National stakeholder workshop: Immunisation policy for migrants, refugees and travellers

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DATE: 9 August 2013

TIME: 8:30 - 16:30

VENUE: Tyree Room, Sciantia Building, The University of New South Wales

ORGANISERS: CRE Immnunisation

 

The NHMRC Centre for Research Excellence in Immunisation led by UNSW academic, Prof Raina MacIntyre convened a national stakeholder workshop at UNSW on August 9th which brought together leading infectious diseases researchers, clinicians, federal and state government policy makers.

There were two themes – one on immunisation issues for migrant and refugee groups and the other for immunisation issues for international travellers. This is the first time such a meeting has been held in Australia.

The Centre for Research Excellence convened this meeting to bring together key stakeholders from around the country to address immunisation needs of refugees, migrants and travellers, particularly in relation to “catch up” vaccines for older migrant and refugee children and awareness of important travel vaccinations. The workshop looked at practical solutions to ensuring older children who have immigrated to Australia are fully vaccinated according to the current Australian National Immunisation Program schedule. The workshop heard that currently catch-up vaccination is not routinely funded for such children, leading to risk of outbreaks of infectious diseases in under-immunised communities.

One of such outbreak presented at the workshop, which highlights the health problems is a large outbreak of measles in Western Sydney last year,linked with an under-vaccinated migrant population. Through migration, many of the children missed out on the vaccinations. This pocket of under-vaccinated children led to the largest measles outbreak in NSW since 1997. If we want to maintain measles control and prevent further outbreaks of measles, we need to ensure high coverage at a local level. This could be achieved by further education and more promotion of immunisation in low coverage communities, as well as funding of catch-up immunisation for migrants and refugees nationally.Parents might not be aware of the national immunisation program, may not have easy access to health care, or may not have the money to pay for “catch up” vaccines. There might be other language or cultural barriers, too.

Pre-travel immunisation is important for the prevention of vaccine-preventable diseases in the individual traveller but also to prevent importation of disease into Australia. In recent years, the number of typhoid cases has increased in Australia. Prior to 2007, there were only 50-70 cases a year, then it increased to 100 in 2008, 135 in 2011, 123 in 2012 and already this year it stands at 101 cases – with 32 of them in the month of January alone. Travellers returning to their country of birth to visit friends and relatives are at higher risk of typhoid and other vaccine-preventable diseases. Campaigns aimed at migrant communities are needed to increase awareness of travel risks and promote pre-travel immunisation.

This was the first workshop dedicated to issues of immunisation in migrants, refugees and travellers and will inform research priorities for the CRE, as well as allowing an exchange of ideas and solutions among the key stakeholders in the field.

 

Dr Stephen Conaty

Dr Stephen Conaty is a public health physician. From 2007 – 2012 he was Public Health Unit Director at Sydney and South Western Sydney Local Health Districts. In 2012 the largest measles outbreak since 1997 occurred in NSW with the majority of cases located in south western Sydney. He is currently Medical Advisor, Environmental Health Branch, Health Protection NSW

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Professor David Isaacs

David was born in London and has an identical twin brother, Stephen, who is a child psychiatrist. They went to different schools and once swapped schools for a day. His mother was also a child psychiatrist and his father, Alick, discovered interferon in 1957.

David is Clinical Professor in Paediatric Infectious Diseases at the Children’s Hospital at Westmead and the University of Sydney. He is also a general paediatrician who does a monthly clinic in Bourke and he has trained in bio-ethics. In 2004, David started the first Refugee Clinic at the Children’s Hospital at Westmead and is an advocate for children who have suffered or are suffering due to their asylum seeker or refugee status.

