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Large differences in MMR and DTaP-IPV vaccination coverage among primary schools by denomination, the Netherlands,
Joyce Pijpers1, Annika van Roon1, Susan van den Hof2
1Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands.
Vaccine
|December 24, 2025
Summary
Childhood vaccination coverage in the Netherlands is high overall, but lower rates in Orthodox Protestant, Anthroposophical, and Islamic schools pose risks for measles and pertussis outbreaks. Further research is needed to understand vaccination barriers.
Area of Science:
- Public Health
- Epidemiology
- Immunization
Background:
- Measles and pertussis cases are rising globally and in the Netherlands.
- Schools play a role in the transmission of vaccine-preventable diseases.
- Assessing childhood vaccination coverage by school type is crucial.
Purpose of the Study:
- To systematically evaluate childhood vaccination coverage in the Netherlands.
- To analyze coverage by birth cohort and school denomination.
- To identify disparities in vaccination uptake among primary school children.
Main Methods:
- Linked nationwide vaccination data with sociodemographic registries for children born 2013-2020.
- Retrieved vaccination status for MMR, DTaP-IPV, and DTaP-booster from the immunisation register.
- Stratified coverage by school denomination, birth year, and sociodemographics; used Poisson regression.
Main Results:
- MMR and DTaP-IPV coverage exceeded 94% in most schools but was lower in Anthroposophical (78%), Islamic (74%), and Orthodox Protestant (57%) schools.
- Booster coverage ranged from 50% (Orthodox Protestant) to 88% (Catholic/Protestant).
- Coverage declined in Islamic and Orthodox Protestant schools, while fluctuating at Anthroposophical schools; sociodemographic adjustments had minimal impact.
Conclusions:
- Clustering of unvaccinated children in specific school types (Orthodox Protestant, Anthroposophical, Islamic) presents ongoing outbreak risks.
- Understanding vaccination barriers, drivers, and social network influences is essential.
- Targeted interventions may be needed for schools with lower vaccination coverage.
