The research team, led by Usman Muhammad Ibrahim of the Department of Community Medicine at Federal University Dutse and Rasheed Shekoni Federal University Teaching Hospital, together with collaborators from the World Health Organization and several Nigerian teaching hospitals, mined the state’s Integrated Disease Surveillance and Response system, the standardized reporting framework through which health facilities across Nigeria log suspected cases of epidemic-prone diseases. Their analysis covered cases reported between 2019 and 2023, with the patient’s survival status, alive or died, serving as the primary outcome. Data were analyzed in SPSS version 22, with statistical significance set at the conventional 5 percent threshold, and the team applied both unadjusted comparisons and an adjusted regression model to disentangle the factors driving mortality.

The demographic profile of the cases tells its own story. Patients ranged in age from 8 to 180 months, with a median of 60 months, meaning the typical patient was a five-year-old, and an interquartile range of 36 to 84 months. That skew toward school-age children is notable, because pertussis vaccination schedules in most of Africa target infants and toddlers, leaving older children vulnerable as vaccine-induced immunity wanes. The seasonal pattern was equally striking: cases clustered early in the year, with 51.6 percent of all reports falling within epidemiological weeks 1 through 13, and the median reporting week sitting at week 13 of a possible range that stretched from week 2 to week 39.

Geographically, the burden was far from uniform. Cases were reported from only 14 of Jigawa State’s 27 local government areas, and a single district, Auyo, accounted for the largest share at 18.7 percent of all cases. This clustering matters for outbreak response, because it suggests that transmission was concentrated in specific communities rather than diffused evenly across the state, and it gives program managers a concrete starting point for targeted vaccination campaigns and active case-finding.

The mortality figures are where the study becomes genuinely alarming. The overall case-fatality rate across the five years was 7.3 percent, an extraordinarily high figure for a disease that kills fewer than one in a hundred symptomatic patients in well-resourced settings. Death was most frequent among children aged 5 to 9 years, who died at a rate of 8.5 percent, followed by children under five at 7.1 percent. Even more telling, every single pertussis-related death in the dataset, representing 16.9 percent of the cases recorded that year, occurred during the 2023 outbreak. In other words, the disease did not merely become more common as the study period progressed; it became dramatically more lethal.

The year-by-year attack rates trace the re-emergence in fine detail. In 2019, rates stood at 5.0 per 100,000 among both children under five and children aged 5 to 9 years, compared with just 0.6 per 100,000 among adolescents. The pandemic year of 2020 brought a decline to 2.0 per 100,000 in both child groups, a dip consistent with the movement restrictions and reduced transmission of many respiratory pathogens during that period. In 2021, children aged 5 to 9 years carried the highest burden at 2.1 per 100,000. Then the curve bent sharply upward: 2022 saw rates jump to 7.4 per 100,000 among under-fives and 6.3 per 100,000 among 5-to-9-year-olds, while adolescents recorded 0.3 per 100,000. By 2023, the rates had climbed again to 10.2 per 100,000 among under-fives, 8.8 among 5-to-9-year-olds, and 5.1 among adolescents, the first year in which adolescent transmission rose substantially.

The statistical modeling revealed a set of mortality predictors that will unsettle many readers. Mortality was significantly higher in the Northeast Senatorial Zone of the state, where 14.4 percent of cases died, compared with the rest of Jigawa, and dramatically higher during the 2023 outbreak, when the case-fatality rate reached 16.9 percent. Both associations were highly significant, with p values below 0.001. But the most counterintuitive finding concerned vaccination status: children documented as vaccinated had a mortality rate of 15.4 percent, and in the adjusted analysis, unvaccinated cases actually had 80 percent lower odds of dying than vaccinated cases, with an adjusted odds ratio of 0.20 and a 95 percent confidence interval of 0.10 to 0.30.

The authors are careful to frame this vaccination paradox in terms of what it likely reflects rather than what it might naively suggest. Vaccination status recorded in surveillance data is a marker of a complex web of factors, including the severity of illness that brings a child to a health facility, the completeness of the records, and the possibility that children with documented vaccination are those who had enough prior contact with the health system to be counted. The finding underscores, rather than undermines, the study’s central recommendation: routine immunization coverage must be strengthened, and seroprevalence studies are needed to map immunity gaps, particularly among older age groups who appear to be sustaining transmission. Waning immunity in vaccinated children, a well-documented feature of pertussis epidemiology worldwide, remains a plausible contributor that only serological surveys can properly quantify.

