Shingrix replaced Zostavax on the Australian National Immunisation Program (NIP) for shingles vaccination in 2023. Using Australian Immunisation Register data, we analysed Shingrix uptake over the first year after NIP inclusion: nearly one-third of eligible adults aged ≥65 years received ≥1 dose, substantially increasing shingles vaccination coverage. However, protection among older adults remains suboptimal, with equity gaps. Shingrix’s high effectiveness, safety for immunocompromised people and broader eligibility provide an opportunity to better protect high-risk groups.

Introduction:We analysed Australian Immunisation Register (AIR) data for children, adolescents and adults as at 2 February 2025, concentrating primarily on National Immunisation Program (NIP)-funded vaccines. Our focus was on the calendar year 2024 and trends from previous years. This report provides comprehensive analyses and interpretation of vaccination coverage data to inform immunisation policy and programs in Australia. Along with the results outlined below, the report also includes a range of other data for vaccines given across the lifespan, including data on timeliness and vaccination provider settings. Population overall: Children:Fully vaccinated coverage decreased between 2023 and 2024 at all three standard age milestones: 12 months (from 92.8% to 91.6%); 24 months (from 90.8% to 89.4%); and 60 months (from 93.3% to 92.7%). This follows the 1.2-2.0 percentage point decrease in vaccination coverage uptake at these three milestones between the 2020 and 2023 reports. A combination of acceptance and access factors have contributed to this ongoing decline. Population overall: Adolescents:Coverage of a dose of HPV vaccine by the fifteenth birthday decreased in 2024 to 81.1% in girls and 77.9% boys; these values were 3.1 and 3.9 percentage points lower, respectively, than in 2023 and 5.5 and 7.0 percentage points lower than in 2020. In girls and boys turning 15 years of age in 2024, respectively 83.4% and 80.9% had received an adolescent dose of diphtheria-tetanus-pertussis vaccine by 31 December 2024. Overall, 68.5% of girls and 64.4% of boys turning 16 years of age in 2024 had received an adolescent dose of meningococcal ACWY vaccine by 31 December 2024. Population overall: Adults:Zoster vaccination coverage (one dose of Zostavax or two doses of Shingrix given at least 4 weeks apart) was 45.9% for adults aged ≥ 65 years in 2024. Coverage of an adult dose of 13vPCV was 38.6% for adults turning 71 years of age in 2024, which was 1.0 percentage point higher than in 2023; and 41.5% for adults aged ≥ 70 years, which was 6.9 percentage points higher than in 2023. Influenza vaccination coverage decreased in 2024 across all adult age groups. Aboriginal and Torres Strait Islander peoples: Children:Fully vaccinated coverage for Aboriginal and Torres Strait Islander children decreased between 2023 and 2024 at all three age milestones: 12 months (from 89.7% to 89.2%), 24 months (from 87.8% to 86.7%) and 60 months (from 95.0% to 94.4%), following a 2.0-3.4 percentage point decrease between the 2020 and 2023 reports. However, coverage of meningococcal B vaccine, which was introduced onto the NIP for all Aboriginal and Torres Strait Islander children in July 2020, was higher in 2024 than 2023: namely, 83.0% versus 81.0% for the first dose; 80.9% versus 80.0% for the second dose; and 75.0% versus 71.7% for the third dose. Aboriginal and Torres Strait Islander peoples: Adolescents:Coverage of a dose of HPV vaccine by the fifteenth birthday decreased in 2024 in Aboriginal and Torres Strait Islander adolescents to 76.7% for girls and 69.2% for boys; these values were 4.2 and 5.8 percentage points lower, respectively, than in 2023 and 11.1 and 13.8 percentage points lower than in 2020. In Aboriginal and Torres Strait Islander girls and boys turning 15 years of age in 2024, respectively 79.3% and 73.0% had received an adolescent dose of diphtheria-tetanus-pertussis vaccine by 31 December 2024. Coverage of an adolescent dose of meningococcal ACWY vaccine received by 31 December 2024 in Aboriginal and Torres Strait Islander adolescents turning 16 years of age in 2024 was 52.7% for girls and 47.1% for boys. Aboriginal and Torres Strait Islander peoples: Adults:Zoster vaccination coverage (one dose of Zostavax or two doses of Shingrix given at least 4 weeks apart) was 42.2% for Aboriginal and Torres Strait Islander adults aged ≥ 65 years in 2024. Coverage of an adult dose of 13vPCV was 48.7% for Aboriginal and Torres Strait Islander adults turning 71 years of age in 2024, which was 5.7 percentage points higher than in 2023, and 47.8% for those aged ≥ 70 years, which was 8.1 percentage points higher than in 2023. However, it was only 23.2% for those aged 50-69 years. Influenza vaccination coverage decreased in 2024 across all Aboriginal and Torres Strait Islander adult age groups. Conclusion:There have been concerning and persistent downward trends in childhood and adolescent vaccination coverage in Australia since 2020, with further declines in 2024. The picture for adult coverage is more mixed, but consistently suboptimal across all vaccines. National surveys of parents of young children and adults have identified a range of access and acceptance barriers that may be contributing to observed declines in coverage. More research is needed to delineate contributory factors, particularly among adolescents and Aboriginal and Torres Strait Islander peoples. This can then be used to inform evidence-based and culturally appropriate strategies to increase vaccine uptake and coverage equity. The National Immunisation Strategy for Australia 2025-2030 provides a comprehensive framework to guide such measures and improve coverage - and hence the protection provided by vaccine programs - against disease.

