Specialist registrationbull Due-overdue rules hepatitis Bbull ACIR notification payment - quirks
httpsmygovaumygovcontenthtmlhelphtml
New challenges
bull Department Health
bull Proposal to broaden immunisation Humanitarian entrants
bull In accordance with NIP ndash where
bull Operationally feasible
bull Clinically relevant
bull Time allows
Concerns
bull Many countries
bull Many schedules
bull Supply issues
bull No process to transfer offshore to ACIRbull Reliant on paperwork
bull My thoughts ndash DT-containing polio MMRbull Use hexa or penta where available in lt 10y
bull 2nd 3rd set could be the same
New challenges
bull Numbers ndash and complexity of catch-up in context screening
bull ACIR -gt AIRbull Measurement subgroups
bull Asylum seekers ndash TPV
bull After end 2017 ndash catch-up vaccination fundings
bull Other migrant groups
Take home
bull Large number new arrivals ndash Northern regions
bull New offshore vaccination for Humanitarian entrantsbull Which may extend further
bull Paperwork is good (but not in ACIR)
bull Catch-up onshore still difficultbull Back to 202 visas
bull Immunisation policy ndash needs to consider migration
Acknowledgements
bull RCH Immunisation Service especially Sonja Elia for their assistance over many years
bull RCH Immigrant health team ndash Helen Milton Tatiana Polizzi Drs Andy Smith Shidan Tosif Hamish Graham Jane Standish Karen Kiang Sophie Oldfield Rowena Conroy Sanjay Patel Erin OrsquoRourke
bull Kirsten Gordon Yasmin Abubakar Sylvie Bui Hoang Jenny Kendrick our fabulous volunteers
bull Interpreting staff Amin Bhatat Mourteza Khorshidi Sabine MacDonald and many people over many years
bull RCH colleagues
bull RCH Executive and Melbourne Childrenrsquos Campus partners
bull Victorian Foundation for Survivors of Torture
bull Victorian Refugee Health Network
bull Department of Health Crystal Russell Pam Williams Martin Turnbull
bull Dr Mitchell Smith NSW Refugee Health
bull The children adolescents and families we see at RCH
Immunisation schedule by country
httpappswhointimmunization_monitoringglobalsummaryschedules
Polio - Syria
bull WHO ndash outbreak 2013
bull 38 cases
bull Mostly young (lt2y) unimmunised
bull Serotype 1 sim envt strains Egypt Pakistan Israel
bull Nil in 2014
bull BUT Syrian opposition humanitarian arm lsquoAssistance Coordination Unitrsquo (ACU) reported 105 cases of acute flaccid paralysis
Polio
Measles
REFUGEE APPLICANT
ONSHORE
ASYLUM SEEKER
OFFSHORE
HUMANITARIAN ENTRANT
1) DETENTION HEALTH2) POST-RELEASE3) AT SUBSTANTIVE VISA
1) IME (MANDATED)2) DHC (VOLUNTARY)3) POST-ARRIVAL (VOL)
Departure Health Check (DHC) Humanitarian (Voluntary ndash 3d lt travel)
Exam parasite checkMalaria RDT and Rx if positive (location)
CXR and HIV if PHx TBAlbendazole ge 1 y
MMR 9m ndash 54y+- YF vaccine
+- Polio vaccineAx local conditions
+- Repeat IME
Immigration Medical Exam (IME) - all(Compulsory 3ndash12 m prior to travel)
HxExamTB screen 2-10y
CXR ge 11yHIV ge 15yFWTU ge 5y
HBsAg (pregURMHCW)
HCV (HCW)
Syphilis (Humanitarian)
OutcomesFitness to fly assessment
Alert (Red General)+- Health Undertaking
Character requirement
AustraliaPost arrival health screening
Voluntary
AUSCO
Outcomes+- Visa
Alert (Red General)Health Undertaking +- delay travel
Pre-departure health screen (offshore)
Syrian cohortsCombined IME and DHC
HxExam TB screen 2-10y ndash IGRA or TST
CXR ge 11yHIV ge 15yHBsAg (all)FWTU ge 5y
AlbendazoleFull 1st dose catch-up immunisations
Mental health screenDevelopment screen (lt5 y)
Offshore screening ndash Syrian and Iraqi cohorts
bull Immigration Medical Examination and DHC
bull Will include immunisation
bull Plan (11115 ndash Lebanon Turkey Jordan)bull lt10 years = MMR OPV penta (no hexa avail)
bull 10 years + = MMR OPV dTPa
bull Equivalent 1st dose catch-up
bull Challenges with information transfer
bull Difficulties sourcing MMR Jordan (and cases at the time)
OPV vs IPV
bull OPVbull Stopped Victoria 2005bull Excreted 6 weeks
bull Faecal specimen pick up
bull Highly effective immunity (95 3 doses) inc gutbull Prevents wild type infection
bull IPVbull Highly effective paralytic (99 3 doses) less gut
bull Can still get wild-type infection
bull Not recommended pregnancyBF
bull Seroconversion sl lower combination OPV and IPV (sero 3)
OPV only form available
httpswwwasidnetauresourcesclinical-guidelines
httprefugeehealthnetworkorgauengageimmunisation-working-group
April 2015 -httpparlinfoaphgovauparlInfosearchdisplaydisplayw3pquery=Id3A22media2Fpressrel2F377023622
No jab no pay - no plan for migrants
bull Prior to Jan 2016 upper age limit ACIR 7ybull Any child arrivingvaccinated after 7y ndash not on ACIR
bull Centrelink letters (all 27 of themhellip)
bull Establishing prior vaccinationbull Mobile populationsbull Many years agobull Lack of records
bull Duplicationsbull Appointmentsbull Serologybull Vaccines
bull Medical exemptions ndash GPs only
20m Hexa 13 13vPCV MMR-V 22 if had offshore Men C 11 DT-containing dose 4 and 5 IPV dose 4 and check HBV serol (sib infection)
3y MMR-V 22 if had offshore Hexa 13 no Hep B (infection) 13vPCV 11 Men C 11 will need DT-containing dose 4 and IPV dose 4
12 y dTpa 13 then dTnext 2 doses IPV 13 MMR-V 22 if had offshore Hep B adult formulation 12 MenC high school ndash HPV VV dTpa ndash factor in
7 y Hexa 13 no MMR (immune) VV 11 MenC 11 DT-containing dose 4
6 y no Hep B (infection) give DTPa 13 amp IPV 13 or hexa 13 MMR-V 22 MenC DT-containing dose 4
Any recordsAny serologyAny vaccinestimingHx varicellaSchedule changesAnything else ndash eg HH
Associated ACIR issues
bull Workloaddelaysbull Batch errorsbull Longer for offshore (3w)bull Faxed records (8w)
bull Catch-up incentives bull lt7y onlybull Not structured to support best practice
bull Specialist registrationbull Due-overdue rules hepatitis Bbull ACIR notification payment - quirks
httpsmygovaumygovcontenthtmlhelphtml
New challenges
bull Department Health
bull Proposal to broaden immunisation Humanitarian entrants
bull In accordance with NIP ndash where
bull Operationally feasible
bull Clinically relevant
bull Time allows
Concerns
bull Many countries
bull Many schedules
bull Supply issues
bull No process to transfer offshore to ACIRbull Reliant on paperwork
bull My thoughts ndash DT-containing polio MMRbull Use hexa or penta where available in lt 10y
bull 2nd 3rd set could be the same
New challenges
bull Numbers ndash and complexity of catch-up in context screening
bull ACIR -gt AIRbull Measurement subgroups
bull Asylum seekers ndash TPV
bull After end 2017 ndash catch-up vaccination fundings
bull Other migrant groups
Take home
bull Large number new arrivals ndash Northern regions
bull New offshore vaccination for Humanitarian entrantsbull Which may extend further
bull Paperwork is good (but not in ACIR)
bull Catch-up onshore still difficultbull Back to 202 visas
bull Immunisation policy ndash needs to consider migration
Acknowledgements
bull RCH Immunisation Service especially Sonja Elia for their assistance over many years
bull RCH Immigrant health team ndash Helen Milton Tatiana Polizzi Drs Andy Smith Shidan Tosif Hamish Graham Jane Standish Karen Kiang Sophie Oldfield Rowena Conroy Sanjay Patel Erin OrsquoRourke
bull Kirsten Gordon Yasmin Abubakar Sylvie Bui Hoang Jenny Kendrick our fabulous volunteers
bull Interpreting staff Amin Bhatat Mourteza Khorshidi Sabine MacDonald and many people over many years
bull RCH colleagues
bull RCH Executive and Melbourne Childrenrsquos Campus partners
bull Victorian Foundation for Survivors of Torture
bull Victorian Refugee Health Network
bull Department of Health Crystal Russell Pam Williams Martin Turnbull
bull Dr Mitchell Smith NSW Refugee Health
bull The children adolescents and families we see at RCH
Polio - Syria
bull WHO ndash outbreak 2013
bull 38 cases
bull Mostly young (lt2y) unimmunised
bull Serotype 1 sim envt strains Egypt Pakistan Israel
bull Nil in 2014
bull BUT Syrian opposition humanitarian arm lsquoAssistance Coordination Unitrsquo (ACU) reported 105 cases of acute flaccid paralysis
Polio
Measles
REFUGEE APPLICANT
ONSHORE
ASYLUM SEEKER
OFFSHORE
HUMANITARIAN ENTRANT
1) DETENTION HEALTH2) POST-RELEASE3) AT SUBSTANTIVE VISA
1) IME (MANDATED)2) DHC (VOLUNTARY)3) POST-ARRIVAL (VOL)
Departure Health Check (DHC) Humanitarian (Voluntary ndash 3d lt travel)
Exam parasite checkMalaria RDT and Rx if positive (location)
CXR and HIV if PHx TBAlbendazole ge 1 y
MMR 9m ndash 54y+- YF vaccine
+- Polio vaccineAx local conditions
+- Repeat IME
Immigration Medical Exam (IME) - all(Compulsory 3ndash12 m prior to travel)
HxExamTB screen 2-10y
CXR ge 11yHIV ge 15yFWTU ge 5y
HBsAg (pregURMHCW)
HCV (HCW)
Syphilis (Humanitarian)
OutcomesFitness to fly assessment
Alert (Red General)+- Health Undertaking
