A novel measles outbreak control strategy in the Netherlands in 2013-2014 using a national electronic immunization register: A study of early MMR uptake and its determinants.

Thursday, 21st of September 2017

Vaccine. 2017 Sep 15. pii: S0264-410X(17)31234-3. doi: 10.1016/j.vaccine.2017.09.018. [Epub ahead of print]

A novel measles outbreak control strategy in the Netherlands in 2013-2014 using a national electronic immunization register: A study of early MMR uptake and its determinants.

Nic Lochlainn LM¹ Woudenberg T² van Lier A² Zonnenberg I³ Philippi M³ de Melker HE² Hahné SJM⁴.

Abstract

BACKGROUND:

During a large measles outbreak in the Netherlands in 2013-2014 infants aged 6-14months living in municipalities with low (<90%) measles-mumps-rubella (MMR) coverage were individually invited for an early MMR using the national electronic immunization register Præventis. We estimated uptake of early MMR prior to and during the 2013-2014 outbreak and assessed determinants for early MMR vaccination.

METHODS:

We obtained vaccination records from Præventis and defined early MMR as vaccination before 415days (13months) of age. A multi-level multivariable logistic regression model restricted to infants with three diphtheria-pertussis-tetanus-polio (DPTP) vaccinations was used to examine the association between early MMR uptake and sex parents country of birth socioeconomic status (SES; at postcode level) and voting proportions for the Reformed Political Party (SGP; at municipal level) used as a proxy for religious objections towards vaccination.

RESULTS:

In the 29 municipalities with low MMR coverage uptake of early MMR was 0.5-2.2% prior to the outbreak. Between July 2013 and March 2014 5800 (57%) invited infants received an early MMR. Among infants with three DPTP 70% received an early MMR. Only 1% of infants without prior DPTP received an early MMR. Lower early MMR uptake was associated with a higher SGP voter-ship (OR 0.89 per 5% increase 95%CI 0.83-0.96) parents with unknown country of birth (OR 0.66 95%CI 0.47-0.93) and compared with very high SES high SES had significantly lower early MMR uptake (OR 0.66 95%CI 0.50-0.87).

DISCUSSION:

This is the first study describing use of Præventis during an outbreak and to assess determinants of early MMR uptake. More than half of invited infants obtained an early MMR. SES parents with unknown country of birth and religious objections towards vaccination were found to be associated with lower early MMR uptake. In future outbreaks these determinants could be used to tailor intervention strategies.

Copyright © 2017. Published by Elsevier Ltd.