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

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

2001 Somali

2013 BVE CD

2008 Karen Chin

2012 Iran

Afghan

2006 Other

African

2005 Sudan

2016

SyrianIraqi

2014 Held

2015 Held

Nauru

httpdataunhcrorgsyrianrefugeesregionalphp

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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