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

  • Nadia A. CharaniaEmail author
  • Janine Paynter
  • Arier C. Lee
  • Donna G. Watson
  • Nikki M. Turner
Original Paper


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.


Vaccine-preventable disease Children Data-linking Migrant Refugee 



This study was conducted in collaboration with Statistics New Zealand and within the confines of the Statistics Act 1975. We would like to thank members of The Monarch Collaboration ( for their support of this study. This work was supported by the Ministry of Business, Innovation and Employment (MBIE) (Grant Number #:UOAX1512). MBIE was provided the opportunity to review a preliminary version of this manuscript for factual accuracy but the authors are solely responsible for final content and interpretation. The authors received no financial support or other form of compensation related to the development of the manuscript.

Compliance with Ethical Standards

Conflict of interest

Janine Paynter, Arier C. Lee, Donna G. Watson have helped conduct and Nikki M. Turner has been an investigator in research projects funded by GlaxoSmithKline. Nadia A. Charania reports no conflict of interest.

Supplementary material

10903_2019_888_MOESM1_ESM.docx (54 kb)
Supplementary material 1 (DOCX 53 kb)


  1. 1.
    Castles S. International migration at the beginning of the twenty-first century: global trends and issues. ISSJ. 2000;165:269–81.Google Scholar
  2. 2.
    Abel GJ, Sander N. Quantifying global international migration flows. Science. 2014;343(6178):1520–2.Google Scholar
  3. 3.
    Beine M, Parsons C. Climatic factors as determinants of international migration. Scand J Econ. 2015;117(2):723–67.Google Scholar
  4. 4.
    International Organization for Migration (IOM). World Migration Report 2018. Geneva: International Organization for Migration. 2017. Accessed 5 July 2018.
  5. 5.
    United Nations, Department of Economic and Social Affairs, Population Division. International Migration Report 2017: highlights. New York: United Nations. 2017. Accessed 23 Jan 2018.
  6. 6.
    United Nations High Commissioner for Refugees (UNHCR). Global trends: forced displacement in 2017. Geneva: United Nations High Commissioner for Refugees. 2018. Accessed 21 Aug 2018.
  7. 7.
    Immigration New Zealand. New Zealand Refugee Quota Programme. Wellington: Immigration New Zealand. 2018. Accessed 25 March 2018.
  8. 8.
    Merwood P. Labour market outcomes of recent migrants to New Zealand. Wellington: Ministry of Business, Innovation and Employment. 2013.—settlement/recent-migrants-nz.pdf. Accessed 25 Jan 2017.
  9. 9.
    Statistics New Zealand. International Travel and Migration: October 2017. Wellington: Statistics New Zealand. 2017. Accessed 25 March 2018.
  10. 10.
    Gushulak BD, MacPherson DW. Globalization of infectious diseases: the impact of migration. CID. 2004;38(12):1742–8.Google Scholar
  11. 11.
    Ng E, et al. Vaccine-preventable disease-related hospitalization among immigrants and refugees to Canada: study of linked population-based databases. Vaccine. 2016;34(37):4437–42.Google Scholar
  12. 12.
    Lam E, et al. Displaced populations due to humanitarian emergencies and its impact on global eradication and elimination of vaccine-preventable diseases. Confl Health. 2015;10(1):27.Google Scholar
  13. 13.
    Morris MD, et al. Healthcare barriers of refugees post-resettlement. J Commun Health. 2009;34(6):529–38.Google Scholar
  14. 14.
    Paxton GA, et al. East African immigrant children in Australia have poor immunisation coverage. JPCH. 2011;47(12):888–92.Google Scholar
  15. 15.
    Hobbs M, et al. The health status of asylum seekers screened by Auckland Public Health in 1999 and 2000. NZMJ. 2002;115(1160):u152.Google Scholar
  16. 16.
    McLeod A, Reeve M. The health status of quota refugees screened by New Zealand’s Auckland Public Health Service between 1995 and 2000. NZMJ. 2005;118(1224):u1702.Google Scholar
  17. 17.
    Rungan S, et al. Health needs of refugee children younger than 5 years arriving in New Zealand. Pediatr Infect Dis. 2013;32(12):e432–6.Google Scholar
  18. 18.
    Lawrence J, Kearns R. Exploring the ‘fit’ between people and providers: refugee health needs and health care services in Mt Roskill, Auckland, New Zealand. Health Soc Care Commun. 2005;13(5):451–61.Google Scholar
  19. 19.
    Semenza JC, et al. Public health needs of migrants, refugees and asylum seekers in Europe, 2015: infectious disease aspects. Eur J Public Health. 2016;26(3):372–3.Google Scholar
  20. 20.
    Ziersch A, et al. Exploring the relationship between housing and health for refugees and asylum seekers in South Australia: a qualitative study. Int J Environ Res Public Health. 2017;14(9):1036.Google Scholar
  21. 21.
