Most still use outdated tetanus vaccines, missing chances to curb Australia’s worst pertussis epidemic, experts warn.
Australia is missing a crucial opportunity to curb its worst whooping cough epidemic on record, with hospitals continuing to use outdated tetanus vaccines that don’t include protection against the highly contagious disease.
New analysis by the Immunisation Foundation of Australia (IFA) has found most hospitals are ignoring national guidelines that recommend using the combined diphtheria-tetanus-pertussis (dTpa) vaccine for adults needing a tetanus booster.
Instead, 401 of 469 hospitals continue to stock the older two-in-one diphtheria-tetanus (dT) vaccine – a cheaper option that leaves patients vulnerable to whooping cough.
The IFA estimates more than a million Australians aged over 50 have received tetanus protection without the added safeguard against whooping cough, despite the combined vaccine costing only a few dollars more per dose.
“It’s unacceptable that so many vaccines used for tetanus in Australian hospitals do not include added protection against whooping cough, despite established national recommendations,” said IFA founder Catherine Hughes AM, whose 32-day old son Riley died from whooping cough 10 years ago.
“This is a missed opportunity to boost immunisation rates and reduce the impact of an extremely dangerous and highly infectious disease.”
The IFA’s Whooping Cough Report Card also includes commentary from some of Australia’s leading vaccination and infectious diseases experts.
Writing in the IFA’s analysis, paediatrician and vaccine expert Professor Nicholas Wood said the current outbreak was very concerning.
“Whooping cough outbreaks can last for many months, often for years,” he said.
“Australia remains in the midst of a record-breaking whooping cough epidemic so it’s crucial to ensure pregnant women are vaccinated to protect he youngest infants.”
Pertussis is more contagious than influenza or covid and can spread to up to 17 others from a single case. Spring and summer are the peak seasons for the disease.
The disease, often called the “100-day cough” causes severe coughing fits and breathing difficulties and can be deadly for infants and older adults.
School-age children carry the load of whooping cough cases, with nearly 40% of all Australian cases so far in 2025 in those aged 5 to 14 years, according to the Australian Department of Health, Disability and Ageing’s National Notifiable Disease Surveillance System.
A pertussis booster at least every 10 years is recommended by the World Health Organization as a safe and effective way to bolster protection.
Australia has recorded almost 80,000 cases of pertussis in the past two years – the highest ever – and five deaths last year, including two babies aged under 12 months and three adults aged over 65 years.
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The report listed the top five best performing areas in Australia for one-year-old pertussis vaccination coverage (from DoHDA data). The ACT topped the list on 95.32%, followed by Western NSW (95.2%), Northern Sydney (95%), Western Victoria (94.2%) and Central and Eastern Sydney (93.6%).
The top five worse performing areas were North Coast NSW (85.96%), Gold Coast (86.23%), Central Queensland, Wide Bay, Sunshine Coast (88.14%), Country WA (88.44%), and Western Queensland (89.31%).
Despite national recommendations for adults to receive a booster every 10 years, research published in Vaccines in October showed that of 730,000 Australian adults seen by a primary care doctor, fewer than 3% were up to date with their pertussis vaccination.
“Adults are a large component of the massive pertussis epidemic we’ve seen unfold in Australia, so vaccination of adults is part of the solution,” said Professor Raina MacIntyre, head of Global Biosecurity at the Kirby Institute at University of New South and senior author of the study.
“Whooping cough is deadly for infants but has also caused serious complications in adults. Our research found that Australian adults with the lowest levels of vaccination, 45-to-64-year-olds, are most likely to suffer complications associated with whooping cough, including pneumonia.
“Whooping cough risk includes soon-to-be grandparents in the context of protecting their newborn grandchild.
“There are other major risk groups such as people with asthma or chronic lung disease, which causes a much higher risk of complications of whooping cough.”
The IFA and health experts have called for urgent action to close vaccination gaps by replacing all remaining dT vaccines with the combined dTpa in hospitals and emergency departments, expanding access to adult boosters, and introducing maternal immunisation targets to protect newborns.
“We have the vaccines to prevent whooping cough, so it makes sense that we take every opportunity to use them,” Ms Hughes said.
