Het Rijksvaccinatieprogramma in Nederland : Surveillance en ontwikkelingen in 2014-2015

In Nederland is de vaccinatiegraad binnen het Rijksvaccinatieprogramma (RVP) hoog, waardoor weinig mensen de ziekten krijgen waartegen zij worden ingeënt. Alleen de deelname aan de vaccinatie van meisjes tegen het humaan papillomavirus (HPV) ligt lager. Na de vaccinaties komen weinig ernstige bijwerkingen voor. Bijwerkingen die gerapporteerd worden zijn doorgaans niet ernstig van aard zijn. Continue monitoring is nodig om een optimaal vaccinatieprogramma te behouden. Wijzigingen in het vaccinatieschema in 2014-2015 Sinds januari 2014 is de vaccinatie tegen het HPV-virus, dat baarmoederhalskanker kan veroorzaken, teruggebracht naar twee prikken. De vaccinatie wordt aan alle twaalfjarige meisjes aangeboden. Ontwikkelingen voor RVP-ziekten Door de uitbreiding van het pneumokokkenvaccin met drie typen in 2011 is het aantal kinderen gedaald dat van deze drie typen ziek werd. Deze daling was ook te zien onder volwassenen, die mogelijk indirect door de vaccinatie van kinderen zijn beschermd.Kinkhoest nam in 2014 weer toe na een daling in 2013. Het aantal zieken was minder hoog dan tijdens de epidemie in 2012. De bof kwam weinig voor in 2014, al steeg het aantal meldingen weer in de eerste maanden van 2015. De meeste mazelengevallen zijn in de eerste twee maanden van 2014 gerapporteerd, aan het einde van de epidemie die in 2013 begon. De mazelen kwam voor in gebieden waar mensen zich om religieuze redenen vaak niet laten vaccineren. Er zijn geen gevallen van polio gemeld. Vorig jaar waren de controles op polio geïntensiveerd in regio's in Nederland waar vluchtelingen worden opgevangen. Dit betrof vluchtelingen uit enkele niet-Europese landen waar het aantal poliogevallen was gestegen, zoals Syrië. Aangezien polio in die landen in 2014 minder voorkwam zijn de controles tot een normaal niveau teruggebracht. Ontwikkelingen voor toekomstige RVP-kandidaten De Gezondheidsraad kan de minister adviseren om het aantal ziekten die onder het RVP vallen uit te breiden. Het RIVM houdt in de gaten hoe ziekten die hiervoor in aanmerking komen, zich ontwikkelen. In 2014 kwamen uitzonderlijk weinig infecties met het rotavirus voor. Ook daalde het aantal zieken door meningokokken serogroep B. Het aantal mensen met het waterpokken, gordelroos en hepatitis A is de afgelopen jaren stabiel gebleven.In the Netherlands, participation in the National Immunisation Programme (NIP) is high, resulting in low incidences of most diseases included in the NIP. Yet coverage for vaccination against human papillomavirus (HPV) in girls is lower. Only a few severe adverse events following immunisation occurred. Reported adverse events are mostly mild and transient. Continuous monitoring of effectiveness and safety is necessary for the programme to remain optimal. Changes in the vaccination schedule in 2014-2015 Since 2014, girls have been receiving a reduced number of doses against human papillomavirus (HPV). Two doses of HPV vaccine are offered to 12-year-old girls. Developments for diseases included in the NIP The switch to the 10-valent pneumococcal vaccine (PCV10) in 2011 reduced the number of invasive pneumococcal diseases caused by the additional PCV10 serotypes in the vaccinated age groups. A decrease in the incidence of IPD caused by the additional PCV10 serotypes was also seen in the adult age groups, which is probably due to indirect protection. The incidence of pertussis increased in 2014 after a lower incidence in 2013, but was somewhat lower than during the epidemic year 2012. The incidence of mumps was low in 2014, but a resurgence of mumps and an endemic transmission were encountered in the first few months of 2015. The majority of the measles cases reported in 2014 belonged to the measles epidemic in the Bible Belt, which started in 2013. No cases of polio were reported. The environmental routine surveillance, which was intensified in the region where refugees were first cared for in 2013, was changed to routine level again in April 2015. Developments for future NIP candidates The Health Council could advise the Dutch Minister of Health, Welfare and Sports on expansion of the NIP. The National Institute for Public Health and the Environment in the Netherlands (RIVM) investigates developments in potential future NIP candidates. In 2014, the rotavirus season was exceptionally low. A decrease in meningococcal serogroup B disease was seen in 2014. Incidences of varicella zoster virus and hepatitis A remained stable over the previous years.Ministerie van VW