Character requirement
AustraliaPost arrival health screening
Voluntary
AUSCO
Outcomes+- Visa
Alert (Red General)Health Undertaking +- delay travel
Pre-departure health screen (offshore)
Syrian cohortsCombined IME and DHC
HxExam TB screen 2-10y ndash IGRA or TST
CXR ge 11yHIV ge 15yHBsAg (all)FWTU ge 5y
AlbendazoleFull 1st dose catch-up immunisations
Mental health screenDevelopment screen (lt5 y)
Offshore screening ndash Syrian and Iraqi cohorts
bull Immigration Medical Examination and DHC
bull Will include immunisation
bull Plan (11115 ndash Lebanon Turkey Jordan)bull lt10 years = MMR OPV penta (no hexa avail)
bull 10 years + = MMR OPV dTPa
bull Equivalent 1st dose catch-up
bull Challenges with information transfer
bull Difficulties sourcing MMR Jordan (and cases at the time)
OPV vs IPV
bull OPVbull Stopped Victoria 2005bull Excreted 6 weeks
bull Faecal specimen pick up
bull Highly effective immunity (95 3 doses) inc gutbull Prevents wild type infection
bull IPVbull Highly effective paralytic (99 3 doses) less gut
bull Can still get wild-type infection
bull Not recommended pregnancyBF
bull Seroconversion sl lower combination OPV and IPV (sero 3)
OPV only form available
httpswwwasidnetauresourcesclinical-guidelines
httprefugeehealthnetworkorgauengageimmunisation-working-group
April 2015 -httpparlinfoaphgovauparlInfosearchdisplaydisplayw3pquery=Id3A22media2Fpressrel2F377023622
No jab no pay - no plan for migrants
bull Prior to Jan 2016 upper age limit ACIR 7ybull Any child arrivingvaccinated after 7y ndash not on ACIR
bull Centrelink letters (all 27 of themhellip)
bull Establishing prior vaccinationbull Mobile populationsbull Many years agobull Lack of records
bull Duplicationsbull Appointmentsbull Serologybull Vaccines
bull Medical exemptions ndash GPs only
20m Hexa 13 13vPCV MMR-V 22 if had offshore Men C 11 DT-containing dose 4 and 5 IPV dose 4 and check HBV serol (sib infection)
3y MMR-V 22 if had offshore Hexa 13 no Hep B (infection) 13vPCV 11 Men C 11 will need DT-containing dose 4 and IPV dose 4
12 y dTpa 13 then dTnext 2 doses IPV 13 MMR-V 22 if had offshore Hep B adult formulation 12 MenC high school ndash HPV VV dTpa ndash factor in
7 y Hexa 13 no MMR (immune) VV 11 MenC 11 DT-containing dose 4
6 y no Hep B (infection) give DTPa 13 amp IPV 13 or hexa 13 MMR-V 22 MenC DT-containing dose 4
Any recordsAny serologyAny vaccinestimingHx varicellaSchedule changesAnything else ndash eg HH
Associated ACIR issues
bull Workloaddelaysbull Batch errorsbull Longer for offshore (3w)bull Faxed records (8w)
bull Catch-up incentives bull lt7y onlybull Not structured to support best practice
bull Specialist registrationbull Due-overdue rules hepatitis Bbull ACIR notification payment - quirks
httpsmygovaumygovcontenthtmlhelphtml
New challenges
bull Department Health
bull Proposal to broaden immunisation Humanitarian entrants
bull In accordance with NIP ndash where
bull Operationally feasible
bull Clinically relevant
bull Time allows
Concerns
bull Many countries
bull Many schedules
bull Supply issues
bull No process to transfer offshore to ACIRbull Reliant on paperwork
bull My thoughts ndash DT-containing polio MMRbull Use hexa or penta where available in lt 10y
bull 2nd 3rd set could be the same
New challenges
bull Numbers ndash and complexity of catch-up in context screening
bull ACIR -gt AIRbull Measurement subgroups
bull Asylum seekers ndash TPV
bull After end 2017 ndash catch-up vaccination fundings
bull Other migrant groups
Take home
bull Large number new arrivals ndash Northern regions
bull New offshore vaccination for Humanitarian entrantsbull Which may extend further
bull Paperwork is good (but not in ACIR)
bull Catch-up onshore still difficultbull Back to 202 visas
bull Immunisation policy ndash needs to consider migration
Acknowledgements
bull RCH Immunisation Service especially Sonja Elia for their assistance over many years
bull RCH Immigrant health team ndash Helen Milton Tatiana Polizzi Drs Andy Smith Shidan Tosif Hamish Graham Jane Standish Karen Kiang Sophie Oldfield Rowena Conroy Sanjay Patel Erin OrsquoRourke
bull Kirsten Gordon Yasmin Abubakar Sylvie Bui Hoang Jenny Kendrick our fabulous volunteers
bull Interpreting staff Amin Bhatat Mourteza Khorshidi Sabine MacDonald and many people over many years
bull RCH colleagues
bull RCH Executive and Melbourne Childrenrsquos Campus partners
bull Victorian Foundation for Survivors of Torture
bull Victorian Refugee Health Network
bull Department of Health Crystal Russell Pam Williams Martin Turnbull
bull Dr Mitchell Smith NSW Refugee Health
bull The children adolescents and families we see at RCH
Polio
Measles
REFUGEE APPLICANT
ONSHORE
ASYLUM SEEKER
OFFSHORE
HUMANITARIAN ENTRANT
1) DETENTION HEALTH2) POST-RELEASE3) AT SUBSTANTIVE VISA
1) IME (MANDATED)2) DHC (VOLUNTARY)3) POST-ARRIVAL (VOL)
Departure Health Check (DHC) Humanitarian (Voluntary ndash 3d lt travel)
Exam parasite checkMalaria RDT and Rx if positive (location)
CXR and HIV if PHx TBAlbendazole ge 1 y
MMR 9m ndash 54y+- YF vaccine
+- Polio vaccineAx local conditions
+- Repeat IME
Immigration Medical Exam (IME) - all(Compulsory 3ndash12 m prior to travel)
HxExamTB screen 2-10y
CXR ge 11yHIV ge 15yFWTU ge 5y
HBsAg (pregURMHCW)
HCV (HCW)
Syphilis (Humanitarian)
OutcomesFitness to fly assessment
Alert (Red General)+- Health Undertaking
Character requirement
AustraliaPost arrival health screening
Voluntary
AUSCO
Outcomes+- Visa
Alert (Red General)Health Undertaking +- delay travel
Pre-departure health screen (offshore)
Syrian cohortsCombined IME and DHC
HxExam TB screen 2-10y ndash IGRA or TST
CXR ge 11yHIV ge 15yHBsAg (all)FWTU ge 5y
AlbendazoleFull 1st dose catch-up immunisations
Mental health screenDevelopment screen (lt5 y)
Offshore screening ndash Syrian and Iraqi cohorts
bull Immigration Medical Examination and DHC
bull Will include immunisation
bull Plan (11115 ndash Lebanon Turkey Jordan)bull lt10 years = MMR OPV penta (no hexa avail)
bull 10 years + = MMR OPV dTPa
bull Equivalent 1st dose catch-up
bull Challenges with information transfer
bull Difficulties sourcing MMR Jordan (and cases at the time)
OPV vs IPV
bull OPVbull Stopped Victoria 2005bull Excreted 6 weeks
bull Faecal specimen pick up
bull Highly effective immunity (95 3 doses) inc gutbull Prevents wild type infection
bull IPVbull Highly effective paralytic (99 3 doses) less gut
bull Can still get wild-type infection
bull Not recommended pregnancyBF
bull Seroconversion sl lower combination OPV and IPV (sero 3)
OPV only form available
httpswwwasidnetauresourcesclinical-guidelines
httprefugeehealthnetworkorgauengageimmunisation-working-group
April 2015 -httpparlinfoaphgovauparlInfosearchdisplaydisplayw3pquery=Id3A22media2Fpressrel2F377023622
No jab no pay - no plan for migrants
bull Prior to Jan 2016 upper age limit ACIR 7ybull Any child arrivingvaccinated after 7y ndash not on ACIR
bull Centrelink letters (all 27 of themhellip)
bull Establishing prior vaccinationbull Mobile populationsbull Many years agobull Lack of records
bull Duplicationsbull Appointmentsbull Serologybull Vaccines
bull Medical exemptions ndash GPs only
20m Hexa 13 13vPCV MMR-V 22 if had offshore Men C 11 DT-containing dose 4 and 5 IPV dose 4 and check HBV serol (sib infection)
3y MMR-V 22 if had offshore Hexa 13 no Hep B (infection) 13vPCV 11 Men C 11 will need DT-containing dose 4 and IPV dose 4
12 y dTpa 13 then dTnext 2 doses IPV 13 MMR-V 22 if had offshore Hep B adult formulation 12 MenC high school ndash HPV VV dTpa ndash factor in
7 y Hexa 13 no MMR (immune) VV 11 MenC 11 DT-containing dose 4
6 y no Hep B (infection) give DTPa 13 amp IPV 13 or hexa 13 MMR-V 22 MenC DT-containing dose 4
Any recordsAny serologyAny vaccinestimingHx varicellaSchedule changesAnything else ndash eg HH
Associated ACIR issues
bull Workloaddelaysbull Batch errorsbull Longer for offshore (3w)bull Faxed records (8w)
bull Catch-up incentives bull lt7y onlybull Not structured to support best practice
bull Specialist registrationbull Due-overdue rules hepatitis Bbull ACIR notification payment - quirks
httpsmygovaumygovcontenthtmlhelphtml
New challenges
bull Department Health
bull Proposal to broaden immunisation Humanitarian entrants
bull In accordance with NIP ndash where
bull Operationally feasible
bull Clinically relevant
bull Time allows
Concerns
bull Many countries
bull Many schedules
bull Supply issues
bull No process to transfer offshore to ACIRbull Reliant on paperwork
bull My thoughts ndash DT-containing polio MMRbull Use hexa or penta where available in lt 10y
bull 2nd 3rd set could be the same
New challenges
bull Numbers ndash and complexity of catch-up in context screening
bull ACIR -gt AIRbull Measurement subgroups