Two other independent predictors of death emerged from the adjusted model, and both point to the same underlying problem of late and inadequate clinical care. Outbreak timing mattered enormously: compared with outbreaks occurring at epidemiological week 26 or later, cases arising during weeks 1 through 13 had 95 percent lower odds of mortality, with an adjusted odds ratio of 0.05 and a confidence interval of 0.02 to 0.10, and those during weeks 14 through 25 had 90 percent lower odds, at an adjusted odds ratio of 0.10. The authors interpret this as evidence that cases presenting late in outbreak periods, when health systems are overwhelmed and community awareness has faded, fare far worse. Hospital admission itself carried an approximately tenfold higher odds of death, with an adjusted odds ratio of 10.2 and a confidence interval of 5.7 to 18.2, a signal that admitted patients were those arriving with severe, advanced disease, and that delays in presentation were funneling the sickest children into hospitals too late for effective intervention.

Taken together, the Jigawa data sketch a disease that is exploiting every weakness in the local health architecture: gaps in routine immunization, waning protection in older children, delayed care-seeking, and surveillance that captures only part of the true burden. The study’s authors call for strengthened case-based surveillance, earlier detection of outbreaks, improved clinical management of hospitalized cases, and renewed investment in routine immunization, complemented by seroprevalence research to identify the immunity gaps driving transmission. For a disease preventable by one of the oldest and cheapest vaccines in the global arsenal, the message from northwest Nigeria is difficult to ignore. Pertussis has not disappeared from the world’s public health agenda; in places where the systems meant to contain it have frayed, it is reasserting itself with lethal efficiency, and the five-year record from Jigawa State is now among the clearest warnings available.

Subject of Research: Epidemiological trends and mortality of pertussis (whooping cough) in Jigawa State, northwest Nigeria, based on five years of case-based surveillance data

Article Title: Epidemiological trends and pertussis-related mortality in Jigawa State, Northwest Nigeria: evidence from five years of case-based surveillance

Article References: Ibrahim, U. M., Kofi, B., Babura, S. M., Bassey, B. E., Also, U., Danzomo, A. A., El-Yakub, F. A., Yusuf, S., Borodo, A. M., Yusuf, S., Dania, O. M., Nashabaru, I., & Jibo, A. M. (2026). Epidemiological trends and pertussis-related mortality in Jigawa State, Northwest Nigeria: evidence from five years of case-based surveillance. BMC Infectious Diseases. https://doi.org/10.1186/s12879-026-14511-z

Image Credits: AI Generated

DOI: 10.1186/s12879-026-14511-z

Keywords: pertussis, whooping cough, Nigeria, Jigawa State, epidemiology, surveillance, outbreak, case-fatality rate, immunization, vaccine-preventable disease, public health, re-emerging infectious disease

Pertussis, commonly known as whooping cough, is a highly contagious respiratory disease caused by the bacterium Bordetella pertussis. While vaccination has dramatically reduced its burden in many countries, infants too young to complete their primary immunization series remain the most vulnerable group. In its severe form, infant pertussis can produce violent coughing paroxysms, an inspiratory whoop, cyanosis and profound respiratory distress. Complications such as pneumonia, pulmonary hypertension and encephalopathy contribute to the disease’s continued mortality in the youngest patients, and clinicians have long recognized that bacterial or viral co-infections can worsen outcomes substantially.

The infant in this case arrived with classic signs of whooping cough: paroxysmal coughing fits, crowing sounds during inspiration and increasing difficulty breathing. Laboratory evaluation painted a picture consistent with severe pertussis. Her white blood cell count was markedly elevated, a hallmark of the disease that reflects the toxin-driven lymphocytosis characteristic of Bordetella infection. A polymerase chain reaction test performed on sputum came back positive for Bordetella pertussis, confirming the diagnosis. Echocardiographic assessment revealed pulmonary hypertension, a dangerous elevation of pressure in the vessels supplying the lungs that is a recognized and feared complication of severe infant pertussis.

