Annual theme 2025: vaccine-preventable diseases in humans

Respiratory syncytial virus (RSV) is a leading cause of morbidity and mortality in young children and older adults. A long-acting anti-RSV monoclonal antibody (nirsevimab) and bivalent pre-fusion F-protein pregnancy vaccine became available to prevent RSV in young children in 2024; two RSV vaccines for adults ≥ 60 years were also available.

To report 2024 RSV epidemiology in Australia, identify risk factors for severe outcomes, and use and effectiveness of RSV immunisation products.

National sentinel hospital-based RSV surveillance was established in 2024, recruiting hospitalised laboratory-confirmed RSV cases and test-negative controls from 22 sites in a national hospital network (FluCAN-PAEDS).

Between April and December 2024, 3,998 subjects (3,415 children; 582 adults) were hospitalised with RSV. Most cases were infants < 12 months (n = 1,534; 38.4%); 1,661 (41.5%) had underlying medical conditions. Children < 6 months, First Nations children, those born preterm or with underlying medical conditions (cardiac, neurological, genetic and metabolic disease/disorders, immunosuppression) were at greatest risk of severe outcomes. Severe outcomes were more frequent in adults with malignancy, respiratory or cardiac disease. Nirsevimab effectiveness against hospitalisation in infants < 12 months in the two Australian jurisdictions with population-wide immunisation programmes was 83.1% (95% CI: 67.4–91.3). RSV vaccine use (pregnancy; adults ≥ 60 years) was limited, precluding effectiveness assessments.

National surveillance enabled timely 2024 data collection with the capability to evaluate effectiveness of immunisation products preventing RSV. Nirsevimab demonstrated comparable effectiveness to that in the northern hemisphere, informing Australia’s 2025 strategy. Evaluation to assess the impact of more widespread uptake of RSV prevention products continues.

In Scotland, the number of pertussis infections recorded in children in 2024 was the highest of any year in the last decade. The protective role of vaccination against severe infection and associated hospitalisations has not been assessed.

To investigate the effect of vaccination and sociodemographic factors on pertussis-related hospitalisations in Scottish children aged under 18 years.

In a retrospective cohort study, laboratory-confirmed pertussis cases from January 2013 to July 2024 were extracted from the national electronic surveillance system and linked to hospitalisation data from Scottish Morbidity Records and vaccination data from the national immunisations database. The outcome was a pertussis-associated hospitalisation. Multivariable logistic regression was used to calculate odds ratios (OR) for the association between vaccination status and hospitalisation, adjusted for age, sex, ethnicity and deprivation status.

There were 3,982 laboratory-confirmed cases of pertussis during the study period. Children fully vaccinated for age had significantly lower odds of hospitalisations than unvaccinated children (adjusted OR (aOR): 0.31; 95% CI: 0.21–0.46). Being partially vaccinated for age did not significantly reduce hospitalisations relative to unvaccinated children (aOR: 0.80; 95% CI: 0.47–1.33). In the univariable analysis, children living in the most deprived areas had significantly more hospitalisations than those in the least deprived areas (OR: 3.90; 95% CI: 2.41–6.56). This association was not significant when adjusted for the effect of vaccination (aOR: 1.47; 95% CI: 0.84–2.66).

Fully vaccinated children had significantly lower odds of hospitalisation, indicative of less severe disease. This emphasises the importance of fully vaccinating children according to the childhood immunisation schedule.

Pertussis is a highly contagious respiratory infection caused by Bordetella pertussis. Vaccination against pertussis is included in the Italian vaccination programme with three doses administered at 3, 5 and 11 months, booster doses at 6 and 12–18 years, and every 10 years. Vaccination coverage in Tuscany is high among infants (97.7% vs 94.7% national average at 24 months) and adolescents (75.8% vs 68.4% national average at 16 years).

We aimed to investigate case numbers, vaccination status and time points for vaccination of children and adolescents hospitalised for pertussis.

We collected data on children and adolescents aged ≤ 16 years and hospitalised for laboratory-confirmed pertussis in 2016–2024 at a tertiary hospital in Tuscany.