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Dr Margaret Kay

Dr Margaret Kay is senior lecturer at Discipline of General Practice, School of Medicine, the University of Queensland. Dr Kay's clinical and research areas of interest include doctors' health and refugee health. She is a Fellow of the RACGP, Hons Secretary of Doctors' Health Advisory Service Qld and is immediate past chair of Refugee Health Network of Australia (RHeaNA). She is also a member of the Australasian Doctors' Health Network, a member of RACGP Refugee Health Special Interest Group (RHSIG) and member of the Australian Medical Association (Qld)

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Professor Raina MacIntyre

Raina MacIntyre is Professor of Infectious Diseases Epidemiology and Head of the School of Public Health and Community Medicine at UNSW. She is an international leader in emerging infections and vaccinology, and is involved in numerous influenza and respiratory virus research studies that directly inform national and international policy and practice in communicable disease control.

Professor MacIntyre is the lead investigator on this CRE with particular interests in the research themes covering frail elderly vaccinology, travel health and health care worker research.

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Dr Mohamud Sheikh

Dr Mohamud Sheikh is a Senior Public Health Research Fellow at the School of Public Health and Community Medicine, UNSW and an international public health expert. Graduated from the university of Sydney with double master degrees and a doctorate, he has established himself as a young leader in international public health intervention and research to improve the health care of immigrants and refugees. His research interest is in global health, infectious and vaccine preventable diseases, migrant and refugee health. He has extensive links and networks with key refugee and migrant groups within Australia and internationally

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Dr Mitchell Smith

Dr Mitchell Smith is a public health physician and Director of the NSW Refugee Health Service, based in Liverpool Sydney, since its inception in 1999. His roles include policy advice and advocacy for health care for refugees at local, state and national levels. He is currently Chair of the Refugee Health Network of Australia

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Professor Tilman Ruff

Associate Professor Tilman Ruff AM is an infectious diseases and public health physician at the Nossal Institute for Global Health, University of Melbourne, and international medical advisor for Australian Red Cross. He has worked in travel medicine, hepatitis B control, and maternal and child health in Indonesia and Pacific Island countries, for a major vaccine manufacturer, and serves on the Expert Resource Panel for Hepatitis B Control for WHO's Western Pacific Region. He is Co-President of International Physicians for the Prevention of Nuclear War (Nobel Peace Prize 1985) and a founder and Co-Chair of the International Campaign to Abolish Nuclear Weapons (ICAN)

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Professor Robert Booy

Professor Robert Booy is the Head of Clinical Research at NCIRS. His research interests extend from understanding the genetic basis of susceptibility to, and severity of, infectious diseases, especially influenza and invasive disease caused by encapsulated organisms; the clinical, public health, social and economic burden of these diseases; and means by which to prevent or control serious infections through vaccines, drugs and non-pharmaceutical measures.

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Dr Anita Heywood

Dr Anita Heywood is an infectious disease epidemiologist and Senior lecturer at School of Public Health and Community Medicine, UNSW. Her research focuses on knowledge, attitudes and behaviours of international travellers to infectious disease risks and preventative health practices, focusing on migrant travellers visiting friends and relatives (VFR) and their risk of vaccine-preventable diseases. Her additional research interests include the analysis of routine surveillance data to evaluate vaccine programs and evidence-based vaccination policy and practice.

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Associate Professor Karin Leder

Karin is an infectious diseases physician. She has a Masters of Public Health degree (Harvard University) and a PhD (Monash University). Her specific areas of interest include travellers' health, health issues in immigrants and refugees, and waterborne infections. Karin is Head of the Infectious Diseases Epidemiology Unit within the Department of Epidemiology and Preventive Medicine at Monash University, works as a visiting ID specialist at the Royal Melbourne Hospital, is the Melbourne site director for GeoSentinel, and is on the Board of the International Society of Travel Medicine.