bull Asylum seekers ndash TPV
bull After end 2017 ndash catch-up vaccination fundings
bull Other migrant groups
Take home
bull Large number new arrivals ndash Northern regions
bull New offshore vaccination for Humanitarian entrantsbull Which may extend further
bull Paperwork is good (but not in ACIR)
bull Catch-up onshore still difficultbull Back to 202 visas
bull Immunisation policy ndash needs to consider migration
Acknowledgements
bull RCH Immunisation Service especially Sonja Elia for their assistance over many years
bull RCH Immigrant health team ndash Helen Milton Tatiana Polizzi Drs Andy Smith Shidan Tosif Hamish Graham Jane Standish Karen Kiang Sophie Oldfield Rowena Conroy Sanjay Patel Erin OrsquoRourke
bull Kirsten Gordon Yasmin Abubakar Sylvie Bui Hoang Jenny Kendrick our fabulous volunteers
bull Interpreting staff Amin Bhatat Mourteza Khorshidi Sabine MacDonald and many people over many years
bull RCH colleagues
bull RCH Executive and Melbourne Childrenrsquos Campus partners
bull Victorian Foundation for Survivors of Torture
bull Victorian Refugee Health Network
bull Department of Health Crystal Russell Pam Williams Martin Turnbull
bull Dr Mitchell Smith NSW Refugee Health
bull The children adolescents and families we see at RCH
Measles
REFUGEE APPLICANT
ONSHORE
ASYLUM SEEKER
OFFSHORE
HUMANITARIAN ENTRANT
1) DETENTION HEALTH2) POST-RELEASE3) AT SUBSTANTIVE VISA
1) IME (MANDATED)2) DHC (VOLUNTARY)3) POST-ARRIVAL (VOL)
Departure Health Check (DHC) Humanitarian (Voluntary ndash 3d lt travel)
Exam parasite checkMalaria RDT and Rx if positive (location)
CXR and HIV if PHx TBAlbendazole ge 1 y
MMR 9m ndash 54y+- YF vaccine
+- Polio vaccineAx local conditions
+- Repeat IME
Immigration Medical Exam (IME) - all(Compulsory 3ndash12 m prior to travel)
HxExamTB screen 2-10y
CXR ge 11yHIV ge 15yFWTU ge 5y
HBsAg (pregURMHCW)
HCV (HCW)
Syphilis (Humanitarian)
OutcomesFitness to fly assessment
Alert (Red General)+- Health Undertaking
Character requirement
AustraliaPost arrival health screening
Voluntary
AUSCO
Outcomes+- Visa
Alert (Red General)Health Undertaking +- delay travel
Pre-departure health screen (offshore)
Syrian cohortsCombined IME and DHC
HxExam TB screen 2-10y ndash IGRA or TST
CXR ge 11yHIV ge 15yHBsAg (all)FWTU ge 5y
AlbendazoleFull 1st dose catch-up immunisations
Mental health screenDevelopment screen (lt5 y)
Offshore screening ndash Syrian and Iraqi cohorts
bull Immigration Medical Examination and DHC
bull Will include immunisation
bull Plan (11115 ndash Lebanon Turkey Jordan)bull lt10 years = MMR OPV penta (no hexa avail)
bull 10 years + = MMR OPV dTPa
bull Equivalent 1st dose catch-up
bull Challenges with information transfer
bull Difficulties sourcing MMR Jordan (and cases at the time)
OPV vs IPV
bull OPVbull Stopped Victoria 2005bull Excreted 6 weeks
bull Faecal specimen pick up
bull Highly effective immunity (95 3 doses) inc gutbull Prevents wild type infection
bull IPVbull Highly effective paralytic (99 3 doses) less gut
bull Can still get wild-type infection
bull Not recommended pregnancyBF
bull Seroconversion sl lower combination OPV and IPV (sero 3)
OPV only form available
httpswwwasidnetauresourcesclinical-guidelines
httprefugeehealthnetworkorgauengageimmunisation-working-group
April 2015 -httpparlinfoaphgovauparlInfosearchdisplaydisplayw3pquery=Id3A22media2Fpressrel2F377023622
No jab no pay - no plan for migrants
bull Prior to Jan 2016 upper age limit ACIR 7ybull Any child arrivingvaccinated after 7y ndash not on ACIR
bull Centrelink letters (all 27 of themhellip)
bull Establishing prior vaccinationbull Mobile populationsbull Many years agobull Lack of records
bull Duplicationsbull Appointmentsbull Serologybull Vaccines
bull Medical exemptions ndash GPs only
20m Hexa 13 13vPCV MMR-V 22 if had offshore Men C 11 DT-containing dose 4 and 5 IPV dose 4 and check HBV serol (sib infection)
3y MMR-V 22 if had offshore Hexa 13 no Hep B (infection) 13vPCV 11 Men C 11 will need DT-containing dose 4 and IPV dose 4
12 y dTpa 13 then dTnext 2 doses IPV 13 MMR-V 22 if had offshore Hep B adult formulation 12 MenC high school ndash HPV VV dTpa ndash factor in
7 y Hexa 13 no MMR (immune) VV 11 MenC 11 DT-containing dose 4
6 y no Hep B (infection) give DTPa 13 amp IPV 13 or hexa 13 MMR-V 22 MenC DT-containing dose 4
Any recordsAny serologyAny vaccinestimingHx varicellaSchedule changesAnything else ndash eg HH
Associated ACIR issues
bull Workloaddelaysbull Batch errorsbull Longer for offshore (3w)bull Faxed records (8w)
bull Catch-up incentives bull lt7y onlybull Not structured to support best practice
bull Specialist registrationbull Due-overdue rules hepatitis Bbull ACIR notification payment - quirks
httpsmygovaumygovcontenthtmlhelphtml
New challenges
bull Department Health
bull Proposal to broaden immunisation Humanitarian entrants
bull In accordance with NIP ndash where
bull Operationally feasible
bull Clinically relevant
bull Time allows
Concerns
bull Many countries
bull Many schedules
bull Supply issues
bull No process to transfer offshore to ACIRbull Reliant on paperwork
bull My thoughts ndash DT-containing polio MMRbull Use hexa or penta where available in lt 10y
bull 2nd 3rd set could be the same
New challenges
bull Numbers ndash and complexity of catch-up in context screening
bull ACIR -gt AIRbull Measurement subgroups
bull Asylum seekers ndash TPV
bull After end 2017 ndash catch-up vaccination fundings
bull Other migrant groups
Take home
bull Large number new arrivals ndash Northern regions
bull New offshore vaccination for Humanitarian entrantsbull Which may extend further
bull Paperwork is good (but not in ACIR)
bull Catch-up onshore still difficultbull Back to 202 visas
bull Immunisation policy ndash needs to consider migration
Acknowledgements
bull RCH Immunisation Service especially Sonja Elia for their assistance over many years
bull RCH Immigrant health team ndash Helen Milton Tatiana Polizzi Drs Andy Smith Shidan Tosif Hamish Graham Jane Standish Karen Kiang Sophie Oldfield Rowena Conroy Sanjay Patel Erin OrsquoRourke
bull Kirsten Gordon Yasmin Abubakar Sylvie Bui Hoang Jenny Kendrick our fabulous volunteers
bull Interpreting staff Amin Bhatat Mourteza Khorshidi Sabine MacDonald and many people over many years
bull RCH colleagues
bull RCH Executive and Melbourne Childrenrsquos Campus partners
bull Victorian Foundation for Survivors of Torture
bull Victorian Refugee Health Network
bull Department of Health Crystal Russell Pam Williams Martin Turnbull
bull Dr Mitchell Smith NSW Refugee Health
bull The children adolescents and families we see at RCH
REFUGEE APPLICANT
ONSHORE
ASYLUM SEEKER
OFFSHORE
HUMANITARIAN ENTRANT
1) DETENTION HEALTH2) POST-RELEASE3) AT SUBSTANTIVE VISA
1) IME (MANDATED)2) DHC (VOLUNTARY)3) POST-ARRIVAL (VOL)
Departure Health Check (DHC) Humanitarian (Voluntary ndash 3d lt travel)
Exam parasite checkMalaria RDT and Rx if positive (location)
CXR and HIV if PHx TBAlbendazole ge 1 y
MMR 9m ndash 54y+- YF vaccine
+- Polio vaccineAx local conditions
+- Repeat IME
Immigration Medical Exam (IME) - all(Compulsory 3ndash12 m prior to travel)
HxExamTB screen 2-10y
CXR ge 11yHIV ge 15yFWTU ge 5y
HBsAg (pregURMHCW)
HCV (HCW)
Syphilis (Humanitarian)
OutcomesFitness to fly assessment
Alert (Red General)+- Health Undertaking
Character requirement
AustraliaPost arrival health screening
Voluntary
AUSCO
Outcomes+- Visa
Alert (Red General)Health Undertaking +- delay travel
Pre-departure health screen (offshore)
Syrian cohortsCombined IME and DHC
HxExam TB screen 2-10y ndash IGRA or TST
CXR ge 11yHIV ge 15yHBsAg (all)FWTU ge 5y
AlbendazoleFull 1st dose catch-up immunisations
Mental health screenDevelopment screen (lt5 y)
Offshore screening ndash Syrian and Iraqi cohorts
bull Immigration Medical Examination and DHC
bull Will include immunisation
bull Plan (11115 ndash Lebanon Turkey Jordan)bull lt10 years = MMR OPV penta (no hexa avail)
bull 10 years + = MMR OPV dTPa
bull Equivalent 1st dose catch-up
bull Challenges with information transfer
bull Difficulties sourcing MMR Jordan (and cases at the time)
OPV vs IPV
bull OPVbull Stopped Victoria 2005bull Excreted 6 weeks
bull Faecal specimen pick up
bull Highly effective immunity (95 3 doses) inc gutbull Prevents wild type infection
bull IPVbull Highly effective paralytic (99 3 doses) less gut
bull Can still get wild-type infection
bull Not recommended pregnancyBF
bull Seroconversion sl lower combination OPV and IPV (sero 3)
OPV only form available
httpswwwasidnetauresourcesclinical-guidelines
httprefugeehealthnetworkorgauengageimmunisation-working-group
April 2015 -httpparlinfoaphgovauparlInfosearchdisplaydisplayw3pquery=Id3A22media2Fpressrel2F377023622
No jab no pay - no plan for migrants