Despite high childhood coverage and booster doses of pertussis vaccination across the life course, pertussis (whooping cough) outbreaks continue to occur, including in Australia and New Zealand. In January 2026, the European Medicines Agency (EMA) granted marketing authorisation to a new pertussis-only booster vaccine (VacPertagenTM): the first time in two decades that a new acellular pertussis vaccine has been approved in the European Union. Anticipating future licensure of the vaccine in Australia and New Zealand, an expert panel was convened to discuss the clinical and programmatic advantages that this new vaccine may offer in the context of current pertussis epidemiology and vaccination strategies inSuch advantages may also be applicable to other high-income countries experiencing ongoing pertussis outbreaks.

BACKGROUND:In Australia, human papillomavirus (HPV) vaccination is routinely offered at age 12-13 years through school-based programs managed by eight states and territories. Coverage has declined since the onset of the COVID-19 pandemic, with widening equity gaps. In February 2023, Australia moved from a two-dose to a single-dose HPV course. While the move was expected to increase coverage, single-dose coverage declined in the school cohort offered vaccination in 2023. We aimed to document the experience of implementing single-dose HPV vaccination and understand the current challenges in school-based immunisation programs. METHODS:In September 2024, we interviewed 11 state and territory senior immunisation staff online about their experiences implementing single-dose HPV vaccination and about current challenges in their programs. We identified categories and themes using thematic analysis. RESULTS:Factors that facilitated the shift to a single dose included clear and consistent communication once the change was announced, acceptance of the change by parents and providers and the increased flexibility in timing for school visits that a single-dose course provides. The main challenge related to the short timeline and a delayed ability to communicate the upcoming change due to government confidentiality requirements. This resulted in frustration, a need to retrospectively adapt consent forms and vaccine oversupply. Current challenges in the school-based immunisation programs include declining school attendance, staffing, competing priorities in schools, evolving consent processes in the digital era and increasing challenges in engaging parents and students in immunisation. CONCLUSIONS:While implementing the change was straightforward, the shift to a single-dose occurred in a setting of increasing challenges to routinely providing immunisation in schools. Simplifying the HPV vaccination schedule may have inadvertently reduced in-school opportunities for vaccination by only requiring one annual visit. School-based vaccination programs should consider additional strategies to support catch-up vaccination and publicise options for vaccination outside of the school program.

Background:Australia implemented publicly-funded mpox vaccination in August 2022, targeting at-risk groups including gay, bisexual and other men who have sex with men (GBMSM). Data on mpox disease epidemiology, vaccine uptake and coverage are limited. Methods:From 2022 to 2024, mpox epidemiology was described using National Notifiable Diseases Surveillance System data and mpox vaccine uptake (number of doses) using Australian Immunisation Register (AIR) data, for the total population. Vaccination coverage was estimated among GBMSM using AIR data and denominators from the third Australian Study of Health and Relationships (ASHR3; MSM aged 16-69 years, reporting sex with men in past year) and Australian Bureau of Statistics LGBTI+ estimates (gay, bisexual, queer+ [GBQ+]-identifying men aged ≥16 years). Findings:From May 2022 to December 2024, 1579 mpox cases were reported, with small (2022) and large (2024) outbreaks. Most cases were male (99.2%), aged 20-49 years (85.6%); 7.4% were hospitalised and 45.2% unvaccinated. From January 2022 to December 2024, 114,966 vaccine doses were administered to 66,982 people, mostly male (94.2%) and aged 20-49 years (75.6%). Estimated two-dose coverage was 9.6% (8.4%-11.2%) among MSM and 15.0% (13.7%-16.6%) among GBQ+-identifying men. Interpretation:Australia's epidemiological pattern (small 2022 and large 2024 outbreak) appears unique among high-income countries, which may reflect effective initial containment via vaccination and contact tracing in dense sexual networks of GBMSM with strong GBQ+ community connections, resulting in low levels of both disease and vaccine-induced immunity in the broader MSM population. Coverage estimates were lower than self-reported Australian surveys, which are likely not representative of the overall MSM population. Funding:Australian Government Department of Health, Disability and Ageing.