Het Rijksvaccinatieprogramma in Nederland. Surveillance en ontwikkelingen in 2021-2022

RIVM tracks how many people fall ill due to a disease that is included in the National Immunisation Programme (NIP). In 2021, fewer people got such a disease compared to 2020. This is very likely due to COVID-19 control measures such as social distancing and handwashing. There were especially fewer people with invasive pneumococcal disease (about 1,205 people), pertussis (74), and mumps (1). The number of notifications for meningococcal disease caused by serotype W (4) decreased further, after introduction of the vaccine for adolescents into the NIP in 2020. There were no notifications of diphtheria, tetanus, measles, rubella, or polio in 2021. The number of chronic hepatitis B notifications (743) was about the same as in 2020. Between 2014 and 2019 there were many more notifications, with about 1,000 to 1,100 people being made aware they had this disease. The decrease is probably the result of a decrease in doctors’ visits and therefore diagnoses during the COVID-19 pandemic. Only Haemophilus influenzae type b (Hib) occurred more frequently than before the COVID-19 pandemic. In 2020 and 2021 there were 68 notifications per year, compared to 39 in 2019. RIVM currently investigates the cause. The vaccine seems to be as effective as in previous years. In 2021, 1,703,102 children were vaccinated as part of the NIP. They received a total of 2,219,341 vaccinations. Also, 115,886 pregnant women received a vaccination that protects their baby immediately after birth against, amongst others, whooping cough. Vaccination coverage in the Netherlands is slightly lower than last year. This is partly because of the COVID-19 pandemic, which caused some vaccinations to be given later than normally planned. The Health Council of the Netherlands recommended in June 2021 to offer rotavirus vaccination to young babies. In September 2021, the Health Council recommended inviting more risk groups for flu vaccination, including pregnant women. The ministry of Health, Welfare and Sport adopted both recommendations in 2022. Vaccination against COVID-19 works well to prevent severe illness and death, but the protection slowly decreases. Booster vaccinations increase protection again.Het RIVM houdt elk jaar bij hoeveel mensen een ziekte krijgen waartegen vanuit het Rijksvaccinatieprogramma (RVP) wordt gevaccineerd. In 2021 kregen minder mensen zo’n ziekte dan in 2020. Dit komt waarschijnlijk door de coronamaatregelen, zoals afstand houden en handen wassen. Er waren vooral minder mensen met invasieve pneumokokkenziekte (ongeveer 1.250 personen), kinkhoest (74) en bof (1). Ook is het aantal meningokokkenziekte type W ziektegevallen (4) verder gedaald nadat deze vaccinatie in 2020 voor tieners is toegevoegd aan het RVP. Er waren in 2021 geen mensen met difterie, tetanus, mazelen, rodehond of polio. Het aantal meldingen van chronische hepatitis B (743) was ongeveer hetzelfde als in 2020. Tussen 2014 en 2019 waren dat er veel meer, toen per jaar zo’n 1.000 tot 1.100 mensen te horen kregen dat ze deze ziekte hebben. De daling komt waarschijnlijk doordat mensen tijdens de coronapandemie minder vaak naar een dokter gingen. Alleen Haemophilus influenza type B (Hib) komt vaker voor dan vóór de coronapandemie. In 2020 en 2021 waren er 68 meldingen per jaar, vergeleken met 39 in 2019. Het RIVM onderzoekt de oorzaak. Het vaccin lijkt even effectief te zijn als in eerdere jaren. In 2021 zijn 1.703.102 kinderen gevaccineerd via het RVP. Zij kregen in totaal 2.219.341 vaccinaties. Ook hebben 115.886 zwangere vrouwen een vaccinatie gekregen die hun baby vanaf de geboorte beschermt tegen onder andere kinkhoest. Dit is de 22 wekenprik. De vaccinatiegraad in Nederland is iets lager dan vorig jaar. Dit komt voor een deel door de coronapandemie, waardoor sommige vaccinaties later zijn gegeven dan normaal. De Gezondheidsraad adviseerde in juni 2021 om jonge baby’s tegen het rotavirus te vaccineren. In september 2021 adviseerde de Gezondheidsraad om meer risicogroepen uit te nodigen voor de griepvaccinatie, waaronder zwangere vrouwen. Het ministerie van VWS heeft in 2022 beide adviezen overgenomen. Vaccineren tegen de ziekte COVID-19 werkt goed om ernstige ziekte en sterfte te voorkomen, maar de bescherming neemt langzaam af. De booster- en herhaalvaccinaties zorgen ervoor dat de bescherming weer toeneemt

