title: 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.
authors.affiliation: National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands.|University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: Tom
authors.initials: T
authors.lastname: Woudenberg
authors.affiliation: National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands.
authors.forename: Rob S
authors.initials: RS
authors.lastname: van Binnendijk
authors.affiliation: National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands.|University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: Elisabeth A M
authors.initials: EA
authors.lastname: Sanders
authors.affiliation: National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands.|Leiden University Medical Center, Leiden, the Netherlands.
authors.forename: Jacco
authors.initials: J
authors.lastname: Wallinga
authors.affiliation: National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands.
authors.forename: Hester E
authors.initials: HE
authors.lastname: de Melker
authors.affiliation: National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands.
authors.forename: Wilhelmina L M
authors.initials: WL
authors.lastname: Ruijs
authors.affiliation: National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands.
authors.forename: Susan J M
authors.initials: SJ
authors.lastname: Hahné
mesh_terms: D000293:Adolescent; D017677:Age Distribution; D002648:Child; D018563:Disease Notification / Q000706:statistics & numerical data*; D004196:Disease Outbreaks; D058872:Epidemics; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D008297:Male; D019221:Mandatory Reporting; D032541:Mass Vaccination / Q000706:statistics & numerical data*; D008457:Measles / Q000453:epidemiology* / Q000276:immunology / Q000517:prevention & control; D009426:Netherlands / Q000453:epidemiology; D033303:Protestantism; D012111:Residence Characteristics; D014611:Vaccination / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: emerging or re-emerging diseases; epidemiology; measles; outbreaks; surveillance; vaccine-preventable diseases