Based on these findings, the clinical team initiated treatment directed at the pertussis infection. Over the following days, two of the key indicators improved: the abnormally high leukocyte count came down, and the pulmonary artery pressure fell significantly. By conventional markers, the infant appeared to be responding to therapy. Yet her respiratory distress did not ease. This discordance, in which laboratory values normalize while the patient’s clinical condition deteriorates or fails to improve, is precisely the scenario in which clinicians should suspect that a second, undetected pathogen may be driving ongoing lung injury.

That suspicion led the team to deploy metagenomic next-generation sequencing, an unbiased diagnostic technique that differs fundamentally from targeted tests. Whereas PCR assays and cultures are designed to detect specific, suspected organisms, mNGS extracts all genetic material present in a clinical sample, in this case from the respiratory tract, and sequences it without any prior assumption about what might be found. Bioinformatic analysis then maps the resulting reads against comprehensive databases of bacterial, viral, fungal and parasitic genomes, allowing the technique to identify unexpected or fastidious pathogens directly from the sample. The approach has proven especially valuable in critically ill patients, in immunocompromised hosts and in infections where standard diagnostics repeatedly return negative results.

In this infant, mNGS detected genetic material from Pneumocystis jirovecii, an opportunistic fungus that causes Pneumocystis pneumonia, abbreviated PJP. The finding was significant for several reasons. Pneumocystis jirovecii is a yeast-like fungus that most commonly causes pneumonia in people with profoundly weakened immune systems, particularly those with untreated HIV, transplant recipients on immunosuppressive drugs, and children with severe primary immunodeficiencies. Its detection in an infant who was not known to be immunocompromised is rare, and co-infection with Pneumocystis in the setting of severe pertussis has been seldom reported in the medical literature. The authors note that PJP carries a higher mortality, making its timely recognition all the more critical.

The diagnosis, however, arrived late in the infant’s illness. Despite the eventual identification of the fungal co-pathogen, the delay meant that targeted therapy against Pneumocystis came after substantial lung damage had already accumulated. The girl died on the fifteenth day after admission. The authors draw a sobering conclusion from this outcome: Pneumocystis pneumonia can occur even in immunocompetent children with severe pertussis, and a delayed diagnosis may increase mortality. Their central recommendation is that mNGS should be performed when a patient with severe pertussis fails to respond to appropriate treatment, because the technique can provide an effective basis for identifying hidden co-infections that would otherwise remain undiagnosed until autopsy.

The case highlights a broader diagnostic dilemma in pediatric intensive care. Severe pertussis in young infants can produce a devastating pneumonia on its own, and the radiographic and clinical picture of Pneumocystis pneumonia overlaps considerably with other causes of diffuse lung injury, including viral pneumonias and the direct pulmonary effects of Bordetella itself. Furthermore, Pneumocystis cannot be reliably cultured in the laboratory, which means that conventional microbiological workups are structurally blind to it. Microscopic examination of induced sputum or bronchoalveolar lavage fluid with special stains has historically been the diagnostic mainstay, but these methods depend on adequate sampling, experienced microscopists and a clinician who thought to test for the organism in the first place. In an infant whose initial workup convincingly explained her illness with pertussis, the impetus to look for a second pathogen may only arise when the expected recovery stalls.

This is precisely the gap that mNGS is increasingly filling. Studies across adult and pediatric intensive care settings have shown that metagenomic sequencing can shorten the time to diagnosis of opportunistic infections, detect mixed infections involving multiple pathogens simultaneously and reveal organisms that were never suspected clinically. The technology is not without limitations: it is more expensive than targeted tests, results require careful interpretation because sequencing can detect colonizing organisms or environmental contaminants alongside true pathogens, and the quantity of genetic material recovered depends heavily on sample quality. Quantitative thresholds and clinical correlation remain essential to distinguish meaningful detections from background noise. Nevertheless, for critically ill children whose conditions defy explanation, the case-by-case evidence continues to mount that early deployment of unbiased sequencing can change management and, in some instances, alter outcomes.