Overview:We analysed Australian Immunisation Register (AIR) data, predominantly for National Immunisation Program (NIP) funded vaccines, as at 4 February 2024 for children, adolescents and adults, focusing on the calendar year 2023 and trends from previous years. This report aims to provide comprehensive analysis and interpretation of vaccination coverage data to inform immunisation policy and programs. Children:Fully vaccinated coverage in Australian children in 2023 was lower than in 2022 at the 12-month (92.8%, down from 93.3%), 24-month (90.8%, down from 91.0%) and 60-month (93.3%, down from 93.4%) age assessment milestones. This follows the 1.1-1.5 percentage point decrease at these three milestones between the 2020 and 2022 reports, which came after eight years of generally increasing coverage. Fully vaccinated coverage in Aboriginal and Torres Strait Islander (hereafter, respectfully, Indigenous) children was also slightly lower in 2023 than in 2022 at the 12-month (89.7%, down from 90.0%), 24-month (87.8%, down from 87.9%) and 60-month (95.0%, down from 95.1%) milestones, following a 1.9-3.3 percentage point decrease between the 2020 and 2022 reports. Due to the lag time involved in assessment, fully vaccinated coverage figures for 2023 predominantly reflect vaccinations due in 2022, when COVID-19 pandemic-related restrictions had largely been removed. Factors contributing to this ongoing decline in coverage in children include a combination of acceptance and access issues. Adolescents:Among adolescents turning 15 years in 2023, 84.2% of girls and 81.8% of boys (80.9% and 75.0% of Indigenous girls and boys) had received at least one dose of human papillomavirus (HPV) vaccine by their fifteenth birthday, 1.1 and 1.3 percentage points lower than in 2022, respectively (2.1-3.1 percentage points lower for Indigenous adolescents). Coverage of an adolescent dose of meningococcal ACWY vaccine in adolescents turning 17 years in 2023 was 72.8% overall and 62.3% in Indigenous adolescents, 3.1 and 3.3 percentage points lower than in 2022, respectively. These decreases reflect impacts of the pandemic on school-based programs in 2020-2021. To provide an early insight into any immediate impacts on coverage of moving to the NIP single-dose HPV vaccine schedule in 2023 (offered in Year 7 in all jurisdictions), we calculated coverage of at least one dose of HPV vaccine by 31 December in adolescents turning 13 years, with South Australia excluded due to change of delivery from Year 8 in 2022, and found it to be around 3 percentage points lower in 2023 than 2022, and 6 percentage points lower in Indigenous girls, with patterns of diphtheria-tetanus-pertussis vaccination (also single-dose at this age) and HPV vaccination coverage broadly similar. This decrease in vaccinations due in school programs after pandemic restrictions had been removed could be due to impacts of the single-dose HPV transition (i.e. if fewer opportunities for vaccination are provided due to fewer school visits) or may be due to other factors that have changed or disrupted previous school immunisation program operations or reduced parental confidence in vaccination. It is important to promote catch-up vaccination and to monitor renewed efforts to ensure equitable coverage is achieved, particularly given HPV vaccine coverage by 15 years of age in 2023 was 4-8 percentage points lower in adolescents residing in socio-economically disadvantaged and remote areas. Adults:Zoster vaccination coverage in adults turning 71 years was 41.0% overall in 2023, down from 41.3% in 2022, and 36.1% in Indigenous adults, down from 36.5%. However, the availability of the new (non-live) protein-based herpes zoster vaccine (Shingrix) from 1 November 2023 has resulted in increased uptake for the larger eligible cohort. Coverage of 13-valent pneumococcal conjugate vaccine (13vPCV) in adults turning 71 years was 37.6% in 2023, up from 33.8% in 2022, and 43.0% in Indigenous adults, up from 37.7%. Coverage of 13vPCV was lower among Indigenous adults turning 50-59 years (17.5%) and 60-69 years (23.4%) in 2023, despite this vaccine being funded under the NIP. Influenza vaccination coverage decreased across all adult age groups in 2023, both overall and in Indigenous adults, with decreases ranging from 5-11 percentage points. Conclusions:There have continued to be modest but concerning declines in vaccination coverage in children and adolescents relative to pre-pandemic peaks, with decreases greater in Indigenous children and adolescents. Evidence suggests that the factors contributing to these ongoing declines are complex and variable but include both vaccine acceptance and access issues. The picture for adult coverage is more mixed, with coverage increasing for 13vPCV, stable for zoster and decreasing for influenza vaccination, though consistently suboptimal across all vaccines. Ongoing monitoring of vaccination coverage, and further exploration of the reasons underpinning these decreases and suboptimal coverage, are needed to inform approaches to address barriers effectively and to increase vaccine uptake and equity of coverage.