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Professor Peter A. Leggat, AM

Professor Peter A. Leggat, AM, is Head of the School of Public Health, Tropical Medicine and Rehabilitation Sciences, and Associate Dean for Faculty Affairs, Faculty of Medicine, Health and Molecular Sciences, James Cook University (JCU), Australia. He is also Visiting Medical Officer at Lavarack Barracks in Townsville. A former Fulbright Scholar, he has published more than 450 journal papers, more than 70 chapters and more than 20 books, as well as presenting more than 300 papers at national and international conferences. He has consulted with various organisations, including the Australian Defence Force, the Therapeutic Goods Authority and the World Health Organization. He has a strong interest in health workforce development in public health and tropical medicine, including having founded the Australian postgraduate course in travel medicine at JCU in 1993. He is a Founding Member of the International Society of Travel Medicine (ISTM), serving the ISTM in various capacities, and is currently ISTM Secretary Treasurer.

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Professor Nick Zwar

Professor Nick Zwar MBBS, MPH, PhD FRACGP is Professor of General Practice in the School of Public Health and Community Medicine, UNSW. Nick has a long term clinical, teaching and research interest in travel medicine. He has been involved in research on hepatitis A and hepatitis B risk and vaccination of Australian travelers. He was a founding member of the Australian Travel Health Advisory Group which is a joint medical and travel industry group promoting health travel. He is a member of the editorial board of the journal Travel Medicine and Infectious Disease. Nick has written a regular column on travel medicine for Australian Doctor for the last 17 years. He is a member of the International Society for Travel Medicine and holder of the ISTM Certificate in Travel Health.

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Ms Sue Campbell-Lloyd

Ms Sue Campbell-Lloyd is the Immunisation Manager in NSW and is also a member of the National Immunisation Committee (NIC) and the Advisory Committee on the Safety of Vaccines (ACSOV). Ms Campbell-Lloyd has actively participated in the implementation and monitoring of a number of vaccines provided under the National Immunisation Program. She is also a former member of the Australian Technical Advisory Group on Immunisation (ATAGI). Ms Campbell-Lloyd provides expertise in the field of vaccine program implementation.

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Dr Elizabeth Haworth

Elizabeth Haworth is a medical graduate of Sydney University with qualifications in general medicine/paediatrics/infectious diseases and Public Health from the Royal College of Physicians, England. She specialised in Disease Control, working as a regional epidemiologist and director with the Communicable Disease Surveillance Centre/Health Protection Agency, London and based in Oxford. When she returned to Australia in 2010 she maintained an academic appointment as Honorary Senior Clinical Lecturer in Public Health at the University of Oxford and is establishing a link with the University of Tasmania Her research interests have included the control of infectious and environmental diseases and most recently the control of infection at the Hajj and other mass gatherings, the epidemiology and control of health care associated infections and vaccine preventable diseases and the health effects of climate change and environmental sustainability

 

Dr Georgie Paxton

Dr Georgie Paxton is the Head of Immigrant Health at the Royal Childrens Hospital. She has been involved in developing clinical guidelines, education resources and policy in paediatric immigrant health in Victoria. Her research/policy interests include health literacy, the health status of refugee children and young people, learning issues in non-English speaking students and vitamin D. She is the lead author of the Victorian Governments Refugee Status Report, published in 2011, and Chair of the Victorian Refugee Network.

 

Dr Paul Douglas

Dr Paul Douglas is the Chief Medical Officer and Global Manager Health for the Department of Immigration and Citizenship. He graduated from the UNSW, has a Master degree in Health Administration as well as Fellowship with RACMA. His background includes rural general practice as well as remote Papua New Guinea. Before taking on his current role he was the Director of Population Health, Planning and Performance in two NSW area health services. His role as CMO entails senior leadership on all policy and operational health matters across the immigration portfolio. Amongst a variety groups he is a member of significance is a membership of the National TB Advisory Committee and Chair of the Intergovernmental Immigration Health and Refugee Working Group.

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Dr Vicky Sheppeard

Vicky is a Public Health Physician who has been working for NSW Health since 1999. Vicky commenced as Director, Communicable Diseases Branch, Health Protection NSW in May this year. Prior to that she managed health protection services in the Nepean Blue Mountains and Western Sydney Local Health Districts from 2008 to 2013.