bull Prior to Jan 2016 upper age limit ACIR 7ybull Any child arrivingvaccinated after 7y ndash not on ACIR
bull Centrelink letters (all 27 of themhellip)
bull Establishing prior vaccinationbull Mobile populationsbull Many years agobull Lack of records
bull Duplicationsbull Appointmentsbull Serologybull Vaccines
bull Medical exemptions ndash GPs only
20m Hexa 13 13vPCV MMR-V 22 if had offshore Men C 11 DT-containing dose 4 and 5 IPV dose 4 and check HBV serol (sib infection)
3y MMR-V 22 if had offshore Hexa 13 no Hep B (infection) 13vPCV 11 Men C 11 will need DT-containing dose 4 and IPV dose 4
12 y dTpa 13 then dTnext 2 doses IPV 13 MMR-V 22 if had offshore Hep B adult formulation 12 MenC high school ndash HPV VV dTpa ndash factor in
7 y Hexa 13 no MMR (immune) VV 11 MenC 11 DT-containing dose 4
6 y no Hep B (infection) give DTPa 13 amp IPV 13 or hexa 13 MMR-V 22 MenC DT-containing dose 4
Any recordsAny serologyAny vaccinestimingHx varicellaSchedule changesAnything else ndash eg HH
Associated ACIR issues
bull Workloaddelaysbull Batch errorsbull Longer for offshore (3w)bull Faxed records (8w)
bull Catch-up incentives bull lt7y onlybull Not structured to support best practice
bull Specialist registrationbull Due-overdue rules hepatitis Bbull ACIR notification payment - quirks
httpsmygovaumygovcontenthtmlhelphtml
New challenges
bull Department Health
bull Proposal to broaden immunisation Humanitarian entrants
bull In accordance with NIP ndash where
bull Operationally feasible
bull Clinically relevant
bull Time allows
Concerns
bull Many countries
bull Many schedules
bull Supply issues
bull No process to transfer offshore to ACIRbull Reliant on paperwork
bull My thoughts ndash DT-containing polio MMRbull Use hexa or penta where available in lt 10y
bull 2nd 3rd set could be the same
New challenges
bull Numbers ndash and complexity of catch-up in context screening
bull ACIR -gt AIRbull Measurement subgroups
bull Asylum seekers ndash TPV
bull After end 2017 ndash catch-up vaccination fundings
bull Other migrant groups
Take home
bull Large number new arrivals ndash Northern regions
bull New offshore vaccination for Humanitarian entrantsbull Which may extend further
bull Paperwork is good (but not in ACIR)
bull Catch-up onshore still difficultbull Back to 202 visas
bull Immunisation policy ndash needs to consider migration
Acknowledgements
bull RCH Immunisation Service especially Sonja Elia for their assistance over many years
bull RCH Immigrant health team ndash Helen Milton Tatiana Polizzi Drs Andy Smith Shidan Tosif Hamish Graham Jane Standish Karen Kiang Sophie Oldfield Rowena Conroy Sanjay Patel Erin OrsquoRourke
bull Kirsten Gordon Yasmin Abubakar Sylvie Bui Hoang Jenny Kendrick our fabulous volunteers
bull Interpreting staff Amin Bhatat Mourteza Khorshidi Sabine MacDonald and many people over many years
bull RCH colleagues
bull RCH Executive and Melbourne Childrenrsquos Campus partners
bull Victorian Foundation for Survivors of Torture
bull Victorian Refugee Health Network
bull Department of Health Crystal Russell Pam Williams Martin Turnbull
bull Dr Mitchell Smith NSW Refugee Health
bull The children adolescents and families we see at RCH
Departure Health Check (DHC) Humanitarian (Voluntary ndash 3d lt travel)
Exam parasite checkMalaria RDT and Rx if positive (location)
CXR and HIV if PHx TBAlbendazole ge 1 y
MMR 9m ndash 54y+- YF vaccine
+- Polio vaccineAx local conditions
+- Repeat IME
Immigration Medical Exam (IME) - all(Compulsory 3ndash12 m prior to travel)
HxExamTB screen 2-10y
CXR ge 11yHIV ge 15yFWTU ge 5y
HBsAg (pregURMHCW)
HCV (HCW)
Syphilis (Humanitarian)
OutcomesFitness to fly assessment
Alert (Red General)+- Health Undertaking
Character requirement
AustraliaPost arrival health screening
Voluntary
AUSCO
Outcomes+- Visa
Alert (Red General)Health Undertaking +- delay travel
Pre-departure health screen (offshore)
Syrian cohortsCombined IME and DHC
HxExam TB screen 2-10y ndash IGRA or TST
CXR ge 11yHIV ge 15yHBsAg (all)FWTU ge 5y
AlbendazoleFull 1st dose catch-up immunisations
Mental health screenDevelopment screen (lt5 y)
Offshore screening ndash Syrian and Iraqi cohorts
bull Immigration Medical Examination and DHC
bull Will include immunisation
bull Plan (11115 ndash Lebanon Turkey Jordan)bull lt10 years = MMR OPV penta (no hexa avail)
bull 10 years + = MMR OPV dTPa
bull Equivalent 1st dose catch-up
bull Challenges with information transfer
bull Difficulties sourcing MMR Jordan (and cases at the time)
OPV vs IPV
bull OPVbull Stopped Victoria 2005bull Excreted 6 weeks
bull Faecal specimen pick up
bull Highly effective immunity (95 3 doses) inc gutbull Prevents wild type infection
bull IPVbull Highly effective paralytic (99 3 doses) less gut
bull Can still get wild-type infection
bull Not recommended pregnancyBF
bull Seroconversion sl lower combination OPV and IPV (sero 3)
OPV only form available
httpswwwasidnetauresourcesclinical-guidelines
httprefugeehealthnetworkorgauengageimmunisation-working-group
April 2015 -httpparlinfoaphgovauparlInfosearchdisplaydisplayw3pquery=Id3A22media2Fpressrel2F377023622
No jab no pay - no plan for migrants
bull Prior to Jan 2016 upper age limit ACIR 7ybull Any child arrivingvaccinated after 7y ndash not on ACIR
bull Centrelink letters (all 27 of themhellip)
bull Establishing prior vaccinationbull Mobile populationsbull Many years agobull Lack of records
bull Duplicationsbull Appointmentsbull Serologybull Vaccines
bull Medical exemptions ndash GPs only
20m Hexa 13 13vPCV MMR-V 22 if had offshore Men C 11 DT-containing dose 4 and 5 IPV dose 4 and check HBV serol (sib infection)
3y MMR-V 22 if had offshore Hexa 13 no Hep B (infection) 13vPCV 11 Men C 11 will need DT-containing dose 4 and IPV dose 4
12 y dTpa 13 then dTnext 2 doses IPV 13 MMR-V 22 if had offshore Hep B adult formulation 12 MenC high school ndash HPV VV dTpa ndash factor in
7 y Hexa 13 no MMR (immune) VV 11 MenC 11 DT-containing dose 4
6 y no Hep B (infection) give DTPa 13 amp IPV 13 or hexa 13 MMR-V 22 MenC DT-containing dose 4
Any recordsAny serologyAny vaccinestimingHx varicellaSchedule changesAnything else ndash eg HH
Associated ACIR issues
bull Workloaddelaysbull Batch errorsbull Longer for offshore (3w)bull Faxed records (8w)
bull Catch-up incentives bull lt7y onlybull Not structured to support best practice
bull Specialist registrationbull Due-overdue rules hepatitis Bbull ACIR notification payment - quirks
httpsmygovaumygovcontenthtmlhelphtml
New challenges
bull Department Health
bull Proposal to broaden immunisation Humanitarian entrants
bull In accordance with NIP ndash where
bull Operationally feasible
bull Clinically relevant
bull Time allows
Concerns
bull Many countries
bull Many schedules
bull Supply issues
bull No process to transfer offshore to ACIRbull Reliant on paperwork
bull My thoughts ndash DT-containing polio MMRbull Use hexa or penta where available in lt 10y
bull 2nd 3rd set could be the same
New challenges
bull Numbers ndash and complexity of catch-up in context screening
bull ACIR -gt AIRbull Measurement subgroups
bull Asylum seekers ndash TPV
bull After end 2017 ndash catch-up vaccination fundings
bull Other migrant groups
Take home
bull Large number new arrivals ndash Northern regions
bull New offshore vaccination for Humanitarian entrantsbull Which may extend further
bull Paperwork is good (but not in ACIR)
bull Catch-up onshore still difficultbull Back to 202 visas
bull Immunisation policy ndash needs to consider migration
Acknowledgements
bull RCH Immunisation Service especially Sonja Elia for their assistance over many years
bull RCH Immigrant health team ndash Helen Milton Tatiana Polizzi Drs Andy Smith Shidan Tosif Hamish Graham Jane Standish Karen Kiang Sophie Oldfield Rowena Conroy Sanjay Patel Erin OrsquoRourke
bull Kirsten Gordon Yasmin Abubakar Sylvie Bui Hoang Jenny Kendrick our fabulous volunteers
bull Interpreting staff Amin Bhatat Mourteza Khorshidi Sabine MacDonald and many people over many years
bull RCH colleagues
bull RCH Executive and Melbourne Childrenrsquos Campus partners
bull Victorian Foundation for Survivors of Torture
bull Victorian Refugee Health Network
bull Department of Health Crystal Russell Pam Williams Martin Turnbull
bull Dr Mitchell Smith NSW Refugee Health
bull The children adolescents and families we see at RCH
Offshore screening ndash Syrian and Iraqi cohorts
bull Immigration Medical Examination and DHC
bull Will include immunisation
bull Plan (11115 ndash Lebanon Turkey Jordan)bull lt10 years = MMR OPV penta (no hexa avail)
bull 10 years + = MMR OPV dTPa
bull Equivalent 1st dose catch-up
bull Challenges with information transfer
bull Difficulties sourcing MMR Jordan (and cases at the time)
OPV vs IPV
