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Immunity to poliomyelitis in The Netherlands.
M A Conyn-Van Spaendonck1, H E de Melker, F Abbink
1Department of Infectious Diseases Epidemiology, National Institute of Public Health and the Environment, Bilthoven, The Netherlands. mae.conyn@rivm.nl
American Journal of Epidemiology
|February 7, 2001
Summary
Despite high vaccination rates, polio outbreaks persist in unvaccinated groups. This study assessed poliovirus immunity in the general population and unvaccinated religious communities, revealing critical gaps in protection for vulnerable groups.
Area of Science:
- Epidemiology
- Immunology
- Public Health
Background:
- The Netherlands has experienced recurrent poliomyelitis outbreaks over the past 30 years, primarily affecting unvaccinated individuals within specific religious communities.
- High vaccination coverage (97%) has not prevented these localized outbreaks, highlighting the need to understand immunity levels in both vaccinated and unvaccinated populations.
Purpose of the Study:
- To determine the prevalence of neutralizing antibodies against poliovirus types 1, 2, and 3 in the general Dutch population and in unvaccinated religious groups.
- To assess the long-term persistence of immunity from natural infection and inactivated polio vaccine (IPV).
- To evaluate the impact of recent polio outbreaks on seroprevalence within these groups.
Main Methods:
- A population-based serological study was conducted in 1995-1996, analyzing 9,274 serum samples.
- Neutralizing antibody titers against poliovirus types 1, 2, and 3 were measured.
- Participants included the general population and members of religious groups that reject vaccination.
Main Results:
- In the general population, antibody prevalence was high: 96.6% for type 1, 93.4% for type 2, and 89.7% for type 3.
- Antibodies demonstrated long-term persistence in both naturally infected and IPV-vaccinated individuals.
- In Orthodox Reformed individuals rejecting vaccination, antibody prevalence was significantly lower: 65.0% (type 1), 59.0% (type 2), and 68.7% (type 3). Recent outbreaks impacted seroprevalence in this group but not the general population.
Conclusions:
- While the general population exhibits robust immunity to poliovirus, unvaccinated religious communities remain highly vulnerable.
- The persistence of polio outbreaks in these groups underscores the limitations of voluntary vaccination strategies.
- Given the lack of political feasibility for mandatory vaccination, global poliovirus eradication is essential to protect unvaccinated populations from future poliomyelitis.