A total of 384 children and adolescents were hospitalised in 2016–2024. Annual case numbers increased from an average of 28.2 cases in 2016–2019 to 259 cases in 2024, with 136 (52.5%) cases in adolescents. Of the 107 cases aged 12–16 years, 93 (86.9%) were unvaccinated or had not received the second booster. A considerable time gap between the earliest eligible day for vaccination and hospitalisation was observed. In infants, a median of 31 days (interquartile range (IQR): 10–131 days) was noticed for the first dose, 44 days (IQR: 22–70 days) for the second and 53 days for the third. In 12–16-year-olds, a median of 395 days (IQR: 236–717) was seen for the second booster.

Administering adolescent booster doses earlier, vaccinating at the earliest eligible time points, and promoting timely vaccination through targeted communication campaigns may reduce pertussis-related hospitalisations.

Influenza A(H1N1)pdm09, A(H3N2) and B/Victoria viruses circulated in Europe in 2023/24, with A(H1N1)pdm09 dominance. First influenza infections in childhood may lead to different vaccine effectiveness (VE) in subsequent years.

The VEBIS primary care network estimated influenza VE in Europe using a multicentre test‐negative study.

Primary care practitioners collected information and specimens from patients consulting with acute respiratory infection. We estimated VE against influenza (sub)type and clade, by age group and by year of age for A(H1N1)pdm09, using logistic regression.

We included 29,958 patients, with 3,054, 1,053 and 311 influenza A(H1N1)pdm09, A(H3N2) and B cases, respectively. All-age VE against influenza A(H1N1)pdm09 was 52% (95% CI: 44–59). By year of age, VE was 27% (95% CI: −2 to 47) at 44 years with peaks at 72% (95% CI: 52–84) and 54% (95% CI: 41–64) among children and those 65 years and older, respectively. All-age A(H1N1)pdm09 VE against clade 5a.2a was 41% (95% CI: 24–54) and −11% (95% CI: −69 to 26) against clade 5a.2a.1. The A(H3N2) VE was 35% (95% CI: 20–48) among all ages and ranged between 34% and 40% by age group. All-age VE against clade 2a.3a.1 was 38% (95% CI: 1–62). All-age VE against B/Victoria was 83% (95% CI: 65–94), ranging between 70 and 92% by age group.

The 2023/24 VEBIS primary care VE against medically attended symptomatic influenza infection was high against influenza B/Victoria, but lower against influenza A(H1N1)pdm09 and A(H3N2). Clade- and age-specific effects may have played a role in the lower A(H1N1)pdm09 VE.

Vaccine-derived polioviruses (VDPVs) continue to circulate internationally, causing sporadic cases and outbreaks of paralytic polio in countries certified as polio-free. In 2022, sustained detection of type 2 VDPVs was reported in environmental surveillance samples collected from London. Genetic mutations indicative of loss of attenuation of virulence were observed, consistent with community transmission events over several months.

We aimed to determine the extent of geographical spread of transmission in an area of environmental poliovirus detection.

We implemented an opportunistic, cross-sectional survey in areas where environmental surveillance indicated sustained VDPV transmission between October 2022 and April 2023. Residual stool samples taken from children < 16 years presenting to primary or secondary healthcare were examined for enteroviruses, including poliovirus. Methods for poliovirus detection recommended by the World Health Organization, including virus isolation in cell culture, PCR and molecular characterisation, were applied to residual stool material on a daily basis with real-time clinical reporting.

We examined 1,251 stool samples from 1,051 children presenting to healthcare with illness over a 6-month period. A range of enteroviruses from groups A, B and C were found, but no poliovirus was detected. Documented polio vaccination coverage was high, between 95% and 98% in under 5-year-olds.

Poliovirus was not widespread in the area of environmental poliovirus isolation. Opportunistic poliovirus testing of residual stool samples taken from children seeking healthcare was feasible and can be implemented rapidly in areas where poliovirus circulation is suspected, although untargeted sampling may not adequately capture populations at highest risk.

Vaccination programmes initiated in the early 1970s reduced the incidence of measles in Austria, which resulted in the interruption of endemic measles virus (MeV) circulation and the achievement of elimination status in 2018. However, large outbreaks occurred in 2023 and 2024.

By assessing MeV-specific IgG antibody levels, we analysed if immunity recently declined due to the COVID-19 pandemic, vaccine-induced immunity waned over long term or immunity gaps already pre-existed in the population.

We determined anti-MeV antibody levels in a retrospective dataset of 56,360 diagnostic samples (from 50,754 individuals) collected 2010–2024 and correlated antibody cutoffs to titres from a live-virus neutralisation test.

