Intended for healthcare professionals


Netherlands faces measles epidemic

BMJ 2000; 320 doi: (Published 08 January 2000) Cite this as: BMJ 2000;320:76
  1. Tony Sheldon
  1. Utrecht

    The Dutch health ministry is urging parents to ensure their children are vaccinated against measles as the latest figures indicate an epidemic spreading across the country that has not yet peaked.

    The national bureau for the coordination of communicable disease control has reported 1750 cases since April, compared with just nine for 1998. Forty children have been admitted to hospital with serious complications, including encephalitis, pneumonia, and ear and eye infections; three children have died.

    The epidemic has broken out despite a 96%take up of the national measles, mumps and rubella (MMR) vaccine for babies over 14 months. The UK figure for take up of the MMR vaccine is estimated at 88

    The Dutch health ministry said that in 99%of measles cases, children were not vaccinated owing to religious objections, concerns about claims of side effects from the vaccine, forgetting, or not regarding it as important.

    The Netherlands is regarded as unique in having a large population group, estimated at 300000, belonging to a strict orthodox Protestant faith that has objections to immunisation.

    In the so called Bible Belt, extending from the north east to south west of the country, where measles vaccination can be as low as 60%there have been previous measles epidemics, the last in 1988.

    In June this year five cases were reported to the communicable disease bureau, all from the same primary school, where only 7%of children were vaccinated. It emerged that 80 pupils were at home sick with measles.

    By September, 304 cases had been reported, 301 of whom had not been vaccinated, 268 for religious reasons (Eurosurveillance Weekly, 30 September, New cases have now been reported from The Hague and Dordrecht in the provinces of South Holland and Zeeland.

    Dr Frits Woonink, a specialist in infectious diseases with the Utrecht southeast community health services, who received the first reports of the epidemic, fears that in some areas as few as 25%of cases are reported and there could be 5000 cases across the country.

    He said an important lesson could be learnt that even in a western European country, measles can have serious complications for children and there are good reasons to continue vaccination.

    Dr Norman Begg, head of the immunisation division of the Communicable Disease Surveillance Centre, north London, said that, while Britain did not have a religious group equivalent to that concentrated in the Bible Belt in the Netherlands, children who were not vaccinated were not uniformly spread across the country.

    “These children are very much concentrated in inner city areas, especially parts of east and central London. That is where we would expect to see outbreaks occur.”