bull OPVbull Stopped Victoria 2005bull Excreted 6 weeks
bull Faecal specimen pick up
bull Highly effective immunity (95 3 doses) inc gutbull Prevents wild type infection
bull IPVbull Highly effective paralytic (99 3 doses) less gut
bull Can still get wild-type infection
bull Not recommended pregnancyBF
bull Seroconversion sl lower combination OPV and IPV (sero 3)
OPV only form available
httpswwwasidnetauresourcesclinical-guidelines
httprefugeehealthnetworkorgauengageimmunisation-working-group
April 2015 -httpparlinfoaphgovauparlInfosearchdisplaydisplayw3pquery=Id3A22media2Fpressrel2F377023622
No jab no pay - no plan for migrants
bull Prior to Jan 2016 upper age limit ACIR 7ybull Any child arrivingvaccinated after 7y ndash not on ACIR
bull Centrelink letters (all 27 of themhellip)
bull Establishing prior vaccinationbull Mobile populationsbull Many years agobull Lack of records
bull Duplicationsbull Appointmentsbull Serologybull Vaccines
bull Medical exemptions ndash GPs only
20m Hexa 13 13vPCV MMR-V 22 if had offshore Men C 11 DT-containing dose 4 and 5 IPV dose 4 and check HBV serol (sib infection)
3y MMR-V 22 if had offshore Hexa 13 no Hep B (infection) 13vPCV 11 Men C 11 will need DT-containing dose 4 and IPV dose 4
12 y dTpa 13 then dTnext 2 doses IPV 13 MMR-V 22 if had offshore Hep B adult formulation 12 MenC high school ndash HPV VV dTpa ndash factor in
7 y Hexa 13 no MMR (immune) VV 11 MenC 11 DT-containing dose 4
6 y no Hep B (infection) give DTPa 13 amp IPV 13 or hexa 13 MMR-V 22 MenC DT-containing dose 4
Any recordsAny serologyAny vaccinestimingHx varicellaSchedule changesAnything else ndash eg HH
Associated ACIR issues
bull Workloaddelaysbull Batch errorsbull Longer for offshore (3w)bull Faxed records (8w)
bull Catch-up incentives bull lt7y onlybull Not structured to support best practice
bull Specialist registrationbull Due-overdue rules hepatitis Bbull ACIR notification payment - quirks
httpsmygovaumygovcontenthtmlhelphtml
New challenges
bull Department Health
bull Proposal to broaden immunisation Humanitarian entrants
bull In accordance with NIP ndash where
bull Operationally feasible
bull Clinically relevant
bull Time allows
Concerns
bull Many countries
bull Many schedules
bull Supply issues
bull No process to transfer offshore to ACIRbull Reliant on paperwork
bull My thoughts ndash DT-containing polio MMRbull Use hexa or penta where available in lt 10y
bull 2nd 3rd set could be the same
New challenges
bull Numbers ndash and complexity of catch-up in context screening
bull ACIR -gt AIRbull Measurement subgroups
bull Asylum seekers ndash TPV
bull After end 2017 ndash catch-up vaccination fundings
bull Other migrant groups
Take home
bull Large number new arrivals ndash Northern regions
bull New offshore vaccination for Humanitarian entrantsbull Which may extend further
bull Paperwork is good (but not in ACIR)
bull Catch-up onshore still difficultbull Back to 202 visas
bull Immunisation policy ndash needs to consider migration
Acknowledgements
bull RCH Immunisation Service especially Sonja Elia for their assistance over many years
bull RCH Immigrant health team ndash Helen Milton Tatiana Polizzi Drs Andy Smith Shidan Tosif Hamish Graham Jane Standish Karen Kiang Sophie Oldfield Rowena Conroy Sanjay Patel Erin OrsquoRourke
bull Kirsten Gordon Yasmin Abubakar Sylvie Bui Hoang Jenny Kendrick our fabulous volunteers
bull Interpreting staff Amin Bhatat Mourteza Khorshidi Sabine MacDonald and many people over many years
bull RCH colleagues
bull RCH Executive and Melbourne Childrenrsquos Campus partners
bull Victorian Foundation for Survivors of Torture
bull Victorian Refugee Health Network
bull Department of Health Crystal Russell Pam Williams Martin Turnbull
bull Dr Mitchell Smith NSW Refugee Health
bull The children adolescents and families we see at RCH
OPV vs IPV
bull OPVbull Stopped Victoria 2005bull Excreted 6 weeks
bull Faecal specimen pick up
bull Highly effective immunity (95 3 doses) inc gutbull Prevents wild type infection
bull IPVbull Highly effective paralytic (99 3 doses) less gut
bull Can still get wild-type infection
bull Not recommended pregnancyBF
bull Seroconversion sl lower combination OPV and IPV (sero 3)
OPV only form available
httpswwwasidnetauresourcesclinical-guidelines
httprefugeehealthnetworkorgauengageimmunisation-working-group
April 2015 -httpparlinfoaphgovauparlInfosearchdisplaydisplayw3pquery=Id3A22media2Fpressrel2F377023622
No jab no pay - no plan for migrants
bull Prior to Jan 2016 upper age limit ACIR 7ybull Any child arrivingvaccinated after 7y ndash not on ACIR
bull Centrelink letters (all 27 of themhellip)
bull Establishing prior vaccinationbull Mobile populationsbull Many years agobull Lack of records
bull Duplicationsbull Appointmentsbull Serologybull Vaccines
bull Medical exemptions ndash GPs only
20m Hexa 13 13vPCV MMR-V 22 if had offshore Men C 11 DT-containing dose 4 and 5 IPV dose 4 and check HBV serol (sib infection)
3y MMR-V 22 if had offshore Hexa 13 no Hep B (infection) 13vPCV 11 Men C 11 will need DT-containing dose 4 and IPV dose 4
12 y dTpa 13 then dTnext 2 doses IPV 13 MMR-V 22 if had offshore Hep B adult formulation 12 MenC high school ndash HPV VV dTpa ndash factor in
7 y Hexa 13 no MMR (immune) VV 11 MenC 11 DT-containing dose 4
6 y no Hep B (infection) give DTPa 13 amp IPV 13 or hexa 13 MMR-V 22 MenC DT-containing dose 4
Any recordsAny serologyAny vaccinestimingHx varicellaSchedule changesAnything else ndash eg HH
Associated ACIR issues
bull Workloaddelaysbull Batch errorsbull Longer for offshore (3w)bull Faxed records (8w)
bull Catch-up incentives bull lt7y onlybull Not structured to support best practice
bull Specialist registrationbull Due-overdue rules hepatitis Bbull ACIR notification payment - quirks
httpsmygovaumygovcontenthtmlhelphtml
New challenges
bull Department Health
bull Proposal to broaden immunisation Humanitarian entrants
bull In accordance with NIP ndash where
bull Operationally feasible
bull Clinically relevant
bull Time allows
Concerns
bull Many countries
bull Many schedules
bull Supply issues
bull No process to transfer offshore to ACIRbull Reliant on paperwork
bull My thoughts ndash DT-containing polio MMRbull Use hexa or penta where available in lt 10y
bull 2nd 3rd set could be the same
New challenges
bull Numbers ndash and complexity of catch-up in context screening
bull ACIR -gt AIRbull Measurement subgroups
bull Asylum seekers ndash TPV
bull After end 2017 ndash catch-up vaccination fundings
bull Other migrant groups
Take home
bull Large number new arrivals ndash Northern regions
bull New offshore vaccination for Humanitarian entrantsbull Which may extend further
bull Paperwork is good (but not in ACIR)
bull Catch-up onshore still difficultbull Back to 202 visas
bull Immunisation policy ndash needs to consider migration
Acknowledgements
bull RCH Immunisation Service especially Sonja Elia for their assistance over many years
bull RCH Immigrant health team ndash Helen Milton Tatiana Polizzi Drs Andy Smith Shidan Tosif Hamish Graham Jane Standish Karen Kiang Sophie Oldfield Rowena Conroy Sanjay Patel Erin OrsquoRourke
bull Kirsten Gordon Yasmin Abubakar Sylvie Bui Hoang Jenny Kendrick our fabulous volunteers
bull Interpreting staff Amin Bhatat Mourteza Khorshidi Sabine MacDonald and many people over many years
bull RCH colleagues
bull RCH Executive and Melbourne Childrenrsquos Campus partners
bull Victorian Foundation for Survivors of Torture
bull Victorian Refugee Health Network
bull Department of Health Crystal Russell Pam Williams Martin Turnbull
bull Dr Mitchell Smith NSW Refugee Health
bull The children adolescents and families we see at RCH
httpswwwasidnetauresourcesclinical-guidelines
httprefugeehealthnetworkorgauengageimmunisation-working-group
April 2015 -httpparlinfoaphgovauparlInfosearchdisplaydisplayw3pquery=Id3A22media2Fpressrel2F377023622
No jab no pay - no plan for migrants
bull Prior to Jan 2016 upper age limit ACIR 7ybull Any child arrivingvaccinated after 7y ndash not on ACIR
bull Centrelink letters (all 27 of themhellip)
bull Establishing prior vaccinationbull Mobile populationsbull Many years agobull Lack of records
bull Duplicationsbull Appointmentsbull Serologybull Vaccines
bull Medical exemptions ndash GPs only
20m Hexa 13 13vPCV MMR-V 22 if had offshore Men C 11 DT-containing dose 4 and 5 IPV dose 4 and check HBV serol (sib infection)
3y MMR-V 22 if had offshore Hexa 13 no Hep B (infection) 13vPCV 11 Men C 11 will need DT-containing dose 4 and IPV dose 4
12 y dTpa 13 then dTnext 2 doses IPV 13 MMR-V 22 if had offshore Hep B adult formulation 12 MenC high school ndash HPV VV dTpa ndash factor in
7 y Hexa 13 no MMR (immune) VV 11 MenC 11 DT-containing dose 4
