Vaccine-Preventable Disease-Associated Hospitalisations Among Migrant and Non-migrant Children in New Zealand.

Migrants may experience a higher burden of vaccine-preventable disease (VPD)-associated hospitalisations compared to the host population. A retrospective cohort study from 2006 to 2015 was conducted that linked de-identified data from government sources using Statistic NZ's Integrated Data Infrastructure. VPD-related hospitalisations were compared between three cohorts of children from birth to 5 years old: foreign-born children who migrated to NZ, children born in NZ of recent migrant mothers, and a comparator group of children born in NZ without a recent migration background. VPD-related hospitalisation rates were higher among NZ-born non-migrant children compared to NZ-born migrant and foreign-born children for all of the diseases of interest. For instance, 5.21% of NZ-born non-migrant children were hospitalised at least once due to all-cause gastroenteritis compared to 4.47% of NZ-born migrant children and only 1.13% of foreign-born migrant children. The overall hospitalisation rate for NZ-born non-migrant children was 3495 hospitalisations per 100,000 person years. Among children with migrant backgrounds, higher hospitalisation rates were noted among those of Pacific ethnicity and those with refugee backgrounds. Those arriving on Pacific visa schemes were hospitalised at rates ranging from 2644/100,000 person years among foreign-born migrant children and 4839/100,000 person years among NZ-born migrant children. Foreign-born quota refugee children and NZ-born children of quota refugee mothers were hospitalised at a rate of 4000-5000/100,000 person years. It is important to disaggregate migrant data to improve our understanding of migrant health. Children need to be age-appropriately vaccinated, and other individual and environmental factors addressed, to reduce the risk of infectious diseases.

Exploring immunisation inequities among migrant and refugee children in New Zealand.

Migrants may experience immunisation inequities compared with the host population related to barriers with accessing immunisations in their home countries, while migrating and/or post-arrival. This retrospective cohort study explored vaccination rates among migrant and non-migrant children in New Zealand (NZ). Linked de-identified data from various government sources from 1 January 2006 to 31 December 2015 were analysed using Statistic NZ's Integrated Data Infrastructure. Vaccination rates were compared between three cohorts of children aged up to 5 years: foreign-born children who migrated to NZ; children born in NZ of migrant mothers; and a comparator group of children born in NZ to non-migrant mothers. Less than half of foreign-born children (46%) had a record in the NZ National Immunisation Register compared with 95% and 96% among migrant and non-migrant NZ-born children, respectively. Foreign-born migrant children had lower age-appropriate reported vaccination rates by vaccine of interest, ethnicity and visa category compared with NZ-born children. Migrant children from Pacific ethnicities had lower reported coverage than other ethnicities. High rates of not age-appropriately vaccinated were noted among foreign-born children on refugee, Pacific and humanitarian visa schemes. This study highlights possible shortfalls around immunisation data, particularly about recording vaccinations given overseas for foreign-born children, and potential challenges around engagement with immunisation services for migrant children. However, results highlight the successful engagement of quota refugee children as part of NZ's refugee orientation programme. It is important to monitor vaccination coverage by migrant and refugee background to inform improvements to policy and practice for wider population health benefits.

Perceptions of caregivers and providers regarding the potential introduction of the varicella vaccine to the childhood immunisation schedule in New Zealand: A qualitative exploratory study.

AIM: The varicella vaccine has been proposed to be added to the childhood immunisation schedule in New Zealand as the fourth injectable at the 15-month event. We sought to understand the perceptions of caregivers and health-care providers regarding the potential introduction of routine varicella vaccination. METHODS: A qualitative exploratory study was conducted using semi-structured interviews with caregivers and providers (N = 20) in Auckland. Key themes from the interviews were identified through thematic analysis using a combination of deductive and inductive coding. RESULTS: All of the participants were aware of varicella but levels of awareness varied among caregivers regarding the varicella vaccine. Participants expressed positive support towards universal varicella vaccination and a high intention to vaccinate if available as a routine vaccine. However, many concerns were raised about multiple injections at a single immunisation visit, and participants suggested alternative scheduling options. CONCLUSION: The results indicated a need to raise awareness among caregivers about the varicella vaccine, focusing on positive health beliefs about vaccination in terms of protecting the child's health and reducing the impact of a child getting varicella on the family. Health-care providers and government health authorities may play an important role in increasing positive health beliefs about the varicella vaccine. Should the varicella vaccine be introduced as proposed, our findings recommend an educational campaign to address both caregiver and provider concerns about multiple injections and how to manage alternative immunisation schedules. These insights may help inform national strategies for the proposed addition to increase acceptance of the varicella vaccination.