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

A pragmatic harm reduction approach to manage a large outbreak of wound botulism in people who inject drugs, Scotland 2015

Abstract Background People who inject drugs (PWID) are at an increased risk of wound botulism, a potentially fatal acute paralytic illness. During the first 6 months of 2015, a large outbreak of wound botulism was confirmed among PWID in Scotland, which resulted in the largest outbreak in Europe to date. Methods A multidisciplinary Incident Management Team (IMT) was convened to conduct an outbreak investigation, which consisted of enhanced surveillance of cases in order to characterise risk factors and identify potential sources of infection. Results Between the 24th of December 2014 and the 30th of May 2015, a total of 40 cases were reported across six regions in Scotland. The majority of the cases were male, over 30 and residents in Glasgow. All epidemiological evidence suggested a contaminated batch of heroin or cutting agent as the source of the outbreak. There are significant challenges associated with managing an outbreak among PWID, given their vulnerability and complex addiction needs. Thus, a pragmatic harm reduction approach was adopted which focused on reducing the risk of infection for those who continued to inject and limited consequences for those who got infected. Conclusions The management of this outbreak highlighted the importance and need for pragmatic harm reduction interventions which support the addiction needs of PWID during an outbreak of spore-forming bacteria. Given the scale of this outbreak, the experimental learning gained during this and similar outbreaks involving spore-forming bacteria in the UK was collated into national guidance to improve the management and investigation of future outbreaks among PWID

A systematic review of hepatitis B screening economic evaluations in low- and middle-income countries

Background: Chronic hepatitis B infection is a significant cause of morbidity and mortality worldwide; low- and middle-income countries (LMICs) are disproportionately affected. Economic evaluations are a useful decision tool to assess costs versus benefits of hepatitis B virus (HBV) screening. No published study reviewing economic evaluations of HBV screening in LMICs has been undertaken to date. Methods: The following databases were searched from inception to 21 April 2017: MEDLINE, PubMed, EMBASE, CINAHL Plus, the Cochrane Library, Global Health and the Cost-effectiveness Analysis Registry. English-language studies were included if they assessed the costs against the benefits of HBV screening in LMICs. PROSPERO registration: CRD42015024391, 20 July 2015. Results: Nine studies fulfilled the eligibility criteria. One study from Thailand indicated that adding hepatitis B immunoglobulin (HBIG) to HBV vaccination for newborns following screening of pregnant women might be cost-effective for some LMICs, though inadequate total funding and health infrastructure were likely to limit feasibility. A similar study from China indicated a benefit to cost ratio of 2.7 from selective HBIG administration to newborns, if benefits were considered from a societal perspective. Of the two studies assessing screening amongst the general adult population, a single cost-benefit analysis from China found a benefit to cost ratio (BCR) of 1.73 with vaccination guided by HBV screening of adults aged 21–39, compared to 1.42 with vaccination with no screening, both from a societal perspective. Community-based screening of adults in The Gambia with linkage to treatment yielded an incremental cost per disability-adjusted life year averted of $566 (in 2017 USD), less than two-times gross domestic product per capita for that country. Conclusions: Screening with ‘catch-up’ vaccination for younger adults yielded benefits above costs, and screening linked with treatment has shown cost-effectiveness that may be affordable for some LMICs. However, interpretation needs to account for total cost implications and further research in LMICs is warranted as there were only nine included studies and evidence from high-income countries is not always directly applicable

Transmission of mumps virus from mumps-vaccinated individuals to close contacts.

During a recent mumps epidemic in the Netherlands caused by a genotype D mumps virus strain, we investigated the potential of vaccinated people to spread mumps disease to close contacts. We compared mumps viral titers of oral fluid specimens obtained by quantitative PCR from vaccinated (n=60) and unvaccinated (n=111) mumps patients. We also investigated the occurrence of mumps infection among the household contacts of vaccinated mumps patients. We found that viral titers are higher for unvaccinated patients than for vaccinated patients during the 1st 3 days after onset of disease. While no symptomatic cases were reported among the household contacts (n=164) of vaccinated mumps patients (n=36), there were cases with serological evidence of asymptomatic infection among vaccinated household contacts (9 of 66 vaccinated siblings). For two of these siblings, the vaccinated index patient was the most probable source of infection. We conclude that, in this particular outbreak, the risk of a close contact becoming infected by vaccinated patients was small, but present

Transmission of mumps virus from mumps-vaccinated individuals to close contacts.

During a recent mumps epidemic in the Netherlands caused by a genotype D mumps virus strain, we investigated the potential of vaccinated people to spread mumps disease to close contacts. We compared mumps viral titers of oral fluid specimens obtained by quantitative PCR from vaccinated (n=60) and unvaccinated (n=111) mumps patients. We also investigated the occurrence of mumps infection among the household contacts of vaccinated mumps patients. We found that viral titers are higher for unvaccinated patients than for vaccinated patients during the 1st 3 days after onset of disease. While no symptomatic cases were reported among the household contacts (n=164) of vaccinated mumps patients (n=36), there were cases with serological evidence of asymptomatic infection among vaccinated household contacts (9 of 66 vaccinated siblings). For two of these siblings, the vaccinated index patient was the most probable source of infection. We conclude that, in this particular outbreak, the risk of a close contact becoming infected by vaccinated patients was small, but present