Individuals born before 1970 (n = 15,007) had antibody levels > 3,000 IU/L, persisting into higher age, and < 2% (n = 300) of them were seronegative. In contrast, individuals born after 1990 (n = 12,778) displayed seronegativity rates of 13–20% and lower median antibody concentrations in seropositive individuals (449–773 IU/L). In these individuals, antibody levels decreased noticeably between the ages of 2 and 10 years but remained stable between those aged 10 and 30 years. There was no significant difference in seronegativity rates at the age of 12–24 months in children born 2016–2019 and 2020–2022 (the years of the COVID-19 pandemic).

In Austria, there are significant immunity gaps in individuals born after 1970, which pre-existed before the COVID-19 pandemic. Thus, young and middle-aged populations not immune against measles should be vaccinated to counteract a further decline of immunity at the population level and prevent outbreaks whenever MeV is imported.

Respiratory syncytial virus (RSV) is a leading cause of hospitalisation in children worldwide. Recent regulatory approval of monoclonal antibody (mAb) nirsevimab for infants and the RSVpreF vaccine for pregnant women offers promising approaches to mitigate RSV-associated morbidity.

To evaluate potential impacts of routine prophylactic campaigns (mAbs targeting infants or maternal vaccination) introduced in the 2024/25 season on hospitalisations from RSV lower respiratory tract infections in Lombardy, Italy.

We used a catalytic model informed by data from pre-COVID-19 pandemic (before 2020) and post-pandemic periods (until 2022) to quantify the number of cases and hospitalisations that could be averted by seasonal nirsevimab administration to infants and RSVpreF maternal vaccination, considering changes in susceptibility caused by reduced RSV circulation during the pandemic.

As a marked proportion of RSV hospitalisations occurs in infants aged ≤ 1 year, seasonal mAb administration to 80% of newborns (uptake levels observed in Spain) was estimated to avert 50.2% (95% CI: 43.5–55.8) of hospitalisations in the total population. Coverage levels close to those observed for childhood vaccines (95%) could result in an additional average 18% reduction in hospitalisations. Vaccination of 65% of pregnant women, resembling the diphtheria–tetanus–pertussis vaccine coverage in Lombardy for this population, was estimated to avert 30.5% (95% CI: 19.6–39.7) of hospitalisations. At influenza vaccine coverage (12%), less than 8% of hospitalisations could be averted by maternal immunisation.

Routine nirsevimab administration to infants demonstrates clear potential to reduce RSV-associated hospitalisations. Maternal immunisation can help in achieving high protection in at-risk populations.

During the first year of the COVID-19 pandemic, vaccination programmes targeted children and adolescents to prevent severe outcomes of SARS-CoV-2 infection.

To estimate COVID-19 vaccine effectiveness (VE) against hospitalisation due to COVID-19 in the paediatric population, among those with and without previously documented SARS-CoV-2 infection.

We established a fixed cohort followed for 12 months in Denmark, Norway, Italy, Luxembourg, Navarre (Spain) and Portugal using routine electronic health registries. The study commenced with paediatric COVID-19 vaccination campaign at each site between June 2021 and January 2022. The outcome was hospitalisation with a laboratory-confirmed SARS-CoV-2 infection or COVID-19 as the main diagnosis. Using Cox proportional hazard models, VE was estimated as 1 minus the confounder-adjusted hazard ratio of COVID-19 hospitalisation between vaccinated and unvaccinated. A random-effects meta-analysis was used to pool VE estimates.

We included 4,144,667 5–11-year-olds and 3,861,841 12–17-year-olds. In 12–17-year-olds without previous infection, overall VE was 69% (95% CI: 40 to 84). VE declined with time since vaccination from 77% ≤ 3 months to 48% 180–365 days after immunisation. VE was 94% (95% CI: 90 to 96), 56% (95% CI: 3 to 80) and 41% (95% CI: −14 to 69) in the Delta, Omicron BA.1/BA.2 and BA.4/BA.5 periods, respectively. In 12–17-year-olds with previous infection, one dose VE was 80% (95% CI: 18 to 95). VE estimates were similar for 5–11-year-olds but with lower precision.

Vaccines recommended for 5–17-year-olds provided protection against COVID-19 hospitalisation, regardless of a previously documented infection of SARS-CoV-2, with high levels of protection in the first 3 months of the vaccination.