6 y no Hep B (infection) give DTPa 13 amp IPV 13 or hexa 13 MMR-V 22 MenC DT-containing dose 4
Any recordsAny serologyAny vaccinestimingHx varicellaSchedule changesAnything else ndash eg HH
Associated ACIR issues
bull Workloaddelaysbull Batch errorsbull Longer for offshore (3w)bull Faxed records (8w)
bull Catch-up incentives bull lt7y onlybull Not structured to support best practice
bull Specialist registrationbull Due-overdue rules hepatitis Bbull ACIR notification payment - quirks
httpsmygovaumygovcontenthtmlhelphtml
New challenges
bull Department Health
bull Proposal to broaden immunisation Humanitarian entrants
bull In accordance with NIP ndash where
bull Operationally feasible
bull Clinically relevant
bull Time allows
Concerns
bull Many countries
bull Many schedules
bull Supply issues
bull No process to transfer offshore to ACIRbull Reliant on paperwork
bull My thoughts ndash DT-containing polio MMRbull Use hexa or penta where available in lt 10y
bull 2nd 3rd set could be the same
New challenges
bull Numbers ndash and complexity of catch-up in context screening
bull ACIR -gt AIRbull Measurement subgroups
bull Asylum seekers ndash TPV
bull After end 2017 ndash catch-up vaccination fundings
bull Other migrant groups
Take home
bull Large number new arrivals ndash Northern regions
bull New offshore vaccination for Humanitarian entrantsbull Which may extend further
bull Paperwork is good (but not in ACIR)
bull Catch-up onshore still difficultbull Back to 202 visas
bull Immunisation policy ndash needs to consider migration
Acknowledgements
bull RCH Immunisation Service especially Sonja Elia for their assistance over many years
bull RCH Immigrant health team ndash Helen Milton Tatiana Polizzi Drs Andy Smith Shidan Tosif Hamish Graham Jane Standish Karen Kiang Sophie Oldfield Rowena Conroy Sanjay Patel Erin OrsquoRourke
bull Kirsten Gordon Yasmin Abubakar Sylvie Bui Hoang Jenny Kendrick our fabulous volunteers
bull Interpreting staff Amin Bhatat Mourteza Khorshidi Sabine MacDonald and many people over many years
bull RCH colleagues
bull RCH Executive and Melbourne Childrenrsquos Campus partners
bull Victorian Foundation for Survivors of Torture
bull Victorian Refugee Health Network
bull Department of Health Crystal Russell Pam Williams Martin Turnbull
bull Dr Mitchell Smith NSW Refugee Health
bull The children adolescents and families we see at RCH
httprefugeehealthnetworkorgauengageimmunisation-working-group
April 2015 -httpparlinfoaphgovauparlInfosearchdisplaydisplayw3pquery=Id3A22media2Fpressrel2F377023622
No jab no pay - no plan for migrants
bull Prior to Jan 2016 upper age limit ACIR 7ybull Any child arrivingvaccinated after 7y ndash not on ACIR
bull Centrelink letters (all 27 of themhellip)
bull Establishing prior vaccinationbull Mobile populationsbull Many years agobull Lack of records
bull Duplicationsbull Appointmentsbull Serologybull Vaccines
bull Medical exemptions ndash GPs only
20m Hexa 13 13vPCV MMR-V 22 if had offshore Men C 11 DT-containing dose 4 and 5 IPV dose 4 and check HBV serol (sib infection)
3y MMR-V 22 if had offshore Hexa 13 no Hep B (infection) 13vPCV 11 Men C 11 will need DT-containing dose 4 and IPV dose 4
12 y dTpa 13 then dTnext 2 doses IPV 13 MMR-V 22 if had offshore Hep B adult formulation 12 MenC high school ndash HPV VV dTpa ndash factor in
7 y Hexa 13 no MMR (immune) VV 11 MenC 11 DT-containing dose 4
6 y no Hep B (infection) give DTPa 13 amp IPV 13 or hexa 13 MMR-V 22 MenC DT-containing dose 4
Any recordsAny serologyAny vaccinestimingHx varicellaSchedule changesAnything else ndash eg HH
Associated ACIR issues
bull Workloaddelaysbull Batch errorsbull Longer for offshore (3w)bull Faxed records (8w)
bull Catch-up incentives bull lt7y onlybull Not structured to support best practice
bull Specialist registrationbull Due-overdue rules hepatitis Bbull ACIR notification payment - quirks
httpsmygovaumygovcontenthtmlhelphtml
New challenges
bull Department Health
bull Proposal to broaden immunisation Humanitarian entrants
bull In accordance with NIP ndash where
bull Operationally feasible
bull Clinically relevant
bull Time allows
Concerns
bull Many countries
bull Many schedules
bull Supply issues
bull No process to transfer offshore to ACIRbull Reliant on paperwork
bull My thoughts ndash DT-containing polio MMRbull Use hexa or penta where available in lt 10y
bull 2nd 3rd set could be the same
New challenges
bull Numbers ndash and complexity of catch-up in context screening
bull ACIR -gt AIRbull Measurement subgroups
bull Asylum seekers ndash TPV
bull After end 2017 ndash catch-up vaccination fundings
bull Other migrant groups
Take home
bull Large number new arrivals ndash Northern regions
bull New offshore vaccination for Humanitarian entrantsbull Which may extend further
bull Paperwork is good (but not in ACIR)
bull Catch-up onshore still difficultbull Back to 202 visas
bull Immunisation policy ndash needs to consider migration
Acknowledgements
bull RCH Immunisation Service especially Sonja Elia for their assistance over many years
bull RCH Immigrant health team ndash Helen Milton Tatiana Polizzi Drs Andy Smith Shidan Tosif Hamish Graham Jane Standish Karen Kiang Sophie Oldfield Rowena Conroy Sanjay Patel Erin OrsquoRourke
bull Kirsten Gordon Yasmin Abubakar Sylvie Bui Hoang Jenny Kendrick our fabulous volunteers
bull Interpreting staff Amin Bhatat Mourteza Khorshidi Sabine MacDonald and many people over many years
bull RCH colleagues
bull RCH Executive and Melbourne Childrenrsquos Campus partners
bull Victorian Foundation for Survivors of Torture
bull Victorian Refugee Health Network
bull Department of Health Crystal Russell Pam Williams Martin Turnbull
bull Dr Mitchell Smith NSW Refugee Health
bull The children adolescents and families we see at RCH
April 2015 -httpparlinfoaphgovauparlInfosearchdisplaydisplayw3pquery=Id3A22media2Fpressrel2F377023622
No jab no pay - no plan for migrants
bull Prior to Jan 2016 upper age limit ACIR 7ybull Any child arrivingvaccinated after 7y ndash not on ACIR
bull Centrelink letters (all 27 of themhellip)
bull Establishing prior vaccinationbull Mobile populationsbull Many years agobull Lack of records
bull Duplicationsbull Appointmentsbull Serologybull Vaccines
bull Medical exemptions ndash GPs only
20m Hexa 13 13vPCV MMR-V 22 if had offshore Men C 11 DT-containing dose 4 and 5 IPV dose 4 and check HBV serol (sib infection)
3y MMR-V 22 if had offshore Hexa 13 no Hep B (infection) 13vPCV 11 Men C 11 will need DT-containing dose 4 and IPV dose 4
12 y dTpa 13 then dTnext 2 doses IPV 13 MMR-V 22 if had offshore Hep B adult formulation 12 MenC high school ndash HPV VV dTpa ndash factor in
7 y Hexa 13 no MMR (immune) VV 11 MenC 11 DT-containing dose 4
6 y no Hep B (infection) give DTPa 13 amp IPV 13 or hexa 13 MMR-V 22 MenC DT-containing dose 4
Any recordsAny serologyAny vaccinestimingHx varicellaSchedule changesAnything else ndash eg HH
Associated ACIR issues
bull Workloaddelaysbull Batch errorsbull Longer for offshore (3w)bull Faxed records (8w)
bull Catch-up incentives bull lt7y onlybull Not structured to support best practice
bull Specialist registrationbull Due-overdue rules hepatitis Bbull ACIR notification payment - quirks
httpsmygovaumygovcontenthtmlhelphtml
New challenges
bull Department Health
bull Proposal to broaden immunisation Humanitarian entrants
bull In accordance with NIP ndash where
bull Operationally feasible
bull Clinically relevant
bull Time allows
Concerns
bull Many countries
bull Many schedules
bull Supply issues
bull No process to transfer offshore to ACIRbull Reliant on paperwork
bull My thoughts ndash DT-containing polio MMRbull Use hexa or penta where available in lt 10y
bull 2nd 3rd set could be the same
New challenges
bull Numbers ndash and complexity of catch-up in context screening
bull ACIR -gt AIRbull Measurement subgroups
bull Asylum seekers ndash TPV
bull After end 2017 ndash catch-up vaccination fundings
bull Other migrant groups
Take home
bull Large number new arrivals ndash Northern regions
bull New offshore vaccination for Humanitarian entrantsbull Which may extend further
bull Paperwork is good (but not in ACIR)
bull Catch-up onshore still difficultbull Back to 202 visas
bull Immunisation policy ndash needs to consider migration
Acknowledgements
bull RCH Immunisation Service especially Sonja Elia for their assistance over many years
bull RCH Immigrant health team ndash Helen Milton Tatiana Polizzi Drs Andy Smith Shidan Tosif Hamish Graham Jane Standish Karen Kiang Sophie Oldfield Rowena Conroy Sanjay Patel Erin OrsquoRourke
bull Kirsten Gordon Yasmin Abubakar Sylvie Bui Hoang Jenny Kendrick our fabulous volunteers
bull Interpreting staff Amin Bhatat Mourteza Khorshidi Sabine MacDonald and many people over many years