BACKGROUND:The COVID-19 pandemic drove the implementation of vaccine mandates to protect spaces and/or increase vaccine uptake, though their design, timing, and scope varied across jurisdictions. This study examines the associations of vaccine mandate announcements and removals with COVID-19 vaccine uptake in France, Italy, and California (USA). METHODS:We employed interrupted time series (ITS) analysis using aggregated data from Our World in Data and the Oxford COVID-19 Government Response Tracker. The primary outcomes were the weekly number of first and booster doses per 100,000 people. We estimated changes in the rate and trend of vaccine uptake following policy announcements and removals, adjusting for COVID-19 cases, deaths, and temporal autocorrelation to account for other influencing factors. FINDINGS:Initial mandate announcements were associated with immediate increases in vaccine uptake: 113% (95% CI: 63 to 178%) in Italy, 195% (95% CI: 113 to 308%) in France, and 32% (95% CI: 16 to 51%) in California. However, these associations attenuated in more fully adjusted models, especially in France, where the initial association was no longer statistically significant after controlling for epidemiological conditions and temporal autocorrelation. Mandate removals were more consistently associated with declines in booster uptake in Italy and France, including declines of 62% (95% CI: -74 to -45%) and 70% (95% CI: -79 to -57%), respectively, while partial removal in California coincided with increased booster uptake. CONCLUSION:Vaccine mandate announcements were associated with short-term increases in vaccine uptake during key periods of the pandemic. Their removal was often associated with a slowing in uptake, highlighting the need for coordinated communication strategies to sustain coverage. Future policy responses should consider timing, mandate design, and transition planning in contexts where such policies are used.

OBJECTIVE:This study estimates Australia's measles susceptibility across all age groups. To our knowledge, this study is the first internationally to combine multiple consecutive serosurvey and population immunisation register data. METHODS:We estimated age-specific measles susceptibility in 2019 using data from nationally representative seroprevalence surveys for people born between 1920 and 1960 (infection-acquired immunity) and those born 1961-1999 (infection/vaccine-acquired immunity). For people born 2000-2018 (vaccine-acquired immunity only), we estimated measles susceptibility from coverage of one or two doses of measles-containing vaccine from the Australian Immunisation Register and presumed vaccine effectiveness, adjusting for 0·04% waning of protection per year. RESULTS:Susceptibility increased from less than 1% across those born 1920-1960 to 11% for the 1993-1995 cohort, and ranged from 7-14% for those born 2000-2015. We estimated that 1.7 million Australians (6·7%) were susceptible to measles in 2019 (95%UI: 1·3-3·2 million). Among notifications of measles infection between 2008 and 2022, people aged 15-35 years at time of notification accounted for 50%. CONCLUSIONS:Despite sustained high two-dose measles vaccine coverage, Australia's overall population-level measles immunity is at the lower end of the World Health Organization estimated herd protection threshold range (93-95%). IMPLICATIONS FOR PUBLIC HEALTH:Our estimates provide baseline data to inform vaccination activities to address immunity gaps in older age groups, particularly those likely to travel internationally.