Staat van infectieziekten in Nederland, 2013

In dit rapport wordt gelinked naar een bijlage: appendix150205001.De uitbraak van mazelen in 2013 was de meest in het oog springende infectieziekte van dat jaar. Dit blijkt uit de Staat van Infectieziekten in Nederland 2013, die inzicht geeft in ontwikkelingen van infectieziekten bij de Nederlandse bevolking. Daarnaast worden de ontwikkelingen in het buitenland beschreven die voor Nederland relevant zijn. Met deze jaarlijkse uitgave informeert het RIVM beleidsmakers van het ministerie van Volksgezondheid, Welzijn en Sport (VWS). Elk jaar komt in de Staat van Infectieziekten een thema aan bod; dit jaar is dat de hoeveelheid jaren in goede gezondheid die verloren gaan (ziektelast) door infectieziekten. Sommige infectieziekten, zoals maag-darminfecties, komen erg vaak voor maar veroorzaken over het algemeen geen ernstige klachten. Andere daarentegen, bijvoorbeeld tetanus, komen slechts zelden voor maar veroorzaken relatief veel sterfgevallen. Een gezondheidsmaat die deze aspecten van ziekten combineert is de Disability Adjusted Life Year (DALY). Voor 32 infectieziekten is de ziektelast in Nederland tussen 2007 en 2011 geschat. De gemiddelde jaarlijkse ziektelast voor de totale Nederlandse bevolking was het hoogst voor ernstige pneumokokkenziekte (9444 DALY's per jaar) en griep (8670 DALY's per jaar), die respectievelijk 16 en 15 procent van de totale ziektelast van alle 32 infectieziekten vertegenwoordigen. Na polio en difterie (0 gevallen in de onderzochte periode), werd de laagste ziektelast geschat voor rodehond op 0,14 DALY's per jaar. De ziektelast voor deze ziekten is zo laag dankzij het Rijksvaccinatieprogramma. De ziektelast per individu varieerde van 0,2 DALY's per honderd infecties voor giardiasis (diarree die wordt veroorzaakt door een parasiet), tot 5081 en 3581 DALY's per honderd infecties voor respectievelijk hondsdolheid en een variant van de ziekte van Creutzfeldt-Jakob. Voor alle ziektelaststudies geldt dat de resultaten afhankelijk zijn van de modelparameters en aannames, en van de beschikbaarheid van accurate gegevens over de mate waarin de ziekten voorkomen. Toch kunnen deze schattingen informatief zijn voor beleidsmakers binnen de gezondheidszorg om prioriteiten te kunnen aanbrengen in preventieve en andere maatregelen.The measles outbreak in 2013 was the most striking infectious disease of that year. This is demonstrated in the State of Infectious Diseases in the Netherlands 2013, which provides insight into infectious disease trends in the Dutch population. Developments in other countries that are relevant for the Netherlands are also described. This annual RIVM publication informs policy-makers from the Ministry of Health, Welfare and Sport (VWS). Every year the State of Infectious Diseases in the Netherlands publishes reports on a particular theme. This year's topic concerns the estimation of disease burden: how many years of health life are lost due to infectious diseases? Some infectious diseases, such as gastrointestinal infections, occur frequently in the population, but do not generally give rise to serious complaints. In contrast, other diseases, for example tetanus, occur rarely but may lead to a high risk of death. A summary measure of population health that combines the morbidity and premature mortality attributable to a disease in a single quantity is the Disability Adjusted Life Year (DALY). For 32 infectious diseases, we estimated the disease burden in the Netherlands between 2007 and2011. The highest average annual burden for the total Netherlands population was estimated for invasive pneumococcal disease (9444 DALYs per year) and influenza (8670 DALYs per year), which represent 16 and 15 percent, respectively, of the total burden of all 32 diseases considered. After poliomyelitis and diphtheria (no cases in the period investigated), the lowest burden was estimated for rubella, at 0.14 DALYs per year. The extremely low burden for these diseases is due to the National Immunization Programme. The disease burden per individual varied from 0.2 DALYs per 100 infections for giardiasis (diarrhea that is caused by a parasite), to 5081 and 3581 DALYs per 100 infections for rabies and variant Creutzfeldt-Jakob disease, respectively. As with all burden of disease studies, results depend on disease model parameters and assumptions and on the availability of accurate data on the incidence of infection. Nevertheless, estimates of disease burden can be informative for public health policy-makers regarding the prioritization of preventive and other measures.Ministerie van VW

