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The National Immunisation Programme in the Netherlands Developments in 2012 RIVM report 201001002/2012 T.M. van ‘t Klooster et al. National Institute for Public Health and the Environment P.O. Box 1 | 3720 BA Bilthoven www.rivm.com The National Immunisation Programme in the Netherlands Developments in 2012 RIVM Report 201001002/2012 RIVM Report 201001002 Colophon © RIVM 2012 Parts of this publication may be reproduced, provided acknowledgement is given to the 'National Institute for Public Health and the Environment', along with the title and year of publication. Editors: T.M. van 't Klooster H.E. de Melker Report prepared by: H.G.A.M. van der Avoort1, W.A.M. Bakker1, G.A.M. Berbers1, R.S. van Binnendijk1, M.C. van Blankers1, J.A. Bogaards1, H.J. Boot1†, M.A.C. de Bruijn1, P. Bruijning-Verhagen1, A. Buisman1, C.A.C.M. van Els1, A. van der Ende4, I.H.M. Friesema1, S.J.M. Hahné1, C.W.G. Hoitink1, P. Jochemsen1, P. Kaaijk1, J.M. Kemmeren1, A.J. King1, F.R.M. van der Klis1, T.M. van ’t Klooster1, M.J. Knol1, F. Koedijk1, A. Kroneman1, E.A. van Lier1, A.K. Lugner1, W. Luytjes1, N.A.T. van der Maas1, L. Mollema1, M. Mollers1, F.R. Mooi1, S.H. Mooij5, D.W. Notermans1, W. van Pelt1, F. Reubsaet1, N.Y. Rots1, M. Scherpenisse1, I. Stirbu-Wagner3, A.W.M. Suijkerbuijk2, L.P.B. Verhoef1, H.J. Vriend1 1 Centre for Infectious Disease Control, RIVM 2 Centre for Prevention and Health Services Research, RIVM 3 Netherlands Institute for Health Services Research, NIVEL 4 Reference Laboratory for Bacterial Meningitis, AMC 5 Public Health Service Amsterdam Contact: H.E. de Melker Centre for Infectious Disease Control [email protected] This investigation has been performed by order and for the account of Ministry of Health, Welfare and Sports, within the framework of V201001, Development future National Immunisation Programme. Page 2 of 158 RIVM Report 201001002 Abstract The National Immunisation Programme in the Netherlands Developments in 2012 The National Institute for Public Health and the Environment (RIVM) annually presents developments in the National Immunisation Programme (NIP). It gives an overview of how often diseases included in the NIP do occur and the changes made in the programme. The report also indicates which vaccines are used and which side effects were reported after vaccination. Developments for potential target diseases are included as well. The participation level in the NIP has been high for many years, resulting in low incidences for most target diseases. The programme is also safe because there are relative few side effects, which are usually mild and transient. For an optimal programme, continuous monitoring stays necessary. Notable developments in 2011 and 2012 In 2011, the vaccine against pneumococcal disease was extended with three types. It is still too early to see an effect. The number of notifications of acute hepatitis B infections dropped to an all time low since hepatitis B could first be diagnosed (late 1960s). In 2011 the NIP incorpored hepatitis B vaccination for all infants in order to prevent the disease furthermore. Despite the introduction of more effective vaccines and an additional booster at 4 years of age, a large pertussis epidemic occurred in 2012 in the Netherlands. The increase was the highest in infants of 0-2 months of age, children 8 years and older and adults. The increase from 8-years of age can be partly explained by a decreasing vaccine effectiveness as from this age. The mumps outbreak that started late 2009 among students continued up to 2012. Nevertheless, the number of reported cases in the season 2011/2012 was lower than in the previous season. In 2011, 50 cases of measles were reported. The incidence of non-imported cases (34 cases) was above the WHO elimination target (one per million inhabitants). In 2011, the vaccination against cervical cancer (HPV) for the first group of 12- year-olds was completed. Of them 56 percent was fully vaccinated (three doses). Potential new target diseases With regard to potential new target diseases, the incidence of meningococcal serogroup B disease has further decreased in 2011, although the incidence of meningococcal serogroup Y has increased in 2011. The rise in incidence of rotavirus-associated gastroenteritis did not continue in 2011. The number of hepatitis A infections was the lowest since this became notifiable in 1999. For varicella and herpes zoster, no striking changes occurred in 2011. Keywords: National Immunisation Programme, rotavirus, varicella zoster, Meningococcal B disease, hepatitis A Page 3 of 158 RIVM Report 201001002 Page 4 of 158 RIVM Report 201001002 Rapport in het kort Het Rijksvaccinatieprogramma in Nederland Ontwikkelingen in 2012 Het RIVM geeft jaarlijks een overzicht hoe vaak ziekten uit het Rijksvaccinatieprogramma (RVP) voorkomen en welke veranderingen daarin plaatsvinden. Het overzicht geeft ook aan welke vaccins zijn gebruikt en welke bijwerkingen na vaccinaties optraden. Hetzelfde geldt voor ontwikkelingen over nieuwe vaccins die eventueel in de toekomst in het RVP worden opgenomen. De vaccinatiegraad is al vele jaren hoog, waardoor weinig mensen ziekten krijgen waartegen zij via het RVP worden gevaccineerd. Het vaccinatieprogramma is bovendien veilig omdat er relatief weinig bijwerkingen voorkomen, die doorgaans niet ernstig van aard zijn. Voor een optimaal programma blijft continue monitoring nodig. Opvallende ontwikkelingen in 2011 en 2012 In 2011 is het vaccin tegen pneumokokkenziekte uitgebreid met drie typen van deze bacterie. Het is nog te vroeg om daar effect van te zien. Het aantal meldingen van acute hepatits B-infecties is nog nooit zo laag geweest sinds de ontdekking van het virus eind jaren zestig van de vorige eeuw. Met de invoering van het hepatitis B-vaccin in 2011 voor alle zuigelingen (voorheen was dat een beperktere doelgroep) hoopt het RVP nog meer hepatitis B te voorkomen. In 2012 deed zich in Nederland een kinkhoestepidemie voor, hoewel het vaccin in 2005 is verbeterd en een extra booster op 4-jarige leeftijd aan het vaccinatieschema is toegevoegd. De ziekte kwam het meest voor bij baby’s tussen 0 en 2 maanden oud, kinderen van 8 jaar en ouder, en volwassenen. De toename vanaf 8-jarige leeftijd is onder andere te verklaren doordat het vaccin vanaf die leeftijd minder effectief wordt. De bofuitbraak die begon in 2009 onder doorgaans gevaccineerde studenten, hield aan tot in 2012. Wel was het aantal meldingen lager dan in 2011 en 2010. In totaal zijn er 50 gevallen van mazelen gemeld in 2011. Het aantal niet- geïmporteerde gevallen (34 gevallen) was hoger dan de doelstelling die de WHO daarvoor heeft opgesteld (één per miljoen inwoners). In 2011 waren de inentingen tegen baarmoederhalskanker (HPV) voor de eerste groep 12-jarigen afgerond. Van hen had 56 procent zich volledig laten inenten (3 doses). Mogelijke toevoegingen aan RVP Van de ziekten die in de toekomst mogelijk onder het RVP gaan vallen, kwam meningokokken B in 2011 steeds minder vaak voor, maar meningokokken Y juist vaker. Maagdarminfecties veroorzaakt door het rotavirus namen niet verder toe. Het aantal hepatitis A-gevallen was in 2011 het laagst sinds de ziekte in 1999 meldingsplichtig is geworden. Voor waterpokken en gordelroos zijn geen grote veranderingen waargenomen. Trefwoorden: Rijksvaccinatieprogramma, rotavirus, varicella zoster, meningokokken B, hepatitis A Page 5 of 158 RIVM Report 201001002 Page 6 of 158 RIVM Report 201001002 Preface This report presents an overview of the developments in 2012 for the diseases included in the current National Immunisation Programme (NIP): diphtheria, pertussis, tetanus, poliomyelitis, Haemophilus influenzae serotype b (Hib) disease, mumps, measles, rubella, meningococcal serogroup C disease, hepatitis B, pneumococcal disease and human papillomavirus (HPV) infection. Furthermore, surveillance data with regard to potential new target diseases, for which a vaccine is available, are described: rotavirus infection, varicella zoster virus infection (VZV) and hepatitis A infection. Moreover, meningococcal serogroup B disease is included in this report, since a new vaccine has been developed and registration will be applied for in the near future. This report includes also other meningococcal serogroups (i.e. non-serogroup B and C types) to enable study of the trends in these serogroups. In addition, data on vaccines for infectious diseases tested in clinical trials which are relevant for the Netherlands, are included in this report. The report is structured as follows: Chapter 1 gives a short introduction, while in Chapter 2 surveillance methods used to monitor the NIP are described. Recent results on vaccination coverage of the NIP are discussed in Chapter 3. Chapter 4 focuses on current target diseases of the NIP. For each disease, key points mark the most prominent findings, followed by an update of information on epidemiology, pathogen and adverse events following immunisation (AEFI). If applicable, recent and planned changes in NIP are mentioned. Results of ongoing studies are described, together with the planning of future studies and international developments. Chapter 5 describes new target diseases which might need consideration for the future NIP. Finally, in Chapter 6 vaccines for infectious diseases, which are tested in clinical trials, are described. In Appendix 2 mortality and morbidity figures from 1997 onwards from various data sources per disease are published. Page 7 of 158 RIVM Report 201001002 Page 8 of 158 RIVM Report 201001002 Contents Summary—13 1 Introduction—17
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