Background/objectives: Influenza vaccines are recommended and free in Australia for children aged <5 years, but uptake remains low at 25.8% compared to the targets of 40% and 50%. National data on barriers hindering paediatric influenza vaccination can inform strategies to improve uptake. The aim of this study was to measure barriers to influenza vaccination in Australian children aged <5 years. Methods: A national, cross-sectional survey of parents of children aged <5 years was conducted in March/April 2024. Parents were recruited using an online panel and asked about their intention to get an influenza vaccine for their youngest child in the upcoming influenza season. An adapted version of the validated Vaccine Barriers Assessment Tool measured 14 influenza vaccination barriers. Analysis assessed the prevalence of barriers and differences between parents intending to and those unsure or not intending to vaccinate by calculating the prevalence difference and 95% confidence interval. Results: A total of 2000 parents were recruited nationally. The most common barrier was parents feeling distressed when thinking about vaccinating their child against influenza (66.1% of intending parents, 65.6% of unsure/not intending parents). The barrier with the largest difference between intending and not intending/unsure parents was not prioritising their child’s influenza vaccination (47.2% vs. 6.1%, PD = 41.1 ppts, 95% CI: 35.9%, 46.3%). Other barriers with large differences were parents not feeling guilty if their unvaccinated child got influenza (41.5% vs. 7.5%, PD = 34.0 ppts, 95% CI: 28.8%, 39.1%) and parents not believing that influenza vaccines are effective (31.3% vs. 3.0%, PD = 28.2 ppts, 95% CI: 23.6%, 32.9%). Conclusions: Parents should be encouraged and supported to prioritise influenza vaccination alongside routine childhood vaccines in campaigns that emphasise disease risk and the importance, safety and effectiveness of influenza vaccination, and by optimising access to influenza vaccination. We recommend conducting similar surveys regularly to monitor trends in parental barriers to childhood influenza vaccination.

Cervical cancer is a preventable disease and is related to persistent health equities. Whilst several priority populations face health inequities related to cervical cancer prevention, my co-authors and I bring special attention to those who identify as culturally and linguistically diverse (CALD). By reflecting on some of our research and work experiences, we propose four ways that governments and policymakers can enact the community engagement goals of the published and proposed cervical cancer prevention and treatment strategies for CALD communities. This includes: (1) Developing a culturally appropriate approach to collecting and interpreting cultural, ethnic and linguistic data; (2) Building and adapting the effective multicultural community policies and partnerships developed during COVID-19; (3) Incorporating national strategy recommendations across all relevant government policies and (4) Sustainably resourcing and supporting participatory health promotion activities and interventions. By implementing the recommendations above, Australia will continue to lead the elimination of cervical cancer as a public health problem. It will demonstrate how genuine and authentic CALD partnerships and collaborations can reduce national CALD health inequities.

Background: Australia was one of the first countries to include rotavirus vaccines in its National Immunisation Program, in 2007. We compared trends in acute gastroenteritis (AGE) and intussusception-coded hospitalisations over 13-year post-vaccine period against five-year pre-vaccine baseline. Methods: In a descriptive before-after study, incidence of hospitalisations with ICD-code of rotavirus AGE (A08.0), other AGE (K52, A01-A09 excluding A08.0) or intussusception (K56.1) between 2002 and 2020 was calculated using population denominators by age and Indigenous status. We used 2002-2006 as pre-vaccine baseline and calculated Incidence Rate Ratios [IRRs] for 2008-2019 and 2020. Findings: In children aged <5 years, mean annual hospitalisation rate/100,000 decreased by 85% for rotavirus-coded AGE, from 248.3 in 2002-2006 to 37.6 (IRR 0.15; 95% CI 0.15-0.16) in 2008-2019 (61.4% for Indigenous children, from 680.2 to 262.2), and 46% for other AGE, from 1274.5 to 689.1 (IRR 0.54; CI 0.54-0.55), decreasing further in 2020 to 6.3 (rotavirus-coded) and 445.0 (other AGE). Rates for rotavirus-coded and other AGE declined in 2008-2019 in those aged 5-<20 years (IRR 0.52; CI 0.49-0.56 and 0.86; CI 0.85-0.87, respectively), but increased in 20-<65 years (IRR 2.38; CI 2.01-2.83 and 1.15; CI 1.15-1.16) and >= 65 years (IRR 2.24; CI 1.91-2.62 and 1.24; CI 1.23-1.25). Average annual hospitalisation rate for intussusception in infants was similar in pre-vaccine and post-vaccine periods (IRR 0.97; CI 0.90-1.04). Conclusion: Over a 13-year period post-rotavirus vaccine introduction we document major sustained declines in hospitalisations coded as rotavirus and other AGE in age groups <20 years, with no change in intussusception hospitalisation rates in infants. Despite small increases in AGE hospitalisations in adults, likely due to increased PCR testing, our findings are consistent with highly favourable risk benefit ratio at whole-of-population level in Australia.