Is there an association between socioeconomic status and immune response to infant and childhood vaccination in the Netherlands?

Introduction Socioeconomic status (SES) is a well-known determinant of health, but its relation with vaccine-induced immunity is less documented. We explored the association between SES and immunoglobulin G (IgG) levels against vaccine-preventable diseases in vaccinated children in the Dutch National Immunization Programme. Methods Data from a population-wide cross-sectional serosurvey in the Netherlands (2006–2007) were used. We compared geometric mean IgG concentrations/titers (GMC/T ratios) against measles, mumps, rubella, Haemophilus influenzae type b (Hib), Neisseria meningococcus type C, diphtheria, tetanus, poliovirus types 1,2,3 and pertussis in children of high versus low SES by linear regression analysis. We included 894 children (0–12 years) at one of two timeframes: 1 month to 1 year, or 1–3 years after vaccination. Mother’s educational level and net household income served as binary indicators of SES. Results Of 58 possible associations of vaccine-induced antibody responses with educational level and 58 with income, 10 (9%) were statistically significant: 2 favouring (that is, with higher IgG levels at) high educational level (for Hib 1 m-1y after vaccination (GMC/T ratio: 2.99, 95%CI: 1.42–6.30) and polio 2 1 m-1y after the 9-year booster dose (1.14, 1.01–1.27)) and 8 favouring low income (polio 1, 2 and 3 1 m-1y after the 11-month booster (0.74, 0.58–0.94; 0.79, 0.64–0.97; 0.72, 0.55–0.95), polio 3 and pertussis 1-3y after the 11-month booster (0.70, 0.56–0.88; pertussis-prn: 0.60, 0.37–0.98; pertussis-ptx: 0.66, 0.47–0.95), mumps and rubella 1-3y after first vaccination (0.73, 0.55–0.97; 0.70, 0.55–0.90), and rubella 1 m-1y after second vaccination (0.83, 0.55–0.90)). After adjustment for multiple testing, none of the differences remained significant. There was no association between SES and proportion of children with protective IgG levels

Increased Population Prevalence of Low Pertussis Toxin Antibody Levels in Young Children Preceding a Record Pertussis Epidemic in Australia

Background: Cross-sectional serosurveys using IgG antibody to pertussis toxin (IgG-PT) are increasingly being used to estimate trends in recent infection independent of reporting biases. Methods/Principal Findings: We compared the age-specific seroprevalence of various levels of IgG-PT in cross-sectional surveys using systematic collections of residual sera from Australian diagnostic laboratories in 1997/8, 2002 and 2007 with reference to both changes in the pertussis vaccine schedule and the epidemic cycle, as measured by disease notifications. A progressive decline in high-level ($62.5 EU/ml) IgG-PT prevalence from 19 % (95 % CI 16–22%) in 1997/98 to 12 % (95 % CI 11–14%) in 2002 and 5 % (95 % CI 4–6%) in 2007 was consistent with patterns of pertussis notifications in the year prior to each collection. Concomitantly, the overall prevalence of undetectable (,5 EU/ml) levels increased from 17 % (95 % CI 14– 20%) in 1997/98 to 38 % (95 % CI 36–40%) in 2007 but among children aged 1–4 years, from 25 % (95 % CI 17–34%) in 1997/98 to 62 % (95 % CI 56–68%) in 2007. This change followed withdrawal of the 18-month booster dose in 2003 and preceded record pertussis notifications from 2008 onwards. Conclusions/Significance: Population seroprevalence of high levels of IgG-PT is accepted as a reliable indicator of pertussis disease activity over time within and between countries with varying diagnostic practices, especially in unimmunised age groups. Our novel findings suggest that increased prevalence of undetectable IgG-PT is an indicator of waning immunit

