3 May 2011

Research shows most patients in Dutch epidemics belong to Protestant fundamentalist groups who refuse to vaccinate children

Epiphenom   -   April 29, 2011

Religious groups reduce vaccination rates

By Tom Rees

The Netherlands has a healthcare problem. Despite a high overall vaccination coverage, in the last two decades there have been epidemics of poliomyelitis (1992-1993), measles (1999-2000), rubella (2004-2005) and mumps (2007-2008).

These epidemics were all largely confined to an area stretching from the south-west to the north-east of the country. This is the Dutch Bible belt - shown in the graphic - where there are a relatively high number of orthodox (aka fundamentalist) Protestants. Almost all patients in these epidemics belonged to the orthodox protestant minority and were unvaccinated because of religious objections.

But what's not clear is whether Protestant minorities have a low vaccination rate, and whether that is really linked to their religion. After all, they are also more likely to be rural, and low-income.

So Wilhelmina Ruijs (Radboud University Nijmegen Medical Centre) and colleagues looked to see whether regions of the Netherlands with more Orthodox Protestants have lower vaccination rates, after controlling for urbanization, poverty, and immigration.

It turns out that they do. Vaccination was a little lower in areas with a lot of Orthodox Protestants - 93.6%, compared with 96.9% elsewhere. That's a small difference, but it only takes a small drop in vaccination rates to decrease 'herd' immunity to the point where an epidemic can break out.

More interestingly, 84% of the variation in vaccine coverage from one area to the next was down to the presence of these churches. The other factors had relatively little influence.

Ruijs, W., Hautvast, J., van der Velden, K., de Vos, S., Knippenberg, H., & Hulscher, M. (2011). "Religious subgroups influencing vaccination coverage in the Dutch Bible belt: an ecological study" BMC Public Health, 11 (1) DOI: 10.1186/1471-2458-11-102

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1 comment:

  1. Teenage girl dies after contracting measles in Dutch Bible Belt outbreak

    Amsterdam Herald, October 28, 2013

    A 17-year-old girl has died from complications related to measles during an outbreak of the disease in the Dutch Bible Belt.

    The public health institute RIVM said the girl, from the Zeeland town of Tholen had not been immunised against the disease.

    It is the first death linked to measles since an outbreak began in May in communities in southern and central regions of the Netherlands, where many families refuse to take part in vaccination programmes out of religious conviction.

    The girl in Zeeland, whose death was announced at the weekend, had health complications including a growth in her back that restricted her breathing and meant she had used an electric wheelchair for most of her life.

    She was a pupil at the reformed Calvijn College in Goes, which also lost a 17-year-old pupil during the last major outbreak of measles in 2000.

    Govert Kamerik, a director of the college, told De Volkskrant she had made a "conscious" decision not to receive the vaccination.

    He said: "It is precisely because of her illness that she looked at her faith in a serious and grown-up way. She made a conscious choice in spite of her weak health not to be immunised."

    Just over 2,000 people have been diagnosed with measles since May, of whom 121 have needed hospital treatment. Half of the most serious patients suffered inflammation of the lung.

    Health officials say the true number of infections this time is almost certainly higher than 2,000 because many mild cases will not have been reported to family doctors.

    The outbreak has been concentrated in places where the take-up rate for measles immunisation is below 90 per cent. Unvaccinated children aged between four and 12 have been the most likely group to contract the disease.

    Around 250,000 people in the Netherlands opt out of the national vaccination programme on grounds of conscience.

    Community leaders in the affected area have reacted with fury to suggestions from leading politicians, including Prime Minister Mark Rutte, that they should drop their objection to vaccination. Some members of Rutte’s Liberal (VVD) party went as far as calling for the MMR (measles, mumps and rubella) to be made compulsory.

    Religious leaders said it was not for politicians to determine “the will of God” and rebuked them for not concentrating on other threats to public health such as smoking and drinking.

    Roel Coutinho, director of the RIVM’s Centre for Infectious Disease Control, has also said that making vaccination compulsory carried the risk of strengthening parents’ objections because they might feel the state was forcing them to betray their consciences.