A literature review and evidence-based evaluation of the Dutch national immunisation schedule yield possibilities for improvements

A J M Pluijmaekers; A Steens; H Houweling; N Y Rots; K S M Benschop; R S van Binnendijk; R Bodewes; J G M Brouwer; A Buisman; E Duizer; C A C M van Els; J M Hament; G den Hartog; P Kaaijk; K Kerkhof; A J King; F R M van der Klis; H Korthals Altes; N A T van der Maas; D L van Meijeren; M Middeldorp; S D Rijnbende-Geraerts; E A M Sanders; I K Veldhuijzen; E Vlaanderen; A C G Voordouw; E R A Vos; J de Wit; T Woudenberg; J A van Vliet; H E de Melker

doi:10.1016/j.jvacx.2024.100556

A literature review and evidence-based evaluation of the Dutch national immunisation schedule yield possibilities for improvements

Vaccine X. 2024 Sep 26:20:100556. doi: 10.1016/j.jvacx.2024.100556. eCollection 2024 Oct.

Authors

A J M Pluijmaekers¹, A Steens¹, H Houweling¹, N Y Rots¹, K S M Benschop¹, R S van Binnendijk¹, R Bodewes¹, J G M Brouwer¹, A Buisman¹, E Duizer¹, C A C M van Els^{1

2}, J M Hament¹, G den Hartog^{1

3}, P Kaaijk¹, K Kerkhof¹, A J King¹, F R M van der Klis¹, H Korthals Altes¹, N A T van der Maas¹, D L van Meijeren¹, M Middeldorp¹, S D Rijnbende-Geraerts⁴, E A M Sanders^{1

5}, I K Veldhuijzen¹, E Vlaanderen⁶, A C G Voordouw¹, E R A Vos¹, J de Wit¹, T Woudenberg¹, J A van Vliet¹, H E de Melker¹

Affiliations

¹ Center for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM), The Netherlands.
² Faculty of Infectious Diseases and Immunology, Department of Biomolecular Health Sciences, Faculty of Veterinary Medicine, Utrecht University, The Netherlands.
³ Laboratory of Medical Immunology, Radboud UMC, Nijmegen, The Netherlands.
⁴ Public Health, Municipality of Utrecht, The Netherlands.
⁵ Department of Paediatric Immunology and Infectious Diseases, Wilhelmina Children's Hospital and University Medical Centre Utrecht, The Netherlands.
⁶ Municipal Health Service of Hollands Noorden, The Netherlands.

Abstract

National Immunisation Programmes (NIPs) develop historically. Its performance (disease incidences, vaccination coverage) is monitored. Reviewing the schedule as a whole could inform on further optimisation of the programme, i.e., providing maximal protection with the lowest number of doses. We systematically evaluated the performance and strategies of the Dutch pathogen-specific NIP schedules through literature review, assessment of surveillance data and expert opinions. Pathogen-specific vaccinations were categorised according to their strategy of protection: I) elimination or eradication, II) herd immunity or III) 'only' individual protection. The schedule of each vaccine-component was evaluated based on fixed criteria: 1. Is the achieved protection adequate? 2. Is the intended protection achieved? 3. Does the programme include too many or too few doses? 4. Is the timing optimal or acceptable? and 5. Are there drawbacks of the NIP for (part of) the population? Identified issues were explored using surveillance data and literature. Using fixed criteria facilitated comparison between pathogens and revealed opportunities to optimise the Dutch NIP by: i. Reducing the number of polio and tetanus vaccinations; ii. prolonging the interval between diphtheria, pertussis, tetanus, polio, hepatitis B, and Hib vaccine doses for improved effectiveness; iii. Expedite the second measles vaccination from 9 to 2-4 years of age to offer unvaccinated children and primary vaccine failures an earlier chance to be protected; and iv. Delaying the second mumps vaccination to enhance protection in adolescents/young adults. No schedule adaptations were deemed necessary for the vaccines against HPV, rubella, pneumococcal disease, and meningococcal disease. Based on this evaluation the NITAG advised to move the DTaP-IPV-HBV-Hib-booster from age 11 to 12 months, the second MMR-dose from 9 to 2-4 years, replace the Tdap-IPV at 4 years with a Tdap at 5-6 years and move the dt-IPV from 9 to 14 years. Implementation of these changes is planned for 2025.

Publication types

Review