Key Facts:
- Hospitals ignore Government recommendations to protect against whooping cough with combined tetanus-diphtheria-whooping cough vaccine when treating wounds
- Australians being short-changed, with more than a million older adults protected from tetanus, but not whooping cough
- A whooping cough booster is recommended for adults at least every 10 years, yet fewer than three per cent of adults are up to date
- With five deaths in 2024 and spring/summer being peak season for cases, immediate action on whooping cough is urged
Missed opportunity to curb record whooping cough epidemic
Hospitals defy key vaccination recommendations amid cost pressures
While Australia battles a record-breaking whooping cough epidemic, hospitals facing cost pressures are turning away from national guidelines designed to bolster defences against the highly infectious and potentially deadly illness.1
New analysis by the Immunisation Foundation of Australia (IFA) reveals that many Australians admitted to hospital emergency departments with a tetanus-prone wound do not receive a combined diphtheria-tetanus and pertussis (whooping cough) (dTpa) vaccine, despite the Australian Immunisation Handbook stating "Adults who need a tetanus-containing vaccine are recommended to receive dTpa vaccine rather than diphtheria and tetanus (dT) vaccine".1,2
The analysis of 469 hospitals found that 401 of these continue to stock the older diphtheria and tetanus (dT) vaccine, which costs just a few dollars less per dose than a whooping cough-containing booster.1 These findings support a recent study which found that more than one million Australians aged over 50 years who were up to date with tetanus protection had received dT instead of the three-in-one dTpa vaccine.3
"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.1-3 This is a missed opportunity to boost immunisation rates and reduce the impact of an extremely dangerous and highly infectious disease,"1 said IFA Founder Catherine Hughes AM, whose 32-day old son Riley died from whooping cough 10 years ago.
The benefits of dTpa for routine wound management in emergency departments have been quantified in the US, where a study showed that vaccination with dTpa instead of dT could prevent around 42,000 cases of whooping cough in the following three years.4
Whooping cough is a highly infectious bacterial infection that attacks the airways, causing uncontrollable coughing and difficulty breathing.5 Often referred to as the '100 day cough', whooping cough is more contagious than influenza or COVID-19.6,7 Once infected, an unprotected person can pass the illness to as many as 17 others and remain contagious for three weeks.6-8
While whooping cough is well known to be fatal in infants, it can also cause serious illness in older children and adults, including death in older people.8 In Australia, whooping cough was responsible for five fatalities last year, including two infants under the age of 12 months, and three adults aged over 65 years.9
Whooping cough cases in Australia are at an all-time high, with nearly 80,000 confirmed notifications in the past 24 months – the highest ever recorded epidemic in Australia.10
The IFA analysis comes as new research published in Vaccines reveals concerningly low levels of whooping cough vaccination in the Australian community, despite boosters being recommended for adults at least every 10 years.5,11 It shows that, of 730,000 Australian adults seen by a primary care doctor, as low as three per cent were up to date with whooping cough booster vaccination.11
"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,"11 she said.
"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."11
The IFA is joining medical experts in urging immediate action to strengthen whooping cough protection in Australia. This includes making whooping cough vaccines affordable and accessible to adults at higher risk of severe illness, as well as ensuring all hospital emergency departments and urgent care clinics replace the older dT vaccine with the combined dTpa vaccine, eliminating inconsistency in vaccine availability. Experts note that while historically there has been a significant cost difference between dT and dTPa, the gap is now far less.
In addition, the Foundation is also advocating for maternal immunisation targets, helping ensure the youngest and most vulnerable Australians are protected from birth.
"We have the vaccines to prevent whooping cough so it makes sense that we take every opportunity to use them," said Ms Hughes.
The Immunisation Foundation of Australia will mark Whooping Cough Day on 8 November with a call for all Australians to remain up to date with whooping cough boosters. With most cases notified during spring and summer, now is the time to act.12
On the day the Foundation will operate a pop-up immunisation clinic at the Canberra Pregnancy Babies & Children's Expo – Saturday 8 and Sunday 9 November – providing whooping cough and RSV vaccines to expectant parents.
