Large measles epidemic in the Netherlands, May 2013 to March 2014: changing epidemiology

Abstract

Since the early 1990s, the Netherlands has experienced several large measles epidemics, in 1992–94, 1999–2000 and in 2013–14. These outbreaks mainly affected orthodox Protestants, a geographically clustered population with overall lower measles-mumps-rubella first dose (MMR-1) vaccination coverage (60%) than the rest of the country (> 95%). In the 2013–14 epidemic described here, which occurred between 27 May 2013 and 12 March 2014, 2,700 cases were reported. Several control measures were implemented including MMR vaccination for 6–14-month-olds and recommendations to reduce the risk in healthcare workers. The vast majority of reported cases were unvaccinated (94%, n = 2,539), mostly for religious reasons (84%, n = 2,135). The median age in the epidemic was 10 years, 4 years older than in the previous epidemic in 1999–2000. A likely explanation is that the inter-epidemic interval before the 2013–2014 epidemic was longer than the interval before the 1999–2000 epidemic. The size of the unvaccinated orthodox Protestant community is insufficient to allow endemic transmission of measles in the Netherlands. However, large epidemics are expected in the future, which is likely to interfere with measles elimination in the Netherlands and elsewhere.

No Jab, No Pay and vaccine refusal in Australia: the jury is out

“…Our recent study estimated that around 3.3% of children aged 1–6 years in 2013 were affected by registered and unregistered objection combined — not much more than in a previous national survey from 2001, which estimated 2.5–3.0% 10 . Although Australia does not have the enclaves of religious‐based objection that occur in countries such as the Netherlands, 11 there have been consistent geographic clusters of recorded objection — highest (about 10%) in regional areas of northern NSW and southeast Queensland, but present in all states 10 . The recent media and government focus on improving vaccination coverage through targeting vaccine refusers can be traced back to the first report of the National Health Performance Authority in 2013, 12 which made data on vaccine coverage publicly available for the first time at a small area level.…”

Fundamentals of Clinical Data Science

“…As an example, pediatric vaccination is recommended and available free of charge in the Netherlands, but is not mandatory. In recent years, Dutch vaccination rates continue to decline [82,83] and are also accompanied by outbreaks of vaccine-preventable illnesses such as measles [84]. Nonetheless, prevention of disease would seem to be a care service of the highest value, yet is not fully accepted in any society [83].…”

Additional Evidence on Serological Correlates of Protection against Measles: An Observational Cohort Study among Once Vaccinated Children Exposed to Measles

“…After March 2014 when the outbreak had ended [29], children were invited to attend the clinic for a finger stick blood sample. Sera were heat-inactivated for 30 min and subsequently stored at −20 • C until use.…”

“…Foreseeing an outbreak based on a serosurvey and mathematical modelling [5,28], we designed a study to assess immunological correlates of protection against measles, assuming that vaccinated children attending schools with low vaccination coverage would likely be exposed to MV. The outbreak, which included an estimated 30,000 measles cases, started in May 2013 and lasted until March 2014 [29]. The main objective of our study was to identify serological correlates of protection against measles and MV infection among once vaccinated children.…”