Journal article
A novel measles outbreak control strategy in the Netherlands in 2013–2014 using a national electronic immunization register: A study of early MMR uptake and its determinants
Background: During a large measles outbreak in the Netherlands in 2013–2014, infants aged
6–14 months living in municipalities with low (<90%) measles-mumps-rubella (MMR) coverage were
individually invited for an early MMR using the national electronic immunization register, Præventis.
We estimated uptake of early MMR prior to and during the 2013–2014 outbreak and assessed determinants
for early MMR vaccination.
Methods: We obtained vaccination records from Præventis, and defined early MMR as vaccination before
415 days (13 months) of age. A multi-level multivariable logistic regression model, restricted to infants
with three diphtheria-pertussis-tetanus-polio (DPTP) vaccinations was used to examine the association
between early MMR uptake and sex, parents’ country of birth, socioeconomic status (SES; at postcode
level) and voting proportions for the Reformed Political Party (SGP; at municipal level), used as a proxy
for religious objections towards vaccination.
Results: In the 29 municipalities with low MMR coverage, uptake of early MMR was 0.5–2.2% prior to the
outbreak. Between July 2013 and March 2014, 5,800 (57%) invited infants received an early MMR. Among
infants with three DPTP, 70% received an early MMR. Only 1% of infants without prior DPTP received an
early MMR. Lower early MMR uptake was associated with a higher SGP voter-ship (OR 0.89 per 5%
increase, 95%CI 0.83–0.96), parents’ with unknown country of birth (OR 0.66 95%CI 0.47–0.93) and compared
with very high SES, high SES had significantly lower early MMR uptake (OR 0.66 95%CI 0.50–0.87).
Discussion: This is the first study describing use of Præventis during an outbreak and to assess determinants
of early MMR uptake. More than half of invited infants obtained an early MMR. SES, parents’ with
unknown country of birth and religious objections towards vaccination were found to be associated with
lower early MMR uptake. In future outbreaks, these determinants could be used to tailor intervention
strategies.
Authors
Languages
- English
Publication year
2017
Publisher
Elsevier
Journal
Vaccine
Volume
5828–5834
Type
Journal article
Categories
- Data
Countries
- Netherlands
Tags
- Coverage monitoring
- Electronic health records
- Immunization information systems
- Registries
WHO Regions
- European Region