The 2013-2014 measles outbreak in The Netherlands: New evidence on measles epidemiology and control

In Chapter 2, we described the measles outbreak of 2013/14 that occurred in The Netherlands. The outbreak took mainly place within the orthodox Protestant community. In total, 2700 measles cases, 181 hospitalisations and 1 death were reported. In Chapter 3, we assessed the actual burden of the 2013/14 measles outbreak by assessing the completeness of reporting. Given that 9% of cases were reported, the estimated total size of the 2013/14 outbreak approximated 31,400 measles cases. In Chapter 4, we assessed the severity and contagiousness of 2539 unvaccinated (94%), 121 once vaccinated (5%) and 16 (1%) at least twice-vaccinated measles cases. Compared with unvaccinated and once-vaccinated cases, twice-vaccinated cases were less severe and less infectious. Our findings support the recommendation of the WHO of a two-dose MMR vaccination schedule. In Chapters 5, 6, and 7, we discussed the uptake, effectiveness, and tolerability of an early MMR vaccination offered to infants between 6 and 14 months of age. The national vaccination register is individual-based and is therefore suitable for tailored interventions such as the administration of an early MMR to infants between 6-14 months of age who live in municipalities with low vaccination coverage (