(Background) High quality Indigenous status data for vaccine preventable diseases (VPDs) in the National Notifiable Diseases Surveillance System (NNDSS) is important for evaluation of immunisation programs and ultimately for improving health outcomes for Aboriginal and Torres Strait Islander peoples. We evaluated Indigenous status completeness, and factors influencing it, for VPDs in the NNDSS. (Methods) Literature review (published and grey); descriptive analysis of NNDSS data for selected VPDs over the 2010–2019 period; standardised online survey (containing closed- and open-ended questions) of key informants; semi-structured follow-up interviews. (Results) National level Indigenous status completeness for those VPDs with a Communicable Diseases Network Australia (CDNA) target of 95% was above that target for Haemophilus influenzae type b, measles, invasive meningococcal disease and invasive pneumococcal disease (IPD: < 5 and ≥ 50 years); and was within four percentage points for hepatitis A, newly acquired hepatitis B and pertussis (< 5 years). For VPDs with an 80% target, completeness was ≥ 90% for diphtheria, mumps, rubella and tetanus; ≥ 80% for IPD (≥ 5 to < 50 years); and below target for unspecified hepatitis B (54%), laboratory confirmed influenza (47%), pertussis (≥ 5 years; 60%) and rotavirus (71%). However, completeness was above 90% for all VPDs in the Northern Territory, and all except laboratory confirmed influenza (89%) in Western Australia. Key barriers to Indigenous status completeness include the absence of an Indigenous status field on most pathology request forms and limited public health authority resource capacity to follow up missing data, particularly for high incidence diseases. (Conclusion) National level Indigenous status completeness is high for most VPDs but low for others, particularly for high incidence diseases predominantly notified by laboratories. Completeness is uniformly high for all VPDs in the Northern Territory and Western Australia; however, this is due to the resource-intensive public health follow-up of all notifications and manual cross-checking of other databases when Indigenous status is missing. To more efficiently optimise Indigenous status completeness in the NNDSS across all jurisdictions, a mix of additional strategies is needed to ensure accurate identification and recording in primary care, hospital, laboratory and public health settings, and effective transfer between them.

Purpose In Australia, adolescents are scheduled to receive vaccinations against diphtheria, tetanus, pertussis, human papillomavirus, and meningococcal disease, delivered via school vaccination programs and general practitioners (GPs). Public health measures implemented in response to the COVID-19 pandemic impacted uptake of some adolescent age-based vaccinations. Limited information is available on parents' approaches to vaccinating their adolescent children during the pandemic. We aimed to explore parents' experiences of adolescent age-based vaccinations during the pandemic, and factors they perceived as hindering or facilitating vaccination. Methods In July 2022 we recruited 21 Australian parents of adolescent children eligible for age-based vaccinations in 2021. We recruited from metropolitan and regional settings, and from states where uptake was most and least affected by pandemic disruptions. We conducted 30-min virtual or phone interviews and analysed the data thematically. Results Parents described how experiences before and during the COVID-19 pandemic influenced their perspectives on and experiences with adolescent age-based vaccinations. Motivation to vaccinate their children was informed by personal beliefs and experiences with the healthcare system. Parents described practical issues, including ease of access to the school vaccination program or a GP, and knowledge about vaccination schedules and services. Parents suggested enhancing promotion of adolescent vaccination benefits and information sharing, and recommended improving access to vaccination services outside the school program. Discussion Findings have potential to improve delivery of adolescent age-based vaccinations, including during future pandemics. While this study was conducted in the Australian context, findings and recommendations have relevance to overseas adolescent age-based vaccination programs.

Importance:Pertussis, or whooping cough, is caused by the Bordetella pertussis bacterium. It induces prolonged cough in all age groups and is a severe, life-threatening disease in young infants. Observations:In an online workshop organized by the International Bordetella Society on November 12, 2024, most participating countries reported very low pertussis incidence during and immediately following the COVID-19 pandemic. Since that time, many countries have seen large outbreaks of pertussis, particularly in adolescents. Before the pandemic, several countries, especially those using acellular pertussis vaccine in infants, reported circulating B pertussis isolates that lacked the acellular vaccine antigen pertactin. However, most recent isolates have been found to express this antigen. A rise in macrolide-resistant B pertussis isolates was also reported by several countries. Conclusions and Relevance:The potential for large outbreaks of pertussis highlights the importance of maintaining or increasing vaccine coverage in pregnancy and in infants and children. The data presented herein suggest a need for new pertussis vaccines that protect against both disease and infection and that reduce transmission.