Containment - lecture 10 - National immunisation program

history NIP

• 1957 first vaccinations implemented → polio, tetanus, diptheria, pertussis

• 1974 rubella

• 1976 measles

• 1987 mumps

• 1993 heamophilus influenzae 

• 2002 meningococcal disease 

• 2006 pneumococcal disease

• 2009 HPV (13 year old girls)

• 2011 hepB

• 2018 MenACWY 

• 2019 maternal pertussis 

• 2022 HPV age 10 boys and girls 

• 2023 maternal flu 

• 2024 rotavirus 

• 2025 rsv 

all the vaccinations in the netherlands 

• 1957 - diptheria, pertussis, tetanus, polio 

• 1974 - rubella 

• 1976 - measles 

• 1987 - mump 

• 1998 - h3qmophilus influenza type B 

• 2002 - meningococcal C 

• 2006 - pneumococcal disease 

• 2009 HPV (13 year old girls) 

• 2011 hebB 

• 2017 - menACWY 

• 2019 - maternal pertussis

• 2022 - HPV at 10 year boys and girls 

• 2023 - maternal flu 

• 2024 - rotavirus 

• 2025 - RSV 

facts about NIP in the Netherlands

• children 0-18 years 

• pregnant women 

• 14 infectious diseases 

• 15 vaccinations and 2 oral doses 

• over 2 million vaccination per year

• costs 90million / year 

NIP principles

• equal access 

• central organization (so you know when something goes wrong, which batch) 

• central registrations

• individual invitationsd 

• reminder

• public information, education, campaigns 

• expertise of professionals 

• monitoring of safety and effectiveness

• assurance of quality and continuity

• cose effective, advantages of scale

3 head principles

• qualitatively strong programme

• based on voluntary participation

• aiming at high coverage of the target group

ingredients vaccine

• active substances → parts of the virus or bacteria against which immunity is built up. (Antibodies in case of immunization)

after production, these residues are removed from the vaccine as much as possible but very small quantities could still be present. 

• excipients → substances added to the vaccine to improve effectiveness/ immune response, extend shelf life and make it easier to administer the vaccine.

• residues → trace amounts of substances used in the production of the vaccine.

3 different vaccines

1. inactivated vaccines fragments of pathogens toxin (difteria/tetanus) recombinant RNA methode (HPV)

2. live attenuated vaccines a weakened virus (measles rotavirus)

3. immunisation antibodies (RSV)

NIP in other countries

• all different in different countries (different rules and regulations) 

vaccine logistics

• distribute vaccines to 250 locations each week

• delivered in cold chain fridge and monitor stock

• the vaccines are distributed to group vaccination sessions

all very specific and registered!! → batch number connected to the child. 

different stakeholders

• vaccine manufacturers → develop, make and sell vaccine

• (local) medicine agency → give registration/permission for the vaccine to be sold

• health council → advice on making the vaccine part of NIP 

• minister/state secretary of health → final decision on the content of the NIP (decide in 3 months) 

youth health care facilities

• big stakeholder in vaccines in the netherlands 

• consultatiebureau → unique in the netherlands that they combine the consultatie with also vaccine advice / administration. 

• they do individual consultation

• vaccination

• registration 

• sometimes there are also mass group vaccination days 

other important stakeholders

• IGJ (inspection) → quality of health care, first done by RIVM but better to have objective party

• Lareb → monitoring side effects 

• midwifes → refer pregnant women to the youth health care centre for maternal vaccination 

• pediatricians → medical risk groups, children hospitalized. 

cooperation of ministery, NHI, and medical professionals

RIVM structures the implementation

• takes 6 months 

• risks of lawsuits so needs to be done well 

vaccinatiegraad

• above 90% is considered ideal for herd immunity (for some even >95% 

• right now nothing is over 90% in the netherlands

measles outbreak

• very problematic

• high R number

• has went down through the years

• important to know where the people are that are not vaccinated (cities, bible belt etc.) → clustering, serotypes and genotypes of the measles are different between these clusters. 

• health inequity → in certain areas less vaccine uptake, might be due to the people there not having there questions answered. They might not have all the information needed. 

vol vertrouwen in vaccinaties

• politiek innitiatief om vaccinatiegraad omhoog te krijgen in Nl. 

• every year (jan, juni) there is a kamer brief where all information about vaccination is send

• WHO has a tool → Tailooring Immunization Programmes. 

TIP

1. define underserved groups and communities → detervax

2. what are barriers and drivers → sociovax 

3. design intervention → done together with people in the neighbourhood and people working there. e.g. midwives betrekken bij vaccineren. 

4. evaluate and implement 

detervax

• epdiemiological study 

• determines coverage national and regional

• stap 1 in TIP; what and where coverage is low. 

• connects to CBS data and RIVM data

• look at trends over time. 

• coverage by sociodemographic denomination. 

sociovas, social scientific research

• how do people think about the NIP 

• investigate changes in attitudes in time

• how to inform people 

• design interventions and pilot them 

RSV

• newest vaccination (immunizatin)

• needs to be given immediately after birth (mostly done in hospital, but not in Nl). 

• oktober to march children are infected. 

• global burden very high → in low and middle income countries children often die. 

• nirsevimab → langwerkend antistof tegen RS. → binds to F protein so the virus can not bind. this antibody works for 6months do protects for the whole season. (only need to give once). 

data RSV vaccination spain

• effectiviteit 82%

• but uptake is super high here (above 90%) this adds to this high effectiviteit.