Measles outbreak in a community with very low vaccine coverage, the Netherlands

A 1999-2000 measles epidemic in the Netherlands started with an outbreak in an orthodox reformed elementary school with 7% vaccine coverage. The overa ll attack rate was 37%: 213 clinical cases among the 255 participating pupi ls (response 62%) and 327 household members. The attack rate ranged from 0% for the oldest groups of pupils to 88% for the youngest, who had not been exposed in previous measles epidemics. None of 25 vaccinated pupils had cli nical symptoms. Among pupils with clinical symptoms, the self-reported comp lication rate was 25%. These data confirm that measles infection causes sev ere disease and that vaccination is the most effective means of preventing the disease and its complications. The data also show that clusters of pars ons refraining from vaccination interfere with measles elimination even in populations with very high overall vaccine coverage (96%).