Participation in and attitude towards the national immunization program in the Netherlands: data from population-based questionnaires

Contains fulltext : 108971.pdf (publisher's version ) (Open Access)BACKGROUND: Knowledge about the determinants of participation and attitude towards the National Immunisation Program (NIP) may be helpful in tailoring information campaigns for this program. Our aim was to determine which factors were associated with nonparticipation in the NIP and which ones were associated with parents' intention to accept remaining vaccinations. Further, we analyzed possible changes in opinion on vaccination over a 10 year period. METHODS: We used questionnaire data from two independent, population-based, cross-sectional surveys performed in 1995-96 and 2006-07. For the 2006-07 survey, logistic regression modelling was used to evaluate what factors were associated with nonparticipation and with parents' intention to accept remaining vaccinations. We used multivariate multinomial logistic regression modelling to compare the results between the two surveys. RESULTS: Ninety-five percent of parents reported that they or their child (had) participated in the NIP. Similarly, 95% reported they intended to accept remaining vaccinations. Ethnicity, religion, income, educational level and anthroposophic beliefs were important determinants of nonparticipation in the NIP. Parental concerns that played a role in whether or not they would accept remaining vaccinations included safety of vaccinations, maximum number of injections, whether vaccinations protect the health of one's child and whether vaccinating healthy children is necessary. Although about 90% reported their opinion towards vaccination had not changed, a larger proportion of participants reported to be less inclined to accept vaccination in 2006-07 than in 1995-96. CONCLUSION: Most participants had a positive attitude towards vaccination, although some had doubts. Groups with a lower income or educational level or of non-Western descent participated less in the NIP than those with a high income or educational level or indigenous Dutch and have been less well identified previously. Particular attention ought to be given to these groups as they contribute in large measure to the rate of nonparticipation in the NIP, i.e., to a greater extent than well-known vaccine refusers such as specific religious groups and anthroposophics. Our finding that the proportion of the population inclined to accept vaccinations is smaller than it was 10 years ago highlights the need to increase knowledge about attitudes and beliefs regarding the NIP

Immunisation coverage and annual report National Immunisation Programme in the Netherlands 2016

