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American Journal of Epidemiology Vol. 143, No. 9: 929-935
Copyright © 1996 by The Johns Hopkins University School of Hygiene and Public Health

research-article

Circulation of Poliovirus during the Poliomyelitis Outbreak in the Netherlands in 1992–1993

M. A. E. Conyn van Spaendonck1,, P. M. Oostvogel2, A. M. van Loon2, J. K. van Wijngaarden3 and D. Kromhout4

1National Institute of Public Health and the Environment (RIVM), Department of Infectious Diseases Epidemiology Bilthoven, Netherlands
2National Institute of Public Health and the Environment (RIVM), Laboratory of Virology, and the World Health Organization Collaborating Center for Reference and Research on Poliomyelitis Bilthoven, Netherlands
3National Institute of Public Health and the Environment (RIVM), Division of Public Health Research Bilthoven, Netherlands
4Medical Inspectorate of Health Bilthoven, Netherlands

Reprint requests to Dr. M. A. E. Conyn-van Spaendonck, National Institute of Public Health and Environmental Protection (RIVM), P.O. Box 1, 3720 BA Bilthoven, Netherlands

A population-based study on the circulation of epidemic poliovirus during the 1992–1993 outbreak in the Netherlands was carried out in order to assess whether the virus circulated outside the group of people who reject vaccination on religious grounds and outside the area where these groups form a sociodemographically closely knit network. The prevalence of poliovirus excretion was estimated in a cross-sectional study with a random sample of 2,400 children aged 5–14 years and 3,000 adults aged 40–64 years; the sample was drawn from the municipal population registers in four regions (three inside and one outside the risk area). Fecal samples for virus isolation and characterization were submitted by mail, and a questionnaire was completed with age, sex, type and level of education, vaccination history, and religious denomination. Both a completed questionnaire and a fecal sample were received from 3,182 persons (response, 58.9%). Wild pollovirus was isolated only from children within the risk group and in the area at risk. The crude excretion rate of the epidemic poliovirus type 3 per 1,000 persons was 2.5, but it amounted to 70.7 for those belonging to Orthodox Reformed churches. The prevalence of vaccine virus excretion per 1,000 persons was 10.2 for children and 5.2 for adults. It was concluded that, during the 1992–1993 outbreak, the risk of poliomyelitis was restricted to religious subpopulations rejecting vaccination. The lack of evidence of poliovirus circulation outside these groups at risk supports the hypothesis that herd immunity is sufficiently maintained in a population vaccinated with inactivated polio vaccine. Am J Epidemiol 1996;143:929–35.

disease outbreaks; immunity; poliomyelitis; polioviruses; poliovirus vaccine


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