Vicky is also a Senior Clinical Lecturer in the School of Public Health at the University of Sydney and Chair of the NSW Regional Committee of the Australian Faculty of Public Health Medicine

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Dr Brett Sutton

Dr Brett Sutton has 20 years experience as a doctor. Since 2003 he has attained a Masters of Public Health and Tropical Medicine and practised Public Health in variety of country contexts. The focus of his international work has primarily been in communicable disease surveillance and control in Afghanistan, Ethiopia and Timor-Leste’s. In the Victorian Department of Health he has recently been acting manager for the Communicable Disease Prevention and Control Section and helped shape policy and procedures for notifiable diseases and other Public Health issues. Dr Sutton is currently chair of Victoria’s Salmonella working group and well as having representation on the Hepatitis B pathology reporting project, the CDI editorial advisory board. He has been the Victorian representative of CDNA since 2012.

 

WORKSHOP POWER POINT PRESENTATIONS

Morning Session: Immunization issues for migrants and refugees

Dr Mitchell Smith

Immunisation issues among refugee & asylum seeker children, adolescents & adults

Dr Margaret Kay

Barriers in general practice for the provision of catch-up immunisation to migrant and refugee children

Professor David Isaacs

Health needs of refugee children accessing comprehensive refugee health services

Dr Mohamud Sheikh

Refugee repatriation and immunisation catch-up: closing gap

Dr Stephen Conaty

Under-immunisation in migrant communities: the measles outbreak in South Western Sydney

Associate Professor Tilman Ruff part I

Associate Professor Tilman Ruff part 2

Associate Prosessor Tilman Ruff part 3

Hepatitis B: from targeted screening and immunisation of migrant mothers to universal immunisation in Australia

 

Afternoon Session: Immunization issues for international travellers

Dr Anita Heywood

Immunisation issues specific to travellers visiting friends and relatives (VFR)

Professor Nick Zwar

Pre-travel advice and understanding of vaccine uptake among Australian travellers

Associate Professor Karin Leder

GeoSentinel Surveillance Network (GSSN) + VFR interventions to increase awareness

Professor Robert Booy

Immunisations and mass gatherings: experience from the Hajj, Sydney World Youth Day and the 2000 Sydney Olympics

 

 

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Raina MacIntyre, Professor of Infectious Diseases Epidemiology and Head of the School of Public Health and Community Medicine at UNSW & Director of CRE Immunisation 

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Dr Margaret Kay, Senior lecturer at Discipline of General Practice, School of Medicine, the University of Queensland

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David Isaacs, Clinical Professor in Paediatric Infectious Diseases at the Children’s Hospital at Westmead and the University of Sydney

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Participants at the workshop

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Professor David Isaacs

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Dr Mohamud Sheikh, Associate Professor and Public Health Research Fellow at the School of Public Health and Community Medicine, UNSW & an international public health expert

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Associate Professor Tilman Ruff ,  infectious diseases and public health physician at the Nossal Institute for Global Health, University of Melbourne & international medical advisor for Australian Red Cross

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Panel discussion; Future solutions to funding gaps and other barriers to vaccination in migrants and refugees

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Panel discussion; Future solutions to funding gaps and other barriers to vaccination in migrants and refugees

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Panel discussion; Future solutions to funding gaps and other barriers to vaccination in migrants and refugees

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Panel discussion; Future solutions to funding gaps and other barriers to vaccination in migrants and refugees

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Dr Anita Heywood, an infectious disease epidemiologist and Senior lecturer at School of Public Health and Community Medicine, UNSW

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Professor Robert Booy, the Head of Clinical Research at NCIRS

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Panel discussion : Knowledge gaps and research priorities specific to international travel and special risk groups and the role of the CRE

 

Report launch: Protecting Australia – closing the gap in immunisation for migrants and refugees

Proceedings from the CRE stakeholder workshop

The NHMRC Centre for Research Excellence in Immunisation in Under-studied and Special Risk Populations is pleased to launch the proceedings of a national stakeholder workshop. This report identifies gaps in immunisation policy and practice in Australia and provides recommendations to ensure equitable access to immunisation for newly arrived migrants and refugees in Australia and to protect Australia’s successful National Immunisation Program from an identified gap which leave us susceptible to outbreaks of vaccine-preventable diseases.

