LARGE ONGOING MEASLES OUTBREAK IN A RELIGIOUS COMMUNITY IN THE NETHERLANDS SINCE MAY 2013

Tuesday, 14th of January 2014

[source]Euro Surveillance and Outbreaks Report[|source]

A single dose of monovalent measles vaccine was included in the Dutch national immunization programme in 1976 for children aged 14 months. Since 1987, children have been offered vaccination against measles, mumps and rubella in a two-dose schedule, at 14 months and nine years of age. Vaccination coverage is generally high in the Netherlands. In 2012, the MMR coverage was 96% for the first dose and 93% for the second dose. However, vaccination uptake is low in some specific groups, for religious reasons (orthodox Protestantism), anthroposophic reasons, and in those with a critical attitude towards vaccination. Vaccination coverage in general among orthodox Protestants was assessed in 2006-2008 as about 60%. Predestination is an important theme in their beliefs: refusal of vaccination is based on the idea that people should not interfere with divine providence.

In this article, the authors document that since the 1999–2000 outbreak, the incidence of measles notifications in the Netherlands has been below the WHO European Region threshold for measles elimination. In turn the authors articulate that this is due to the unique social and geographical clustering of religious communities with low vaccination coverage, prevalent in the country. More details are available at:  http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=20580

 

Abstract

Despite vaccination coverage over 95%, a measles outbreak started in May 2013 in the Netherlands. As of 28 August, there were 1,226 reported cases, including 82 hospitalizations. It is anticipated that the outbreak will continue. Most cases were orthodox Protestants (n=1,087/1,186; 91.7%) and unvaccinated (n=1,174/1,217; 96.5%). A unique outbreak control intervention was implemented: a personal invitation for measles-mumps-rubella (MMR) vaccination was sent for all children aged 6–14 months living in municipalities with MMR vaccination coverage below 90%.