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[Measles epidemiology in the Netherlands: a exploratory analysis of notification]
1Rijksinstituut voor Volksgezondheid en Milieu, Centrum voor Infectieziekten Epidemiologie, Bilthoven.
Objective:
Explorative analysis of the effects of vaccination policy on measles incidence.
Design:
Retrospective study and mathematical modelling.
Method:
Analysis of national and regional case notifications of measles provided by the Inspectorate of Health in the Netherlands over the period from January 1976 (when vaccination was started) through September 1999. Also computer simulations with a mathematical epidemic model of measles were used to calculate the incidence of measles from 1976 onwards.
Results:
According to the model results, measles should not persist with the current vaccination programme. However, the case notification data showed that measles appeared to persist at a nation-wide level. At a regional level, measles did not persist, not even in regions with low vaccine coverage. A possible cause of the unexpected persistence at the national level is the asynchronous regional course of the 6-year epidemic cycle of measles, where measles infection 'jumps' from one region to the other.