bull RCH colleagues
bull RCH Executive and Melbourne Childrenrsquos Campus partners
bull Victorian Foundation for Survivors of Torture
bull Victorian Refugee Health Network
bull Department of Health Crystal Russell Pam Williams Martin Turnbull
bull Dr Mitchell Smith NSW Refugee Health
bull The children adolescents and families we see at RCH
No jab no pay - no plan for migrants
bull Prior to Jan 2016 upper age limit ACIR 7ybull Any child arrivingvaccinated after 7y ndash not on ACIR
bull Centrelink letters (all 27 of themhellip)
bull Establishing prior vaccinationbull Mobile populationsbull Many years agobull Lack of records
bull Duplicationsbull Appointmentsbull Serologybull Vaccines
bull Medical exemptions ndash GPs only
20m Hexa 13 13vPCV MMR-V 22 if had offshore Men C 11 DT-containing dose 4 and 5 IPV dose 4 and check HBV serol (sib infection)
3y MMR-V 22 if had offshore Hexa 13 no Hep B (infection) 13vPCV 11 Men C 11 will need DT-containing dose 4 and IPV dose 4
12 y dTpa 13 then dTnext 2 doses IPV 13 MMR-V 22 if had offshore Hep B adult formulation 12 MenC high school ndash HPV VV dTpa ndash factor in
7 y Hexa 13 no MMR (immune) VV 11 MenC 11 DT-containing dose 4
6 y no Hep B (infection) give DTPa 13 amp IPV 13 or hexa 13 MMR-V 22 MenC DT-containing dose 4
Any recordsAny serologyAny vaccinestimingHx varicellaSchedule changesAnything else ndash eg HH
Associated ACIR issues
bull Workloaddelaysbull Batch errorsbull Longer for offshore (3w)bull Faxed records (8w)
bull Catch-up incentives bull lt7y onlybull Not structured to support best practice
bull Specialist registrationbull Due-overdue rules hepatitis Bbull ACIR notification payment - quirks
httpsmygovaumygovcontenthtmlhelphtml
New challenges
bull Department Health
bull Proposal to broaden immunisation Humanitarian entrants
bull In accordance with NIP ndash where
bull Operationally feasible
bull Clinically relevant
bull Time allows
Concerns
bull Many countries
bull Many schedules
bull Supply issues
bull No process to transfer offshore to ACIRbull Reliant on paperwork
bull My thoughts ndash DT-containing polio MMRbull Use hexa or penta where available in lt 10y
bull 2nd 3rd set could be the same
New challenges
bull Numbers ndash and complexity of catch-up in context screening
bull ACIR -gt AIRbull Measurement subgroups
bull Asylum seekers ndash TPV
bull After end 2017 ndash catch-up vaccination fundings
bull Other migrant groups
Take home
bull Large number new arrivals ndash Northern regions
bull New offshore vaccination for Humanitarian entrantsbull Which may extend further
bull Paperwork is good (but not in ACIR)
bull Catch-up onshore still difficultbull Back to 202 visas
bull Immunisation policy ndash needs to consider migration
Acknowledgements
bull RCH Immunisation Service especially Sonja Elia for their assistance over many years
bull RCH Immigrant health team ndash Helen Milton Tatiana Polizzi Drs Andy Smith Shidan Tosif Hamish Graham Jane Standish Karen Kiang Sophie Oldfield Rowena Conroy Sanjay Patel Erin OrsquoRourke
bull Kirsten Gordon Yasmin Abubakar Sylvie Bui Hoang Jenny Kendrick our fabulous volunteers
bull Interpreting staff Amin Bhatat Mourteza Khorshidi Sabine MacDonald and many people over many years
bull RCH colleagues
bull RCH Executive and Melbourne Childrenrsquos Campus partners
bull Victorian Foundation for Survivors of Torture
bull Victorian Refugee Health Network
bull Department of Health Crystal Russell Pam Williams Martin Turnbull
bull Dr Mitchell Smith NSW Refugee Health
bull The children adolescents and families we see at RCH
20m Hexa 13 13vPCV MMR-V 22 if had offshore Men C 11 DT-containing dose 4 and 5 IPV dose 4 and check HBV serol (sib infection)
3y MMR-V 22 if had offshore Hexa 13 no Hep B (infection) 13vPCV 11 Men C 11 will need DT-containing dose 4 and IPV dose 4
12 y dTpa 13 then dTnext 2 doses IPV 13 MMR-V 22 if had offshore Hep B adult formulation 12 MenC high school ndash HPV VV dTpa ndash factor in
7 y Hexa 13 no MMR (immune) VV 11 MenC 11 DT-containing dose 4
6 y no Hep B (infection) give DTPa 13 amp IPV 13 or hexa 13 MMR-V 22 MenC DT-containing dose 4
Any recordsAny serologyAny vaccinestimingHx varicellaSchedule changesAnything else ndash eg HH
Associated ACIR issues
bull Workloaddelaysbull Batch errorsbull Longer for offshore (3w)bull Faxed records (8w)
bull Catch-up incentives bull lt7y onlybull Not structured to support best practice
bull Specialist registrationbull Due-overdue rules hepatitis Bbull ACIR notification payment - quirks
httpsmygovaumygovcontenthtmlhelphtml
New challenges
bull Department Health
bull Proposal to broaden immunisation Humanitarian entrants
bull In accordance with NIP ndash where
bull Operationally feasible
bull Clinically relevant
bull Time allows
Concerns
bull Many countries
bull Many schedules
bull Supply issues
bull No process to transfer offshore to ACIRbull Reliant on paperwork
bull My thoughts ndash DT-containing polio MMRbull Use hexa or penta where available in lt 10y
bull 2nd 3rd set could be the same
New challenges
bull Numbers ndash and complexity of catch-up in context screening
bull ACIR -gt AIRbull Measurement subgroups
bull Asylum seekers ndash TPV
bull After end 2017 ndash catch-up vaccination fundings
bull Other migrant groups
Take home
bull Large number new arrivals ndash Northern regions
bull New offshore vaccination for Humanitarian entrantsbull Which may extend further
bull Paperwork is good (but not in ACIR)
bull Catch-up onshore still difficultbull Back to 202 visas
bull Immunisation policy ndash needs to consider migration
Acknowledgements
bull RCH Immunisation Service especially Sonja Elia for their assistance over many years
bull RCH Immigrant health team ndash Helen Milton Tatiana Polizzi Drs Andy Smith Shidan Tosif Hamish Graham Jane Standish Karen Kiang Sophie Oldfield Rowena Conroy Sanjay Patel Erin OrsquoRourke
bull Kirsten Gordon Yasmin Abubakar Sylvie Bui Hoang Jenny Kendrick our fabulous volunteers
bull Interpreting staff Amin Bhatat Mourteza Khorshidi Sabine MacDonald and many people over many years
bull RCH colleagues
bull RCH Executive and Melbourne Childrenrsquos Campus partners
bull Victorian Foundation for Survivors of Torture
bull Victorian Refugee Health Network
bull Department of Health Crystal Russell Pam Williams Martin Turnbull
bull Dr Mitchell Smith NSW Refugee Health
bull The children adolescents and families we see at RCH
Associated ACIR issues
bull Workloaddelaysbull Batch errorsbull Longer for offshore (3w)bull Faxed records (8w)
bull Catch-up incentives bull lt7y onlybull Not structured to support best practice
bull Specialist registrationbull Due-overdue rules hepatitis Bbull ACIR notification payment - quirks
httpsmygovaumygovcontenthtmlhelphtml
New challenges
bull Department Health
bull Proposal to broaden immunisation Humanitarian entrants
bull In accordance with NIP ndash where
bull Operationally feasible
bull Clinically relevant
bull Time allows
Concerns
bull Many countries
bull Many schedules
bull Supply issues
bull No process to transfer offshore to ACIRbull Reliant on paperwork
bull My thoughts ndash DT-containing polio MMRbull Use hexa or penta where available in lt 10y
bull 2nd 3rd set could be the same
New challenges
bull Numbers ndash and complexity of catch-up in context screening
bull ACIR -gt AIRbull Measurement subgroups
bull Asylum seekers ndash TPV
bull After end 2017 ndash catch-up vaccination fundings
bull Other migrant groups
Take home
bull Large number new arrivals ndash Northern regions
bull New offshore vaccination for Humanitarian entrantsbull Which may extend further
bull Paperwork is good (but not in ACIR)
bull Catch-up onshore still difficultbull Back to 202 visas
bull Immunisation policy ndash needs to consider migration
Acknowledgements
bull RCH Immunisation Service especially Sonja Elia for their assistance over many years
bull RCH Immigrant health team ndash Helen Milton Tatiana Polizzi Drs Andy Smith Shidan Tosif Hamish Graham Jane Standish Karen Kiang Sophie Oldfield Rowena Conroy Sanjay Patel Erin OrsquoRourke
bull Kirsten Gordon Yasmin Abubakar Sylvie Bui Hoang Jenny Kendrick our fabulous volunteers
bull Interpreting staff Amin Bhatat Mourteza Khorshidi Sabine MacDonald and many people over many years
bull RCH colleagues
bull RCH Executive and Melbourne Childrenrsquos Campus partners
bull Victorian Foundation for Survivors of Torture
bull Victorian Refugee Health Network
bull Department of Health Crystal Russell Pam Williams Martin Turnbull
bull Dr Mitchell Smith NSW Refugee Health
bull The children adolescents and families we see at RCH
httpsmygovaumygovcontenthtmlhelphtml
New challenges
bull Department Health