The Hebei Children’s Hospital team also raises the question of why an apparently immunocompetent infant would develop Pneumocystis pneumonia at all. The report’s listing of related subjects includes severe combined immunodeficiency, and clinicians reading such a case would typically consider an underlying immune defect as a possible predisposing factor, since Pneumocystis infection in infancy can occasionally be the first manifestation of a primary immunodeficiency that had not previously come to attention. Severe pertussis itself may also perturb immune defenses in ways that create an opening for opportunistic organisms, though the precise mechanisms linking the two infections in this patient cannot be established from a single case. The authors’ work was approved by the ethics committee of Hebei Children’s Hospital, carried out in accordance with the Declaration of Helsinki, and published with written informed consent from the child’s legal guardian.

For the wider pediatric community, the report arrives at a moment of renewed attention to pertussis. Resurgence of the disease has been documented in multiple countries in recent years as vaccination rates fluctuate and immunity wanes, returning whooping cough to the differential diagnosis of infant respiratory illness with new urgency. The study, supported by the Medical Science Research Project of Hebei under grant number 20241732, was published open access on October 12, 2026, and its message is directed squarely at frontline clinicians: in an infant with severe pertussis whose respiratory distress persists despite improving leukocyte counts and falling pulmonary pressures, do not stop looking. A second pathogen may be hiding in the lungs, and metagenomic sequencing offers a way to find it before the window for effective treatment closes.

Subject of Research: Diagnosis of Pneumocystis jirovecii co-infection in severe infant pertussis using metagenomic next-generation sequencing

Article Title: Case report of a child with severe pertussis complicated by pneumocystis pneumonia diagnosed through mNGS

Article References: Guo, F., Wang, Y., Jia, Y., Wu, X., & Kang, L. (2026). Case report of a child with severe pertussis complicated by pneumocystis pneumonia diagnosed through mNGS. BMC Pediatrics. https://doi.org/10.1186/s12887-026-07820-4

Image Credits: AI Generated

DOI: 10.1186/s12887-026-07820-4

Keywords: pertussis, Bordetella pertussis, Pneumocystis jirovecii, pneumocystis pneumonia, metagenomic next-generation sequencing, mNGS, co-infection, infants, pulmonary hypertension, pediatric intensive care, case report, diagnostics

The research team, led by Hui Wu of the Jiangxi Provincial Center for Disease Control and Prevention together with colleagues from the Zhejiang Provincial Center for Disease Control and Prevention, set out to fill a conspicuous gap in the evidence base. While the global resurgence of pertussis has been documented extensively in infants and, more recently, in adolescents and young adults, population-based data on the economic consequences of infection among older adults in China were essentially nonexistent. Using multi-stage stratified sampling, the investigators recruited pertussis patients aged sixty or older from three prefecture-level cities in Zhejiang—Hangzhou, Jiaxing, and Jinhua—drawing on national surveillance records, hospital information systems, and face-to-face interviews conducted in 2025. Of those approached, 195 participants completed the study, a response rate of 81.3 percent that lends considerable weight to the findings.

The headline figure is striking: the aggregate economic burden across the cohort reached 1,366,260 RMB, with a mean total cost per case of 7,007 RMB. But averages in cost data can be misleading, and the distribution here was heavily skewed. The median total cost was just 1,819 RMB, with an interquartile range stretching from 653 to 9,234 RMB—a pattern indicating that most patients incurred modest expenses while a minority, chiefly those requiring hospital admission, absorbed enormous costs. This right-skewed distribution is precisely why the researchers turned to generalized linear models with a gamma distribution and log link, a statistical approach designed for non-negative, continuous cost data that would be distorted by ordinary linear regression.

Breaking the burden into its components reveals where the money actually goes. Direct costs—medical expenditures, medications, diagnostic tests, and travel to care—accounted for 75.9 percent of the total, with medical spending alone representing 69.3 percent of the overall burden. Indirect costs, primarily lost productivity and the value of unpaid caregiving time, contributed the remaining 24.1 percent. For a disease that many clinicians still associate with school-age children, these figures underscore that pertussis in older adults is a genuinely resource-intensive condition, one that consumes hospital beds, laboratory capacity, and family resources in equal measure.