FIND FULL REPORT HERE

Australia’s first national stakeholder workshop on immunisation issues for migrants and refugees was held on 9th August 2013 at UNSW Australia, convened by the NHMRC CRE. The workshop was attended by more than 100 invited experts and stakeholders from around Australia, including leaders in infectious disease and migrant and refugee health research, from general practice and other immunisation providers, industry, government representatives, as well as multicultural and refugee health networks. This provided a forum to review the data and evidence, identify gaps, exchange ideas and propose potential solutions in the collective national interest.

A key finding of the workshop was the lack of a systematic mechanism for catch-up immunisation for migrants and refugees, which leaves this population vulnerable to vaccine-preventable diseases. It is in our national interest to address these gaps in communicable disease control and the ongoing success of Australia’s National Immunisation Program.

 

The immunisation gap in migrants and refugees is everyone’s business, and we cannot afford to pass the buck. The recent outbreaks of measles in Sydney occurred despite high rates of measles vaccination as measured by our immunisation register. We cannot control infectious diseases in Australia without closing this gap. It is in our national interest to find a way forward to address this gap in communicable disease control.”

- Professor Raina MacIntyre, Director of the NHMRC Centre for Research Excellence.

 

This report provides an opportunity for government and primary health care providers to work together with migrant and refugee communities to improve immunisation rates.”

- Dr Margaret Kay, General Practitioner and Senior Lecturer at the School of Medicine, The University of Queensland and workshop presenter.

 

Newly arrived migrants and refugees are not a major health risk to other Australians. However, they come from countries that do not always offer the same range of immunisations as Australia. It is in everyone’s interests to ensure that new arrivals receive all the appropriate immunisations, to protect the persons being immunised and to maintain population protection.”

- Professor David Isaacs, Senior Staff Specialist, Department of Infectious Diseases & Microbiology, and the Health Assessments for Refugee Kids Clinic, The Children’s Hospital at Westmead and Clinical Professor in Paediatric Infectious Diseases, University of Sydney and workshop presenter.

 

"The majority of migrants and refugees arriving in Australia are from countries whose immunisation programs are far less comprehensive than our own. They are often vulnerable to vaccine preventable diseases such as measles, hepatitis B and certain types of bacterial meningitis now seen rarely in Australian-born people as a result of our governmentally funded vaccination policies. The Centre for Research Excellence is to be congratulated on its efforts to engage with stakeholders and communities to help address inequalities in this important area of preventive health."

- Professor Margaret Burgess, Division of Paediatrics and Child Health, University of Sydney and founding director of Australia’s National Centre for Immunisation Research and Surveillance (NCIRS) and Chair of the Scientific Advisory Board of the CRE in Immunisation

 

"I am pleased that the NHMRC CRE in Immunisation has been able to convene all stakeholders from around the country for the first time to discuss the issue of control of vaccine-preventable diseases in migrants and refugees. It is important for groups such as this, who are independent of vested interests, to take on an advocacy role for identified gaps in public health. The recommendations from this workshop are concrete, actionable ideas which is a valuable contribution to national disease control efforts. I look forward to seeing some or all of these recommendations considered and implemented nationally."

- Professor Peter Smith, Dean, UNSW Medicine.

 

Media Contacts:

Professor Raina MacIntyre
Director, NHMRC CRE in Immunisation
School of Public Health and Community Medicine
UNSW Australia
Phone: +61 2 93853811

 

Dr Anita Heywood
Lecturer
School of Public Health and Community Medicine
UNSW Australia
Phone: +61 2 9385 3667
 
 

CRE immunisation awarded Certificate of Recognition

READ MORE

 

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