Lecture 3: Dutch immunization programme/Rijksvaccinatieprogramma Flashcards
Are all the diseases that are vaccinated against in the Dutch immunization programme visible in the Netherlands?
Many diseases in the Dutch immunization programme are not that visible in the Netherlands. We still vaccinate against them to prevent suffering (whooping cough).
Does only allowing vaccinated children at daycare centres have an effect from an infectious disease standpoint?
No, these children are 0-2 years/2-4 years. 0-2 years are largely not vaccinated, because it is not on the vaccination schedule for them yet. The measles vaccine is given at 14 months old. So, even with mandatory vaccination, there will be a susceptible pool of children. In addition, mandatory vaccination would lead to exclusion of certain children.
Where did the first techniques for vaccination start?
The first ideas that came close to vaccination started in the Arabic world. Even before the year 0, people gave very diluted scorpion venom to their babies to protect them against the venom from scorpion bites. Even if this is not an infectious disease, the idea of giving a very diluted amount of a substance that makes you ill to protect you from the higher dose of the substance is already the idea of vaccination.
When did the first vaccinations start?
In the 14th century China, Turkey, India and Persia were already variolating children and adults against the human pox. At that time, the pox was killing 20% of people in cities and 40% of the children. The would dry pox crusts, crush them and let the to be variolated person inhale them through a straw into their nose. They found that this protected against smallpox. However, the disadvantages were that you were ingesting live virus from the human pox. This meant 3% of variolated people would die. Later, they started administrating the crusts by putting them in a wound in the skin, thus getting even closer to the concept of vaccination we know today.
How did the practice of vaccination spread to the Western world?
The Western world was informed of variolation through the wife of one of the rich consulates in Turkey that let her children get variolated there. She told the authorities in London about this, but they were very reluctant.
A while later, a big smallpox epidemic broke out in England and her advice was considered. They took seven prisoners and variolated them. They exposed these prisoners to the smallpox and they survived.
In 1720 this technique spread from England to the USA, where they then started using it, especially in armies. If you give the human smallpox, there was still a fatality risk of 3%, in addition to preparation to the variolation like a week of not eating and bloodletting.
Jenner found in 1800 that you could make an extraction from cowpox to variolate against human smallpox. This is where the word for vaccination comes from (vacca = cow, vaccina=cowpox substance). Soon after Pasteur (rabies) and Koch (cholera, diphtheria) developed their vaccines and vaccination programmes were starting. England made smallpox vaccinations mandatory as of 1850, but the cowpox was eradicated in 1980
Which diseases are vaccinated against in the Dutch immunization programme?
Twelve different infectious diseases are vaccinated against in the Netherlands: polio (1957-present), diphtheria, pertussis (second vaccination in pregnancy) and tetanus (combination vaccine), hepatitis B and haemophilus influenza B (HIB), pneumococcal disease, meningococcal disease A C W Y, HPV, measles and rubella (combination), mumps.
When and how did the Dutch vaccination programme start and was it successful?
The Dutch vaccination programme started in 1957 with polio and DKT and prevented 9000 deaths in children since. 2,9 million vaccines are given yearly to children. The amount of vaccinated children and pregnant woman/y is 1,5 million
How much does the Dutch immunization programme cost?
The Dutch immunization programme costs around 90 million euro per year.
How high is the vaccination coverage in the Netherlands?
While the vaccination coverage is not as high as we would like (lower than 95%), it is still quite high (93-94%). The vaccination coverage declined a bit since 2012, but it increased again this year, in spite of the covid pandemic. Especially the HPV vaccination coverage increased with 10,1% (53% to 63,2%).
In the Bible Belt, the vaccination coverage is lower. This group of 3-4% of the population is very stable over the years. When there is a measles outbreak, the religious people in the Bible Belt are affected most, but do take action when the child is sick. Some of them will vaccinate their child in the case of a measles outbreak. The nurses know these people very well and are able to give the vaccination at home, without the neighbours seeing it.
In the biggest cities in the Netherlands the vaccination coverage is less. This is especially the vaccinations in adolescents (HPV, meningococcal A C W Y). These differences are even visible between different neighbourhoods within a city. HPV is even more worrisome. The vaccination coverage increased in general, but is very low in minority groups (e.g. 15% of Moroccan and Turkish girls). Another new development is highly educated people not vaccinating their children, but fortunately this is decreasing again. Another connection is government trust. People with a lower social-economic status are more critical of vaccines and feel less appreciated by the government.
What are the different groups involved in implementing new vaccines in the Netherlands?
There are different groups involved with implementing new vaccines in the Netherlands:
- Gezondheidsraad: experts on the topic (e.g. rotavirus) debate on the necessity and practicality of implementing a vaccine for a specific infectious disease. They advise the Ministerie van Volksgezondheid, Welzijn en Sport.
- Ministerie van Volksgezondheid, Welzijn en Sport: Accept (or not) the advice from the Gezondheidsraad. They think of things to ask about the implementation to the RIVM.
- RIVM: Answer questions from Ministerie van Volksgezondheid, Welzijn en Sport. They make the implementation plan. These plans are shared with the Ministerie van Volksgezondheid, Welzijn en Sport and the people who will give the vaccinations (mostly GGD).
- GGD: Give vaccinations.
What are the recent and new plans for new vaccinations?
The most recent new implementations are the maternal pertussis vaccination, meningococcal vaccine. New plans are: HPV vaccine for boys and lowering the age for the HPV vaccine to 10 years, rotavirus vaccination. Lowering the age for the HPV vaccine and vaccinating boys will hopefully decrease the stigma around this vaccination that it is about sexual behaviour and give the children the chance to get the vaccine later, but still before their first sexual experience.
Are vaccination programmes the same around Europe?
Vaccination strategies vary widely across Europe in time of vaccination and diseases included. This due to the differences in organisation and endemic infectious diseases.
What was the effect of the COVID-19 crisis on immunization programmes?
Vaccination coverage only dropped 1 or 2 % in the Netherlands. This is a big contrast to other countries, as there has been an alarm sounded for this by the WHO and UNICEF as they found that immunization programmes often completely stopped. The WHO has asked health organisations from European countries like the RIVM for advice on type of help and priorities needed to restart these programmes
What are the international goals set by the WHO on the subject of infectious diseases?
Before COVID the international goals set by the WHO were eradication of polio and elimination of measles, rubella and hepatitis B. A barrier for eliminating polio are the vaccine-derived polio cases caused by the live-virus vaccine.
What is the most difficult challenge for vaccination in the Netherlands?
The most difficult challenge for vaccination in the Netherlands is the anti-vax sentiment. It has existed for as long as vaccination (e.g. posters of people getting cow horns because they were variolated with cowpox). It usually becomes less active during epidemics, but this might not be the case for the COVID pandemic. They vary in type: religious, spiritual/anthroposophical. Recently, a new group of critical people emerged: people influenced by social media and conspiracy theories.
