Immunisation Policy in the Netherlands

Transcription

1 Immunisation Policy in the Netherlands DG Sanco Workshop Vaccination Strategy February 13-14, 2008 Marina Conyn-van Spaendonck Centre for Infectious Disease Control

2 Immunisation in the Netherlands National Immunisation Programme National Programme Influenza Prevention Vaccination programme for risk groups: hepatitis B: MSM, drug users BCG for immigrant children Immunisation of travellers

3 National Immunisation Programme since 1957 not mandatory, free of charge delivered to neonates and toddlers through healthy baby clinics; to 4-year and 9-year-olds through public health services, often in mass campaigns / immunisation days individual invitation and reminders if needed centrally registered centrally directed public programme Centre for Infectious Disease Control

4 Vaccination Coverage >95% pockets of low coverage in the so-called bible belt: orthodox reformed people refusing vaccination for religious reasons (in total ± 200,000) resistence from antroposophics, homeopathics and alternative medicine

5 National Immunisation Programme anno 2008 age 0 mnth (< 48 uur) 2 mnth 3 mnth 4 mnth 11 mnth 14 mnth 4 year 9 year general immunisations - DTP-IPV-Hib-1 + Pneu-1 DTP-IPV-Hib-2 + Pneu-2 DTP-IPV-Hib-3 + Pneu-3 DTP-IPV-Hib-4 + Pneu-4 MMR-1 + MenC DTP-IPV-5 DT-IPV-6 + MMR-2 target group hep B only hepb-0 DTP-IPV-Hib-hepB-1 + Pneu-1 DTP-IPV-Hib-hepB-2 + Pneu-2 DTP-IPV-Hib-hepB-3 + Pneu-3 DTP-IPV-Hib-hepB-4 + Pneu-4 MMR-1 + MenC DTP-IPV-5 DT-IPV-6 + MMR-2 Hib in 1993; Men C in 2002; hepatitis B: target group (children of HBsAg+ mothers, children of parents from high-endemic countries ±15%) in 2006; hep B 0 mnths for children of HBsAg+ mothers added in 2007, pneumococci in 2006,... HPV? varicella? influenza? Centre for Infectious Disease Control

6 Unrestricted possibilities for vaccination?

7 The future of the National Immunisation Programme Safe and effective Cost-effective balance meticulessness decisiveness

8 Expansion of the Immunisation Programme: what stakes? Health gains Interest of individual versus group / population Acceptation, vaccine coverage Fit into the programme: logistics Costs Credibility of authorities Pharmaceutical companies

9 Decision making process in the Netherlands RIVM informs Health Council and Ministry of Health on the possible impact of a vaccine through surveillance, modelling, scenario analysis, cost-effectiveness studies Health Council advises the Minister of Health based on the state of science MoH decides on introduction of a vaccine in the NIP Netherlands Vaccine Institute: vaccine production, tender / purchase of vaccine RIVM direction, implementation, evaluation of NIP

10 HPV in the Netherlands Programmatic screening cervixca. since 1976, coverage 75% HPV vaccination in the NIP? - focus on cervixcarcinoma Current planning: End of March: advice of the Health Council to MoH April: decision of Minister of Health In anticipation MoH, RIVM and NVI prepare for the possible inclusion of HPV-vaccination in the NIP. HPV in NIP for 12-year-old girls? Catch-up campaign for or year-old girls? Immunisation days

11 Measles age-specific seroprevalence 0-79 years (1995) % national sample orthodox reformed lvc non-orthodox reformed lvc

12 Measles outbreak in the bible belt : 3292 cases (0.21 per 1000 inhabitants), 519 with complications of which 3 deceased, 72 hospitalised Risk for not orthodox reformed neighbouring neonates not yet vaccinated; additional MMR immunisation at 9 months? Next outbreak anticipated Surveillance protocol: rash disease, non-invasive procedures (PCR urine, saliva, nasopharyngeal swab) or less invasive (capillary bleeding, serology) Plan for investigation: attack rates according to vaccination status, number of doses, time since vaccination; correlates of protection

13 Rubella notifications, the Netherlands, Aantal aangiften selective rubella vaccination 11 year-old girls universal rubella vaccination: boys and girls, 14 mnth, 9 yr Jaar

14 Surveillance: notifications of rubella 2004/2005 effective immunisation programme forms a threat to non-vaccinated groups due to shift in age distribution? 80 number of cases Netherlands week

15 Orthodox Reformed people, MMR vaccination coverage, rubella outbreak in 2004

16 Rubella outbreak in in the Netherlands Rubella infections 387 of which pregnant women 32 resulted in: Intra-uterine fetal death 2 congenitale rubella syndrome CRS 11 congenital rubella-infections CRI 3 Restricted to orthodox reformed groups objecting to vaccination

17 Rubella outbreak in Canada following outbreak in the Netherlands (notifications 2004/2005) number of cases Canada Netherlands week

18 Surveillance through molecular-biology of strains Fylogenetic analysis of Dutch / Canadian rubella outbreak 1F 1a 1g 1B 1C 1E 1D a RVi/Linging.CHN/00 RVi/Dangshan.CHN/00 RVi/Toyama.JPN/67 RVi/EinVered.ISR/92 Isolate INS (Germany 1995) RVi/Gouda.NET/15.05 RVi/Ontario.CAN/27.05 RVi/PAN/99 RVi/SLV/02 RVi/Los Angeles.USA/91 2c RVi/Moscow.RUS/67 RVi/Moscow.RUS/97 2B RVi/TelAviv.ISR/68 RVi/Anqing.CHN/00/2 RVi/Seattle.WA.USA/ A RVi/Beijing.CHN/79 RVi/Beijing.CHN/80 RVi/BEL/63 RVi/NJ.USA/61 RA 27/3 vaccine strain RVi/Tiberias.ISR/88 RVi/Jerusalem.ISR/75 RVi/Beneberak.ISR/79 1D RVi/Saitama.JPN/94 RVi/Dezhou.CHN/02 RVi/MYS/01 RVi/Tokyo.JPN/90 RVi/DalyCity.CA.USA/97 Geno group 1 (a,b,c,d,e,f,g) Geno group 2 (A,B,c) Tipples et al Van Binnendijk et al. 2005

19 Concluding remarks on the NIP in the Netherlands Public programme central direction, individual invitation (based on pop. registry), reminders and registration support with extensive communications: protocols, leaflets, newletters etc. continuous surveillance of and reporting on target diseases, adverse events, population's immunity effective approach high vaccination coverage Opponents: orthodox reformed people - known, stable, nearly impossible to influence; antroposofics, homeopathics etc impact less known, more diffuse herd immunity; growing group? What are the consequences of expanding the NIP with HPV, hepatitis B, influenza, varicella,...

20 National Programme Influenza Prevention target group: chronic conditions of heart, lung or kidney, immunocompromised patients and patients with diabetes, or age > 65 year (next season > 60 year) not mandatory, free of charge delivered in primary care through general practitioners and in nursing homes vaccine made available by Netherlands Vaccine Institute programme co-ordination by RIVM coverage 76% in primary care, 90% in nursing homes