    Charania NA, et al. Exploring immunisation inequities among migrant and refugee children in New Zealand. Hum Vaccin Immunother. 2018;14:1–8.Google Scholar
  22. 22.
    Statistics New Zealand. Ethnicity. Wellington: Statistics New Zealand. Not dated. Accessed 25 March 2017.
  23. 23.
    National Health Board. National Minimum Dataset (Hospital Events) data dictionary. Wellington: Ministry of Health. 2014. Accessed 25 March 2017.
  24. 24.
    Cai W, et al. Hepatitis B virus infections among children and adolescents in Germany: migration background as a risk factor in a low seroprevalence population. Pediatr Infect Dis J. 2011;30(1):19–24.Google Scholar
  25. 25.
    Norredam M, et al. Mortality from infectious diseases among refugees and immigrants compared to native Danes: a historical prospective cohort study. Trop Med Int Health. 2012;17(2):223–30.Google Scholar
  26. 26.
    Singh GK, Miller BA. Health life expectancy, and mortality patterns among immigrant populations in the United States. Can J Public Health. 2004;95(3):I14–21.Google Scholar
  27. 27.
    Domnich A, et al. The “healthy immigrant” effect: does it exist in Europe today? IJPH. 2012;9(3):e7532-1-7.Google Scholar
  28. 28.
    Fennelly K. The ‘‘healthy migrant’’ effect. Minn Med. 2007;90(3):51–3.Google Scholar
  29. 29.
    Correa-Velez I, et al. Hospital utilisation among people born in refugee-source countries: an analysis of hospital admissions, Victoria, 1998-2004. Med J Aust. 2007;186(11):577–80.Google Scholar
  30. 30.
    Ng E. The healthy immigrant effect and mortality rates. Health Rep. 2011;22(4):2–9.Google Scholar
  31. 31.
    Rotermann M. The impact of considering birthplace in analyses of immigrant health. Health Rep. 2011;22(4):37–43.Google Scholar
  32. 32.
    Ng E, Sanmartin C, Manuel DG. Acute care hospitalization, by immigrant category: linking hospital data and the Immigrant Landing File in Canada. Health Rep. 2016;27(8):12–8.Google Scholar
  33. 33.
    Burnett A, Peel M. Health needs of asylum seekers and refugees. BMJ. 2001;322(7285):544–7.Google Scholar
  34. 34.
    McKeary M, Newbold B. Barriers to care: challenges for Canadian refugees and their health care providers. J Refug Stud. 2010;23(4):523–45.Google Scholar
  35. 35.
    Ministry of Health. Eligibility for publicly funded health services. Wellington: Ministry of Health. 2011. Accessed 5 July 2018.
  36. 36.
    New Zealand Government. Paying for healthcare services. Wellington: New Zealand Government. 2018. Accessed 5 July 2018.
  37. 37.
    Pal M, Goodyear-Smith F, Exeter D. Factors contributing to high immunisation coverage among New Zealand Asians. J Prim Health Care. 2014;6(4):304–11.Google Scholar
  38. 38.
    Grimwood K, et al. Rotavirus hospitalisation in NZ children under 3 years of age. J Paediatr Child Health. 2006;42(4):196–203.Google Scholar
  39. 39.
    Gribben B, et al. The incidence of acute otitis media in New Zealand children under five years of age in the primary care setting. J Prim Health Care. 2012;4(3):205–12.Google Scholar
  40. 40.
    Ardern-Holmes SL, et al. Trends in hospitalization and mortality from rotavirus disease in New Zealand infants. Pediatr Infect Dis J. 1999;18(7):614–9.Google Scholar
  41. 41.
    Grant CC, et al. Hospitalisation for pneumonia in children in Auckland, New Zealand. J Paediatr Child Health. 1998;34(4):355–9.Google Scholar
  42. 42.
    Petousis-Harris H, et al. Pneumococcal conjugate vaccines turning the tide on inequity—a retrospective cohort study of New Zealand children born 2006-2015. Clin Infect Dis. 2018. Scholar
  43. 43.
    Ministry of Health. Immunisation handbook 2017. Wellington: Ministry of Health; 2017.Google Scholar
  44. 44.
    Sheikh-Mohammed M, et al. Barriers to access to health care for newly resettled sub-Saharan refugees in Australia. Med J Aust. 2006;185(11–12):594–7.Google Scholar
  45. 45.
    Drummond PD, et al. Barriers to accessing health care services for West African refugee women living in Western Australia. Health Care Women Int. 2011;32(3):206–24.Google Scholar
  46. 46.
    Sheikh M, MacIntyre CR. The impact of intensive health promotion to a targeted refugee population on utilisation of a new refugee paediatric clinic at the children’s hospital at Westmead. Ethn Health. 2009;14(4):393–405.Google Scholar
  47. 47.
    Riggs E, et al. Accessing maternal and child health services in Melbourne, Australia: reflections from refugee families and service providers. BMC Health Serv Res. 2012;12:117.Google Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Public HealthAuckland University of TechnologyAucklandNew Zealand
  2. 2.Department of General Practice and Primary Health CareUniversity of AucklandAucklandNew Zealand
  3. 3.Section of Epidemiology and BiostatisticsUniversity of AucklandAucklandNew Zealand

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