COVID-19 vaccination coverage in the Netherlands in 2021

Op 6 januari 2021 begon in Nederland de vaccinatiecampagne tegen COVID-19, de ziekte die het coronavirus veroorzaakt. Het belangrijkste doel was om de kans op ernstige ziekte en sterfte door COVID-19 te verkleinen. In Nederland zijn in 2021 vier COVID-19-vaccins gebruikt, gemaakt door vier producenten: Pfizer, Moderna, AstraZeneca en Janssen. Voor Pfizer, Moderna en AstraZeneca zijn 2 doses vaccin aanbevolen, of 1 dosis na een infectie met het virus. Voor Janssen was 1 dosis genoeg. Voor mensen met een ernstige afweerstoornis waren om medische redenen 3 vaccindoses nodig. Deze vaccinaties worden de basisserie genoemd. In 2021 zijn er naar schatting ruim 24 miljoen eerste en tweede vaccinaties gezet. Aan het einde van 2021 heeft naar schatting 87,4 procent van de 12-plussers ten minste één vaccinatie tegen corona gekregen. Voor de 18-plussers was dat 89,1 procent. Voor de basisserie heeft naar schatting 84,4 procent van de 12-plussers zich laten vaccineren en 86,0 procent van de 18-plussers. In verhouding hebben meer mensen uit de oudere leeftijdsgroepen zich laten vaccineren dan jongeren. Verder hebben in het oosten en zuidoosten van Nederland meer mensen zich laten vaccineren dan in het westen. In enkele gemeenten, zoals in de Biblebelt en grote steden, is de vaccinatiegraad lager dan gemiddeld. De boostercampagne begon vanaf 18 november 2021, als eerste voor de oudste leeftijdsgroepen. Hiervoor zijn de vaccins Pfizer en Moderna gebruikt. In totaal zijn er in 2021 ruim 4 miljoen boostervaccinaties gezet. Twee maanden na de start had 56,6 procent van de 18-plussers een booster ontvangen. De vaccins zijn gegeven door de GGD (Gemeentelijke Gezondheidsdienst)’en (84,8 procent), huisartsen (9,4 procent) en overige uitvoerders, zoals zorginstellingen (5,8 procent). Het RIVM krijgt informatie over het aantal vaccinaties dat in Nederland is verdeeld, het aantal vaccinaties dat door de GGD’en is gezet (CoronIT) en de vaccinaties die door huisartsen en overige uitvoerders zijn geregistreerd in CIMS. In CIMS staan de vaccinaties waarvan mensen toestemming gaven om de gegevens te delen met het RIVM. Door de tijd heen zijn verschillende databronnen en methoden gebruikt om in kaart te brengen hoeveel mensen in Nederland zijn gevaccineerd (vaccinatiegraad). Dat hing af van de beschikbaarheid van de data over de verdeelde en geregistreerde vaccinaties. Het RIVM rapporteerde elke week over de vaccinatiegraad in Nederland. Ook gaf het gegevens door aan European Centre for Disease Prevention and Control ( ECDC (European Centre for Disease Prevention and Control)) zodat in de Europese Unie de vaccinatiegraad kon worden gevolgd. Daarnaast publiceerde VWS (Ministerie van Volksgezondheid, Welzijn en Sport )data op het Coronadashboard van de Rijksoverheid.On 6 January 2021, the vaccination campaign against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes COVID-19, started in the Netherlands. The goal of the vaccination campaign was to protect against severe illness and death due to COVID-19. In the Netherlands, four COVID-19 vaccines were used in 2021: Pfizer, Moderna, AstraZeneca and Janssen. The recommended number of doses for the Pfizer, Moderna and AstraZeneca vaccines was 2 doses, or only 1 following a coronavirus infection. For the Janssen vaccine, 1 dose was sufficient. For immunocompromised individuals, 3 doses were recommended. These vaccinations formed the primary series. In 2021, an estimated 24 million first and second vaccine doses were administered. It is estimated that 87.4% of those aged 12 and over and 89.1% of those aged 18 and over received at least one dose by the end of 2021. An estimated 84.4% of those aged 12 and over and 86.0% of those aged 18 and over completed the primary series. Vaccination uptake was generally higher in older age groups than in younger age groups. In addition, the eastern and south-eastern regions of the Netherlands had higher vaccination coverages than the western regions. Some municipalities, such as those in the bible belt and the larger cities, had a vaccination coverage below the national average. The first booster campaign in the Netherlands, where the older age groups were given priority, started on 18 November 2021. The Pfizer and Moderna vaccines were used for this campaign. In total, more than 4 million booster vaccinations were administered in 2021. Two months after the start of the campaign, the booster vaccination coverage for those aged 18 years and over was 56.6%. 84.8% of vaccinations were administered by the Municipal Public Health Services (GGDs), 9.4% by general practitioners, and 5,8% by other vaccination administrators, including nursing homes. The National Institute for Public Health and the Environment (RIVM) receives data on the number of vaccine doses distributed in the Netherlands, the number of doses administered by the GGDs as reported in CoronIT, and the number of doses administered by GPs and other vaccination administrators as reported in CIMS. CIMS contains the information on vaccinations where those who were vaccinated consented to sharing the data with RIVM. Over time, depending on the availability of data in the various systems on the distributed vaccines and registered vaccinations, different data sources and methods were used to establish how many people were vaccinated in the Netherlands (vaccination coverage). Based on the data, the RIVM reported weekly updates on the vaccination coverage in the Netherlands. Data was also shared with the European Centre for Disease Prevention and Control (ECDC) to enable European monitoring of the vaccination coverage. In addition, the Ministry of Health, Welfare and Sport published data on the Dutch government’s Coronavirus Dashboard