bull Proposal to broaden immunisation Humanitarian entrants
bull In accordance with NIP ndash where
bull Operationally feasible
bull Clinically relevant
bull Time allows
Concerns
bull Many countries
bull Many schedules
bull Supply issues
bull No process to transfer offshore to ACIRbull Reliant on paperwork
bull My thoughts ndash DT-containing polio MMRbull Use hexa or penta where available in lt 10y
bull 2nd 3rd set could be the same
New challenges
bull Numbers ndash and complexity of catch-up in context screening
bull ACIR -gt AIRbull Measurement subgroups
bull Asylum seekers ndash TPV
bull After end 2017 ndash catch-up vaccination fundings
bull Other migrant groups
Take home
bull Large number new arrivals ndash Northern regions
bull New offshore vaccination for Humanitarian entrantsbull Which may extend further
bull Paperwork is good (but not in ACIR)
bull Catch-up onshore still difficultbull Back to 202 visas
bull Immunisation policy ndash needs to consider migration
Acknowledgements
bull RCH Immunisation Service especially Sonja Elia for their assistance over many years
bull RCH Immigrant health team ndash Helen Milton Tatiana Polizzi Drs Andy Smith Shidan Tosif Hamish Graham Jane Standish Karen Kiang Sophie Oldfield Rowena Conroy Sanjay Patel Erin OrsquoRourke
bull Kirsten Gordon Yasmin Abubakar Sylvie Bui Hoang Jenny Kendrick our fabulous volunteers
bull Interpreting staff Amin Bhatat Mourteza Khorshidi Sabine MacDonald and many people over many years
bull RCH colleagues
bull RCH Executive and Melbourne Childrenrsquos Campus partners
bull Victorian Foundation for Survivors of Torture
bull Victorian Refugee Health Network
bull Department of Health Crystal Russell Pam Williams Martin Turnbull
bull Dr Mitchell Smith NSW Refugee Health
bull The children adolescents and families we see at RCH
New challenges
bull Department Health
bull Proposal to broaden immunisation Humanitarian entrants
bull In accordance with NIP ndash where
bull Operationally feasible
bull Clinically relevant
bull Time allows
Concerns
bull Many countries
bull Many schedules
bull Supply issues
bull No process to transfer offshore to ACIRbull Reliant on paperwork
bull My thoughts ndash DT-containing polio MMRbull Use hexa or penta where available in lt 10y
bull 2nd 3rd set could be the same
New challenges
bull Numbers ndash and complexity of catch-up in context screening
bull ACIR -gt AIRbull Measurement subgroups
bull Asylum seekers ndash TPV
bull After end 2017 ndash catch-up vaccination fundings
bull Other migrant groups
Take home
bull Large number new arrivals ndash Northern regions
bull New offshore vaccination for Humanitarian entrantsbull Which may extend further
bull Paperwork is good (but not in ACIR)
bull Catch-up onshore still difficultbull Back to 202 visas
bull Immunisation policy ndash needs to consider migration
Acknowledgements
bull RCH Immunisation Service especially Sonja Elia for their assistance over many years
bull RCH Immigrant health team ndash Helen Milton Tatiana Polizzi Drs Andy Smith Shidan Tosif Hamish Graham Jane Standish Karen Kiang Sophie Oldfield Rowena Conroy Sanjay Patel Erin OrsquoRourke
bull Kirsten Gordon Yasmin Abubakar Sylvie Bui Hoang Jenny Kendrick our fabulous volunteers
bull Interpreting staff Amin Bhatat Mourteza Khorshidi Sabine MacDonald and many people over many years
bull RCH colleagues
bull RCH Executive and Melbourne Childrenrsquos Campus partners
bull Victorian Foundation for Survivors of Torture
bull Victorian Refugee Health Network
bull Department of Health Crystal Russell Pam Williams Martin Turnbull
bull Dr Mitchell Smith NSW Refugee Health
bull The children adolescents and families we see at RCH
Concerns
bull Many countries
bull Many schedules
bull Supply issues
bull No process to transfer offshore to ACIRbull Reliant on paperwork
bull My thoughts ndash DT-containing polio MMRbull Use hexa or penta where available in lt 10y
bull 2nd 3rd set could be the same
New challenges
bull Numbers ndash and complexity of catch-up in context screening
bull ACIR -gt AIRbull Measurement subgroups
bull Asylum seekers ndash TPV
bull After end 2017 ndash catch-up vaccination fundings
bull Other migrant groups
Take home
bull Large number new arrivals ndash Northern regions
bull New offshore vaccination for Humanitarian entrantsbull Which may extend further
bull Paperwork is good (but not in ACIR)
bull Catch-up onshore still difficultbull Back to 202 visas
bull Immunisation policy ndash needs to consider migration
Acknowledgements
bull RCH Immunisation Service especially Sonja Elia for their assistance over many years
bull RCH Immigrant health team ndash Helen Milton Tatiana Polizzi Drs Andy Smith Shidan Tosif Hamish Graham Jane Standish Karen Kiang Sophie Oldfield Rowena Conroy Sanjay Patel Erin OrsquoRourke
bull Kirsten Gordon Yasmin Abubakar Sylvie Bui Hoang Jenny Kendrick our fabulous volunteers
bull Interpreting staff Amin Bhatat Mourteza Khorshidi Sabine MacDonald and many people over many years
bull RCH colleagues
bull RCH Executive and Melbourne Childrenrsquos Campus partners
bull Victorian Foundation for Survivors of Torture
bull Victorian Refugee Health Network
bull Department of Health Crystal Russell Pam Williams Martin Turnbull
bull Dr Mitchell Smith NSW Refugee Health
bull The children adolescents and families we see at RCH
New challenges
bull Numbers ndash and complexity of catch-up in context screening
bull ACIR -gt AIRbull Measurement subgroups
bull Asylum seekers ndash TPV
bull After end 2017 ndash catch-up vaccination fundings
bull Other migrant groups
Take home
bull Large number new arrivals ndash Northern regions
bull New offshore vaccination for Humanitarian entrantsbull Which may extend further
bull Paperwork is good (but not in ACIR)
bull Catch-up onshore still difficultbull Back to 202 visas
bull Immunisation policy ndash needs to consider migration
Acknowledgements
bull RCH Immunisation Service especially Sonja Elia for their assistance over many years
bull RCH Immigrant health team ndash Helen Milton Tatiana Polizzi Drs Andy Smith Shidan Tosif Hamish Graham Jane Standish Karen Kiang Sophie Oldfield Rowena Conroy Sanjay Patel Erin OrsquoRourke
bull Kirsten Gordon Yasmin Abubakar Sylvie Bui Hoang Jenny Kendrick our fabulous volunteers
bull Interpreting staff Amin Bhatat Mourteza Khorshidi Sabine MacDonald and many people over many years
bull RCH colleagues
bull RCH Executive and Melbourne Childrenrsquos Campus partners
bull Victorian Foundation for Survivors of Torture
bull Victorian Refugee Health Network
bull Department of Health Crystal Russell Pam Williams Martin Turnbull
bull Dr Mitchell Smith NSW Refugee Health
bull The children adolescents and families we see at RCH
Take home
bull Large number new arrivals ndash Northern regions
bull New offshore vaccination for Humanitarian entrantsbull Which may extend further
bull Paperwork is good (but not in ACIR)
bull Catch-up onshore still difficultbull Back to 202 visas
bull Immunisation policy ndash needs to consider migration
Acknowledgements
bull RCH Immunisation Service especially Sonja Elia for their assistance over many years
bull RCH Immigrant health team ndash Helen Milton Tatiana Polizzi Drs Andy Smith Shidan Tosif Hamish Graham Jane Standish Karen Kiang Sophie Oldfield Rowena Conroy Sanjay Patel Erin OrsquoRourke
bull Kirsten Gordon Yasmin Abubakar Sylvie Bui Hoang Jenny Kendrick our fabulous volunteers
bull Interpreting staff Amin Bhatat Mourteza Khorshidi Sabine MacDonald and many people over many years
bull RCH colleagues
bull RCH Executive and Melbourne Childrenrsquos Campus partners
bull Victorian Foundation for Survivors of Torture
bull Victorian Refugee Health Network
bull Department of Health Crystal Russell Pam Williams Martin Turnbull
bull Dr Mitchell Smith NSW Refugee Health
bull The children adolescents and families we see at RCH
Acknowledgements
bull RCH Immunisation Service especially Sonja Elia for their assistance over many years
bull RCH Immigrant health team ndash Helen Milton Tatiana Polizzi Drs Andy Smith Shidan Tosif Hamish Graham Jane Standish Karen Kiang Sophie Oldfield Rowena Conroy Sanjay Patel Erin OrsquoRourke
bull Kirsten Gordon Yasmin Abubakar Sylvie Bui Hoang Jenny Kendrick our fabulous volunteers
bull Interpreting staff Amin Bhatat Mourteza Khorshidi Sabine MacDonald and many people over many years
bull RCH colleagues
bull RCH Executive and Melbourne Childrenrsquos Campus partners
bull Victorian Foundation for Survivors of Torture
bull Victorian Refugee Health Network
bull Department of Health Crystal Russell Pam Williams Martin Turnbull
bull Dr Mitchell Smith NSW Refugee Health
bull The children adolescents and families we see at RCH