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Risk factors for persisting measles susceptibility: a case-control study among unvaccinated orthodox Protestants
Anne C de Munter1, Alma Tostmann2, Susan J M Hahné3
1Department of Infectious Disease Control, Regional Public Health Service Gelderland-Zuid, public Health Centre, Nijmegen, The Netherlands.
Background:
Measles is an infectious disease providing lifelong immunity. Epidemics periodically occur among unvaccinated orthodox Protestants in the Netherlands. During the 2013/2014 epidemic, 17% of the reported patients was over 14 years old. Apparently, they did not catch measles during the previous 1999/2000 epidemic and remained susceptible. We wanted to identify risk factors for this so-called persisting measles susceptibility, and thus risk factors for acquiring measles at older age with increased risk of complications.
Methods:
A case-control study was performed among unvaccinated orthodox Protestants born between 1988 and 1998; cases had measles in 2013/2014, controls during or before 1999/2000. Associations between demographic, geographical and religion-related determinants and persisting measles susceptibility were determined using univariate and multivariable logistic regression. Analyses were stratified in two age-groups: infants/toddlers and primary school-aged children during the 1999/2000 measles epidemic.
Results:
In total, 204 cases and 563 controls were included. Risk factors for persisting measles susceptibility for infants/toddlers in 1999/2000 were belonging to a moderately conservative church, absence of older siblings and residency outside low vaccination coverage (LVC)-municipalities. Risk factors for primary school-aged children were residency outside LVC-municipalities and attendance of non-orthodox Protestant primary school.
Conclusion:
Unvaccinated orthodox Protestant adolescents and adults who resided outside the LVC-municipalities, did not attend an orthodox Protestant primary school, had no older siblings and belonged to a moderately conservative church were at risk for persisting measles susceptibility and, thus, for acquiring measles at older age with increased risk of complications. For this subgroup of orthodox Protestants targeted information on vaccination is recommended.
Insights
Unvaccinated orthodox Protestants residing outside low vaccination areas and not attending orthodox schools were more susceptible to measles. Targeted vaccination information is recommended for this group to prevent complications.
Area of Science:
- Epidemiology
- Public Health
- Infectious Diseases
Background:
- Measles outbreaks periodically affect unvaccinated orthodox Protestant communities in the Netherlands.
- A significant proportion (17%) of measles patients in the 2013/2014 epidemic were over 14, indicating persistent susceptibility from a prior 1999/2000 epidemic.
- Identifying risk factors for measles susceptibility in older children and adults is crucial due to increased complication risks.
Purpose of the Study:
- To identify demographic, geographic, and religion-related risk factors for persisting measles susceptibility among unvaccinated orthodox Protestants.
- To understand why certain individuals remained susceptible to measles after the 1999/2000 epidemic and contracted it during the 2013/2014 outbreak.
Main Methods:
- A case-control study was conducted with unvaccinated orthodox Protestants born between 1988 and 1998.
- Cases had measles in 2013/2014; controls had measles in or before 1999/2000.
- Univariate and multivariable logistic regression analyses were performed, stratified by age groups relevant to the 1999/2000 epidemic.
Main Results:
- 204 cases and 563 controls were analyzed.
- For infants/toddlers in 1999/2000, risk factors included belonging to a moderately conservative church, lacking older siblings, and residing outside low vaccination coverage (LVC) municipalities.
- For primary school-aged children, risk factors were residency outside LVC-municipalities and attending non-orthodox Protestant primary schools.
Conclusions:
- Unvaccinated orthodox Protestants residing outside LVC areas, not attending orthodox schools, lacking older siblings, or belonging to moderately conservative churches are at higher risk of measles susceptibility.
- This susceptibility increases the risk of acquiring measles at an older age, potentially leading to severe complications.
- Targeted vaccination information campaigns are recommended for this specific subgroup to improve measles prevention.
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