Large differences in MMR and DTaP-IPV vaccination coverage among primary schools by denomination, the Netherlands, 2024.

BACKGROUND

Recently, the number of measles and pertussis cases increased worldwide, including in the Netherlands. As schools are important in transmission of several vaccine-preventable diseases, we systematically assessed childhood vaccination coverage in the Netherlands among primary school children by birth cohort for all school denominations.

METHODS

We linked nationwide vaccination data with sociodemographic registries for children born 2013-2020 attending primary school on 01-10-2024. Vaccination status for MMR (at 14 months), DTaP-IPV (at (2)3-5-11 months), and DTaP-booster (at 4 years) was retrieved from the immunisation register. Vaccination coverage was stratified by school denomination, birth year and sociodemographic characteristics. Poisson regression assessed independent associations between denomination and vaccination uptake.

RESULTS

MMR and DTaP-IPV coverage was high (>94 %) in general, Catholic, Protestant, collaborative, and other schools, but lower in Anthroposophical (78 % MMR, 77 % DTaP-IPV), Islamic (74 % MMR, 75 % DTaP-IPV), and Orthodox Protestant schools (57 % MMR, 58 % DTaP-IPV). DTaP-IPV booster coverage was lower than the primary series, ranging from 50 % (Orthodox Protestant) to 88 % (Catholic/Protestant). Primary coverage remained stable for most denominations (overall 95 %) but declined at Islamic schools (MMR: 87 % to 59 %, DTaP-IPV: 88 % to 60 %) and moderately at Orthodox Protestant schools (MMR: 60 % to 54 %, DTaP-IPV: 60 % to 55 %), while coverage at Anthroposophical schools fluctuated (MMR: range 76-81 %, DTaP-IPV: range 74-79 %). Adjusting for sociodemographic variables had little impact.

CONCLUSIONS

Although most unvaccinated children attend schools with high coverage, clustering at Orthodox Protestant, Anthroposophical, and increasingly Islamic schools poses ongoing outbreak risks. Further research on vaccination barriers, drivers, and the role of social networks is needed to better understand vaccination decisions.