The starkest contrast in the study emerged between outpatients and inpatients. Among patients treated without hospital admission, the median total economic burden was a comparatively manageable 811 RMB. Among those hospitalized, the median soared to 11,098 RMB—nearly fourteen times higher, a difference that was highly statistically significant. In the generalized linear model, inpatient status was by far the dominant driver of cost, multiplying the expected total burden by a factor of 11.93 compared with outpatient care. Fever independently increased costs by 32 percent, and each additional day between the onset of symptoms and diagnosis added roughly two percent to the expected total, reflecting how prolonged illness before confirmation compounds both medical and indirect expenses.

Perhaps the most consequential finding concerns hospitalization itself. The overall hospitalization rate among older adults with pertussis in the cohort was 40.5 percent—an extraordinarily high proportion for a vaccine-preventable bacterial infection, and one that signals substantial clinical severity in this age group. To identify who was most at risk, the team fitted a multivariable binary logistic regression model, adjusting for potential confounders and checking for multicollinearity using variance inflation factors. The results painted a clear portrait of vulnerability: rural residence nearly tripled the odds of hospitalization (odds ratio 3.08), male sex raised them nearly threefold (odds ratio 2.80), and each additional year of age increased the odds by 15 percent, a cumulative effect that grows rapidly across the later decades of life.

Clinical presentation mattered as much as demographics. Patients presenting with fever were more than four times as likely to be hospitalized as those without it (odds ratio 4.11), while the presence of complications—conditions such as pneumonia that often accompany pertussis in frail older bodies—nearly tripled the odds (odds ratio 2.94). A prolonged interval between symptom onset and diagnosis also independently elevated hospitalization risk, with each additional day increasing the odds by four percent. Taken together, these determinants suggest a dangerous feedback loop: delayed recognition of pertussis in older adults allows the infection to progress, complications to develop, and the eventual illness to become severe enough to demand inpatient care, which in turn drives the economic burden to its highest levels.

The technical rigor of the study deserves attention in its own right. Cost data violate the assumptions of ordinary least squares regression because they cannot be negative and cluster near zero with a long right tail; the gamma distribution with a log link handles this structure naturally, modeling costs on a multiplicative scale so that coefficients can be interpreted as proportional changes in expected expenditure. The logistic regression for hospitalization followed standard epidemiological practice, and the multi-stage stratified sampling design across three cities with different economic and geographic profiles strengthens the generalizability of the findings within Zhejiang, though the authors and independent observers alike would caution that a single-province, cross-sectional design cannot capture temporal changes or prove causation for the associations identified.

Why is pertussis resurging among the elderly in the first place? The bacterium Bordetella pertussis causes a respiratory infection whose classic symptom—a prolonged, paroxysmal cough—can last for weeks and, in older adults, is easily mistaken for bronchitis, asthma, or other common conditions. Immunity from childhood vaccination wanes over decades, and in China, as in most countries, routine booster vaccination of older adults with tetanus-diphtheria-acellular pertussis (Tdap) vaccines is not standard practice. Waning immunity, improved PCR-based diagnostics that detect infections previously missed, and the cyclical nature of pertussis epidemics all likely contribute to the surge documented in Zhejiang. Older adults also face age-related declines in respiratory reserve, making even a nominally mild infection far more dangerous than it would be in a vaccinated adolescent.

The public health implications are concrete. The authors argue that enhanced diagnosis, strengthened surveillance, and improved clinical management represent the most promising near-term strategies to reduce hospitalizations and blunt the economic burden. Practically, that means training frontline clinicians to consider pertussis in the differential diagnosis of prolonged cough in patients over sixty, expanding access to timely laboratory confirmation, and evaluating whether targeted Tdap vaccination of older adults—already recommended in several high-income countries—would be cost-effective in the Chinese context. With a 40.5 percent hospitalization rate and a per-case cost that can exceed 11,000 RMB for admitted patients, the study makes a compelling economic case that prevention in this age group is not merely a clinical nicety but a fiscal imperative. As populations across China and much of the world continue to age, the silent resurgence of whooping cough among the elderly is a warning that vaccine-preventable diseases never truly disappear—they simply find new, and sometimes older, hosts.

