Mazelen

NRC Handelsblad meldt vanavond op haar website een uitbraak van mazelen in Den Haag. Onder 32 kinderen van twee basisscholen en twee ouders heerst sinds 17 juni deze besmettelijke kinderziekte.

‘Op de scholen zitten veel kinderen uit de antroposofische gemeenschap. Het is, met 34 gevallen van mazelen tot nu toe, de grootste uitbraak van mazelen in Nederland sinds 2000. (...) Geen van de zieke kinderen was gevaccineerd tegen de ziekte. Alle kinderen krijgen inenting aangeboden via het rijksvaccinatieprogramma, maar veel ouders uit de antroposofische gemeenschap weigerden vaccinatie.’

‘De uitbraak van 1999-2000 was veel groter dan de huidige. Toen werden 3.292 mensen ziek, vooral kinderen, en overleden drie patiëntjes. Die uitbraak breidde zich uit in christelijke gemeenschappen uit de Biblebelt. (...) Over de vaccinatiegraad op de betrokken scholen in Den Haag is alleen bekend dat op een van die scholen slechts 65 procent van de negenjarigen de tweede prik kreeg.

In verschillende Europese landen is de mazelen het afgelopen jaar uitgebroken. Of de Haagse uitbraak daarmee verband houdt, is niet bekend.’

NRC Handelsblad baseert zich op een wetenschappelijk artikel, ‘Measles outbreak in an anthroposophic community in The Hague, The Netherlands, June-July 2008’, op 29 juli verschenen in het internettijdschrift Eurosurveillance online, waarin de GGD Den Haag en het RIVM verslag doen van de uitbraak. Hierin staan meer bijzonderheden:

‘On June 17, a general practitioner (GP) reported a suspected case of measles with strong clinical evidence in a previously unvaccinated eight-year-old boy. (...)

It is yet unknown where this case (the index case) acquired the infection from. There was no relevant travel history. The child attends a school of 210 pupils, of whom many come from the anthroposophic community in which parents opt not to vaccinate their children. From June 18 to July 3, nine further cases from the same school were reported. One was laboratory-confirmed and eight were epidemiologically linked.

On June 26, a seven-year-old child from another school (population: 450 pupils), also with many pupils from the anthroposophic community, was diagnosed with measles and confirmed by PCR. The child is a cousin of one of the cases from the first school. From July 3 to July 22, 15 other cases from the second school were reported. All were epidemiologically linked. (...)

Initially, the measles outbreak seemed confined to the two school clusters. Eight incidental cases outside the two schools were reported, but all were family members of the affected school children. Recently, however, two cases outside the school clusters have been reported in other cities (Leiderdorp and Utrecht). Both are epidemiologically linked to the outbreak in The Hague.’

Het artikel bericht ook over de maatregelen die zijn genomen:

‘The municipal health centre of The Hague (GGD) has implemented several outbreak control measures. Since the outbreak was initially limited to the specific anthroposophic population associated with the two schools, measures were aimed at this target group. All parents of children attending the two schools received an information letter. MMR vaccination was offered to all unvaccinated children and to the family members of cases.

However, the school authorities had rightfully predicted that very few would use this opportunity, as most parents in this community had deliberately chosen not to immunise their children. In total, only 10 vaccinations were administered (two to adults, eight to children).’

De autoriteiten tonen zich erg waakzaam, beducht ook voor de uitbraak van mazelen in andere landen. Omgekeerd is het ook niet duidelijk of de oorzaak van de uitbraak in Nederland in het buitenland is gelegen.

‘It is yet unclear where the virus involved in the current outbreak originated from. Although genotype D8 has been detected in Europe before, recent outbreaks of measles in several European countries have, to our knowledge, not been associated with genotype D8. (...) In the last few years the infectious potential of measles seems to be increasing, with outbreaks currently being reported in the United States and several European countries including Italy, Spain, Switzerland and the United Kingdom, some of which were also linked to antroposophical communities.’

De verwijzing naar een ander artikel van 14 april uit hetzelfde wetenschappelijke tijdschrift leert dat een dergelijke gedachte voor de hand ligt, na een flinke uitbraak in Oostenrijk:

‘From the second week of March 2008, public health authorities in the province of Salzburg observed an increased number of measles cases compared to previous years. Twenty cases of measles had been were notified Austria-wide in 2007, 24 in 2006, 10 in 2005, and 14 in 2004.

The current outbreak has affected, as of 14 April, 202 people in Austria, 53 in Germany, and four in Norway, bringing the total number of cases related to this outbreak to 259. The initial case series investigation revealed that the common link was attendance of an anthroposophic school and day care centre in Salzburg city. The majority of the pupils were not vaccinated against measles.’

Destijds in april was het daarom opportuun om het volgende op te merken:

‘In view of the current measles outbreak, Austrian and Swiss authorities advise measles vaccination before travelling to the EURO 2008 soccer games, starting on 7 June, 2008 in Austria and Switzerland.’

Het is vandaag precies drie maanden na het begin van dit weblog. En de allereerste bijdrage ging over... inenten. Het is alsof de duvel ermee speelt. Toen ging het over de bof. De dag erna, op 2 mei, kwamen we er al op terug. En vonden ook ergens in een hoekje op internet verscholen wat antroposofen denken van inenten en waarom men daar niet zo scheutig mee is. Maar na vandaag zal er toch meer dan dat alleen nodig zijn, vermoed ik.