Het RIVM beschrijft jaarlijks de ontwikkelingen binnen het Rijksvaccinatieprogramma (RVP), zowel inhoudelijk als organisatorisch. Vanaf dit jaar zijn de belangrijkste gebeurtenissen en de ontwikkelingen op het gebied van de vaccinatiegraad gebundeld. Belangrijke gebeurtenissen In 2016 waren er geen opvallende uitbraken van RVP-ziekten. Wel stijgt sinds oktober 2015 het aantal patiënten met meningokokkenziekte W, terwijl in het RVP tegen meningokokkenziekte C wordt ingeënt. Opvallend was het stevige debat dat in november 2016 in diverse media is gevoerd tussen voor- en tegenstanders van vaccinatie. Verder heeft het RIVM factsheets gemaakt voor zowel professionals als het publiek met informatie over vaccinaties tegen ziekten die wel beschikbaar zijn maar niet in het RVP zijn opgenomen. Voorbeelden zijn waterpokken, gordelroos en het rotavirus (www.rivm.nl/vaccinaties). Vaccinatiegraad De vaccinatiegraad, oftewel het aandeel zuigelingen, kleuters en schoolkinderen dat de vaccinaties uit het RVP krijgt, is nog steeds hoog. De vaccinatiegraad voor bof, mazelen en rodehond (BMR) daalt al een paar jaar licht. De norm van 95 procent van de Wereldgezondheidsorganisatie (WHO), die nodig is om mazelen uit te bannen, wordt in Nederland bij de eerste BMR-vaccinatie niet meer gehaald. Voor de tweede BMR-vaccinatie was dit al langer zo. Ook bij andere vaccinaties in het RVP is een lichte daling te zien. De deelname aan de HPV-vaccinatie tegen baarmoederhalskanker is voor het eerst afgenomen, van 61 naar 53 procent. Een hoge vaccinatiegraad zorgt ervoor dat kwetsbare en (nog) niet gevaccineerde kinderen tegen ziekten worden beschermd (groepsbescherming). Een dalende vaccinatiegraad vergroot de kans dat in de toekomst ziekten zoals mazelen uitbreken.The RIVM annually describes the developments within the Dutch National Immunisation Programme (NIP), both substantively and organisationally. From this year, the most important events and developments in the field of immunisation coverage have been bundled. Important events In 2016, there were no significant outbreaks of NIP diseases. However, since October 2015, the number of meningococcal disease patients by a different serogroup (W) than the serogroup C which is vaccinated against within the NIP, has risen. Striking was the vigorous debate that was conducted in various media in November 2016 between advocates and opponents of immunisation. Furthermore, the RIVM has made factsheets for professionals as well as the public with information on vaccines against diseases that are available but not included in the NIP. Examples include varicella, herpes zoster and rotavirus (www.rivm.nl/vaccinations). Immunisation coverage The immunisation coverage, i.e. the proportion of newborns, toddlers and schoolchildren who receive vaccinations within the NIP is still high. The immunisation coverage for mumps, measles and rubella (MMR) has declined slightly for a few years. The 95 per cent threshold of the World Health Organization (WHO) needed to eliminate measles is no longer achieved in the Netherlands for the first MMR vaccination. For the second MMR vaccination this has been for longer. Also for other NIP vaccinations there is a slight decrease in participation. The participation in HPV vaccination against cervical cancer has decreased for the first time, from 61 to 53 per cent. A high immunisation coverage ensures that vulnerable and not (yet) vaccinated children are protected against diseases (herd protection). A decreasing immunisation coverage increases the likelihood that diseases such as measles cause outbreaks in the future.Ministerie van VW

Cost-Effectiveness of Adolescent Pertussis Vaccination for The Netherlands: Using an Individual-Based Dynamic Model

BACKGROUND: Despite widespread immunization programs, a clear increase in pertussis incidence is apparent in many developed countries during the last decades. Consequently, additional immunization strategies are considered to reduce the burden of disease. The aim of this study is to design an individual-based stochastic dynamic framework to model pertussis transmission in the population in order to predict the epidemiologic and economic consequences of the implementation of universal booster vaccination programs. Using this framework, we estimate the cost-effectiveness of universal adolescent pertussis booster vaccination at the age of 12 years in the Netherlands. METHODS/PRINCIPAL FINDINGS: We designed a discrete event simulation (DES) model to predict the epidemiological and economic consequences of implementing universal adolescent booster vaccination. We used national age-specific notification data over the period 1996-2000--corrected for underreporting--to calibrate the model assuming a steady state situation. Subsequently, booster vaccination was introduced. Input parameters of the model were derived from literature, national data sources (e.g. costing data, incidence and hospitalization data) and expert opinions. As there is no consensus on the duration of immunity acquired by natural infection, we considered two scenarios for this duration of protection (i.e. 8 and 15 years). In both scenarios, total pertussis incidence decreased as a result of adolescent vaccination. From a societal perspective, the cost-effectiveness was estimated at €4418/QALY (range: 3205-6364 € per QALY) and €6371/QALY (range: 4139-9549 € per QALY) for the 8- and 15-year protection scenarios, respectively. Sensitivity analyses revealed that the outcomes are most sensitive to the quality of life weights used for pertussis disease. CONCLUSIONS/SIGNIFICANCE: To our knowledge we designed the first individual-based dynamic framework to model pertussis transmission in the population. This study indicates that adolescent pertussis vaccination is likely to be a cost-effective intervention for The Netherlands. The model is suited to investigate further pertussis booster vaccination strategies

Bordetella pertussis Strains with Increased Toxin Production Associated with Pertussis Resurgence

A more virulent strain of the disease is emerging