MEASLES - NETHERLANDS

Jim van Steenbergen LCI, PO Box 16071, NL-2500 BB The Hague, The Netherlands
Thu, 30 Dec 1999 13:39:04 +0100

A ProMED-mail post

Number of cases: Since the start of the epidemic 2300 cases have been reported to the LCI. Date of onset of illness of the first case = 15 Apr 1999.

Disease: 82.5% without serious complications, 3 children died, 53 were hospitalised (30 pneumonia, 4 encephalitis, 19 other), another 130 were diagnosed with a pneumonia at home, 152 had otitis media, 87 had other complications (mostly respiratory tract infections).

Age: <1yr 5%, 1-5 yr 30%, 6-10 yr 44%, 11-15 yr 13%, >15yr 7%.

Geographical spread: All over the country but mainly in the so-called bible-belt where people live that do not have their children vaccinated for religious reasons.

Vaccination status: 97% not vaccinated, 3% vaccinated. Reasons for not vaccinating: 86% religious ("It is up to Him to decide who is going to get a disease, not up to the Municipal Health Department"), 1% anthroposophical ("to suffer from measles is good for the development of a child"), 5% below the age of first scheduled MMR-I (measles, mumps, rubella-vaccination in the Netherlands at the age of 14 months), 6% other reasons ("forgotten", measles not a serious disease, not important enough, fear of side effects, bad reaction on earlier vaccination, etc.), 2% unknown.

The Ministry of Health brought these numbers to the attention of the public. Municipal Health Departments and Mother and Child Health-clinics organised special opening hours for measles vaccinations. With the publicity we tried to convince parents that measles can be a serious disease and that vaccination is an excellent preventive intervention.

With the experience of earlier measles epidemics in these groups (1987/88, 1992/1993) we expect this epidemic to continue another few months. Once a case is notified to a Municipal Health Department vaccination is offered to all contacts over the age of six months. Very few (parents) can be convinced however. Besides, many cases go unnoticed as parents do not always seek medical advice, especially not in uncomplicated cases. As was brought to our attention by our Canadian colleagues we exported measles on two occasions to Canada, leading to a small outbreak there. We apologise for further inconvenience due to our tolerance (vaccination is not obligatory in the Netherlands). The national vaccination coverage for MMR-I exceeds 98%, but the unvaccinated are geographically and socially clustered, leading to epidemics once the virus is introduced at a time when there are sufficient newly born susceptibles.