An innovative multistep outbreak response strategy during a 2025 measles outbreak in the Netherlands

Issue

Outbreaks of highly contagious diseases pose public health challenges, including high diagnostic demand, strain on healthcare services, intensive contact tracing, and transmission risks in clinical settings. In 2025 a measles outbreak occurred in Rotterdam-Rijnmond (the Netherlands). We piloted an innovative multistep outbreak response strategy.

Description of the problem

To reduce regional healthcare burden and improve operational efficiency, three approaches were implemented during the outbreak. First, a team of trained medical students conducted home-based sampling of suspected cases. Second, in addition to PCR, measles antibody testing was performed on minimally invasive saliva samples from home-sampled individuals. Third, one-way bulk SMS-alerts were used to inform contacts exposed in healthcare settings.

Results

These approaches were integrated into existing workflows. Among 124 individuals with laboratory test results, 19 were home-sampled by the student team. Median time from exanthem onset to result was 3 days (IQR: 2-3.5) for home-based sampling (n = 19), compared to 5 days (IQR: 2-7) for standard testing routes (n = 105). Saliva sampling was perceived as convenient, especially for children, and logistically feasible. Bulk SMS-alerts enabled rapid outreach to large groups and reduced workload compared to phone call-based tracing.

Lessons

This multistep strategy offered practical tools to strengthen outbreak response and reduce workload, particularly in high-demand settings. Professional home-based sampling, including salivary antibody testing, enabled rapid and minimally invasive testing, especially relevant in outbreaks involving children. It may provide quicker disease verification and additional opportunities for timely post-exposure prophylaxis. Bulk SMS-alerts facilitated rapid outreach to exposed contacts. The strategy was implemented through close collaboration between public health and clinical partners, contributing to regional preparedness.

Key messages

• Professional home-based sampling by trained medical students can allow for quick disease verification and additional opportunities for timely post-exposure prophylaxis.

• Bulk SMS-alerts enable rapid and timely outreach to large groups of exposed contacts, while reducing strain on the public health workforce.