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. 2017 Jan 19;22(3):30443.
doi: 10.2807/1560-7917.ES.2017.22.3.30443.

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

Tom Woudenberg  1   2 , Rob S van Binnendijk  1 , Elisabeth A M Sanders  1   2 , Jacco Wallinga  1   3 , Hester E de Melker  1 , Wilhelmina L M Ruijs  1 , Susan J M Hahné  1
Affiliations

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

Tom Woudenberg et al. Euro Surveill. .

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.

Keywords: emerging or re-emerging diseases; epidemiology; measles; outbreaks; surveillance; vaccine-preventable diseases.

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Conflict of interest statement

Conflict of interest: None declared.

Figures

Figure 1
Figure 1
Reported measles cases by risk group and week of rash onset, the Netherlands, reported between 27 May 2013 and 12 March 2014 (n = 2,700)
Figure 2
Figure 2
A) MMR-1 vaccination coverage combined for birth cohorts 2011/2010/2009 at the age of 2 years, by three-digit postal code. B) Measles incidence from reported cases from May 2013 until March 2014 (n = 2,689), by three-digit postal code in the Netherlands. C) Scatterplot (log-scale) of three-digit postal code areas vaccination coverage and reported measles incidence.
Figure 3
Figure 3
Incidence of reported cases by age group for the 1999–2000 epidemic (n = 3,170) and the 2013–2014 epidemic (n = 2,700), the Netherlands
See this image and copyright information in PMC

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