Migrant, traveller and refugee health

Date Commenced:
Expected Date of Completion:
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Project Main Description

Health inequity and provision of health care to resettled refugees and new migrants are complex and critical issues worldwide. Access to care before, during and after movement is a challenge identified in migrant and refugee groups, as well specific pre-embarkation and post migration challenges. The influence of culture on health service utilisation and health outcome has been well documented. These groups often have higher rates of vaccine preventable diseases, combined with lower access to care and preventive services. Two decades ago, the most important of these groups were from South East Asia, but a shift in global conflict and migration patterns over this time means that our newest refugees and migrants are from Africa and the Middle East. The specific issues facing these ethnic groups are different from the previous wave of migration. It is reported that immigrants from the horn of Asia, Middle East and Africa have an unmet health needs, with 17% having yet to access health care at al. Resettled refugees have not only faced the challenges of accessing health care services, but have been overwhelmed by other demanding resettlement issues such as poor housing, unemployment, poverty, acculturation, language, social services needs among other. The research in this theme focuses on interventions to reach hard-to-reach migrant and refugee groups, and on comparing disease risks and immunisation strategies in older and newer migrant and refugee groups.

The traveller visiting friends and relatives (VFR) is a special category of migrants that deserve special attention in vaccine-preventable diseases. The changing nature of organisms with their potential for mutation and crossing species, plus the impact of international travel and trade means that infectious diseases pose a continuing and evolving world-wide threat.  All entrants and re-entrants to Australia have the potential to import disease. For instance, virtually all measles clusters in Australia begin with an imported case and recent large outbreaks of dengue usually reflect virus importation from other countries via an infected index case. Travellers to some countries have considerable risk of infection, which they may bring back to Australia. Diarrhoeal and respiratory infections are common in travellers, both in the country of travel and on return. During the SARS (severe acute respiratory syndrome) epidemic, travel was a major mode of spread of the infection globally, causing WHO warnings about SARS-affected countries. These events highlight the fact that travellers are exposed to a range of infection risks, and may return carrying a pathogen. Indeed, the nature of contemporary travel means that individuals may be still within the incubation period when they arrive in their destination country. Our CRE will conduct a range of social, epidemiologic and clinical studies to inform vaccination needs in migrants, refugees and travellers.


Stream news

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

Certificate of recognition from NSW Refugee health services

Nauru families health risks - Immunisation issues

Travel and infectious diseases news story

CRE on news: Vaccination in migrants, travellers and refugees

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



Research projects


  • Determining the contribution of travel-associated infectious diseases in travellers visiting friends and relatives (VFR) to notifiable diseases in Australia - Enhanced surveillance project (CI R. MacIntyre, PRP A. Heywood, PRP H. Seale)
  • Travellers visiting friends and relatives: perceived barriers to the uptake of travel advice and travel vaccinations amongst Migrant Australians (CI MacIntyre, PRP A. Heywood, PRP H. Seale)
  • Influenza and pneumococcal vaccination survey amongst Australian pilgrims to the Hajj, in Mecca, Saudi Arabia. (CI R. Booy)
  • GP travel medicine survey to understand barriers to the provision of pre-travel preventative health advice to migrant Australians in primary care.  (PRP Heywood, PRP Seale)



  • Travellers visiting friends and relatives: New approaches to understanding and reducing infectious disease risks. Airport survey of VFR travellers (CI MacIntyre, PRP Heywood, PRP Seale, PhD student Dr Chun Hin Ma)
  • Determinants of infectious disease in Australian travellers visiting friends and relatives – a prospective cohort study (PRP Heywood, PRP Seale)
  • Australian Chinese travellers visiting friends and relatives: New approaches to understanding and reducing infectious disease risks. Airport substudy (CI MacIntyre, PRP Heywood, PhD student Dr Tara Ma)
  • Immunisation and immigration: mapping missed vaccination opportunities of Australia-bound refugees from the horn of Africa (CI MacIntyre, PRP Sheikh, PRP Heywood)
  • Modelling of travel-related infections (CRE fellow Gardner, PRP Heywood, CI MacIntyre)





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


Other activities

  • Consultation with NSW Refugee Health Service (2012)
  • Consultation with The Children’s Hospital at Westmead Refugee Clinic (2012)
  • Consultation with Border Health, Department of Health and Ageing – traveller airport survey (September 2013)



Wood J G, Heywood A E, Menzies R I, McIntyre P B, MacIntyre CR . Predicting localised measles outbreak potential in Australia. Vaccine. Online publication . January 2015. [Full Text]

Barasheed O, Rashid H, Heron L, Ridda I, Haworth E, Nguyen-Van-Tam J, Dwyer DE, Booy R on behalf of the Hajj Research Team. Influenza vaccination among Australian Hajj Pilgrims: Uptake, attitudes, and barriers. Jounal of Travel Medicine. 21(6): 384-390. November 2015. [Full text]

Heywood AE. Newall AT. Gao Z. Wood JG. Breschkin A. Nicholson S. Gidding HF. Dwyer DE. Gilbert GL. Macintyre CR. Changes in seroprevalence to hepatitis A in Victoria, Australia: A comparison of three time points. Vaccine. 30(42):6020-6, 2012 Sep 14. [Full text]

Freeman E, Torvaldsen S, Tobin S, Lawrence G, Macintyre CR. Trends and risk factors for hepatitis A in NSW, 2000-2009: the trouble with travel. N S W Public Health Bull. 2012;23(7-8):153-7. [Full text]

Heywood AE. Watkins RE. Iamsirithaworn S. Nilvarangkul K. Macintyre CR. A cross-sectional study of pre-travel health-seeking practices among travelers departing Sydney and Bangkok airports. BMC Public Health. 12:321, 2012. [Full text]

Seale H. Mak JP. Razee H. Macintyre CR. Examining the knowledge, attitudes and practices of domestic and international university students towards seasonal and pandemic influenza. BMC Public Health. 12:307, 2012. [Full text]

Heywood AE. Zhang M. MacIntyre CR. Seale H.Travel risk behaviours and uptake of pre-travel health preventions by university students in Australia.BMC Infectious Diseases. 12:43, 2012. [Full text]

Project Status