Large measles epidemic in the Netherlands May 2013 to March 2014: changing epidemiology.
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Euro Surveill. 2017 Jan 19;22(3). pii: 30443. doi: 10.2807/1560-7917.ES.2017.22.3.30443.
Large measles epidemic in the Netherlands May 2013 to March 2014: changing epidemiology.
Woudenberg T12 van Binnendijk RS1 Sanders EA12 Wallinga J13 de Melker HE1 Ruijs WL1 Hahné SJ1.
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 2700 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 = 2539) mostly for religious reasons (84% n = 2135). 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.
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