Subject of Research: Economic burden and hospitalization determinants of pertussis among older adults in Zhejiang, China

Article Title: Economic burden of pertussis, its influencing factors, and hospitalization determinants among older adults (≥ 60 years) in Zhejiang, China: a cross-sectional study (2024–2025)

Article References: Wu, H., Zhou, Y., Zhu, Y., He, H., & Guo, S. (2026). Economic burden of pertussis, its influencing factors, and hospitalization determinants among older adults (≥ 60 years) in Zhejiang, China: a cross-sectional study (2024–2025). BMC Public Health. https://doi.org/10.1186/s12889-026-29610-4

Image Credits: AI Generated

DOI: 10.1186/s12889-026-29610-4

Keywords: pertussis, whooping cough, older adults, economic burden, hospitalization, Zhejiang, China, public health, health economics, vaccination, Bordetella pertussis, cross-sectional study

The scientific case for immunisation has never been stronger. Modelling of fifty years of the Expanded Programme on Immunization shows that vaccines have made a major contribution to improved survival and health worldwide. Recent evaluations of meningococcal B vaccines demonstrate how careful development, rigorous surveillance and real-world data can produce highly effective and safe products that substantially reduce severe childhood disease. Human papillomavirus vaccination has been associated with a substantial reduction in invasive cervical cancer risk, and rotavirus vaccination is recognised as a highly effective tool against severe gastroenteritis and hospitalisation in young children. The economic returns are equally striking: a recent American Academy of Pediatrics policy statement estimates that from 1994 to 2003 vaccination averted 500 million cases of vaccine-preventable disease, 32 million hospitalisations and 1.1 million deaths in the United States, saving 540 billion dollars in direct costs and 2.7 trillion dollars in indirect costs. European studies confirm similar reductions in disease and economic burden, and the World Health Organization has recognised that vaccines also curb antimicrobial resistance by preventing infections that would otherwise require antibiotics.

Yet the academy argues that this evidence base is being undermined by two interacting sets of barriers: access and acceptance. Access barriers include missed opportunities for vaccination during routine health visits, long travel distances and transportation costs in rural or underserved settings, weak follow-up and reminder systems, and limited timeliness in completing vaccine series. Socioeconomic position, maternal education and health literacy shape both the ability to navigate services and the capacity to interpret vaccination information. Marginalised and mobile groups, including migrants, refugees and displaced persons, face additional structural and administrative obstacles, fragmented care and legal and language barriers. Systematic reviews show that migrant and refugee populations in Europe often experience lower vaccination coverage than host populations, and recent register-based evidence among Ukrainian refugee children in Norway illustrates how mobility and incomplete records leave significant gaps in documented immunisation.

Acceptance barriers compound the problem. Parental confidence in vaccines varies between countries and communities and can be weakened by institutional mistrust, pandemic fatigue, inconsistent policy messaging and misinformation. In Europe, false claims are commonly amplified through social media, messaging applications and politicised narratives, gaining traction when families encounter access barriers, receive contradictory advice or perceive vaccine-preventable diseases as remote threats. The academy stresses that effective responses require far more than fact sheets: they demand social listening, pre-bunking and rapid correction of false claims, multilingual community engagement, trusted clinicians and community messengers, and transparent policy decisions visibly aligned with scientific evidence. Vaccine confidence, the paper argues, must be treated as a dynamic challenge that shifts with events rather than a static attitude to be measured once.

The consequences of these immunity gaps are no longer hypothetical. A comprehensive review in The New England Journal of Medicine documented a dramatic resurgence of measles, with more than 395,000 confirmed cases worldwide in 2024 and a further sharp increase in early 2025. Measles is emphatically not a benign childhood illness: it can cause encephalitis, post-infectious immune amnesia and subacute sclerosing panencephalitis, a devastating late complication. In the WHO European Region, more than 127,000 measles cases were recorded in 2024, double the number in 2023 and the highest figure since 1997, with children under five accounting for more than 40 percent of cases and 38 deaths reported. Pertussis has surged in parallel, with nearly 300,000 cases reported in the European Region in 2024, more than a three-fold increase on the previous year. Earlier joint statements by the European Commission, WHO Europe and UNICEF had already linked missed measles vaccination during and after the COVID-19 period to an up to sixty-fold increase in reported cases in 2023 compared with 2022.

The position paper sets out the cost of inaction in stark terms. Epidemiologically, clusters of susceptible children drive recurrent outbreaks, cross-border transmission and avoidable deaths. Individually, children who contract vaccine-preventable diseases may suffer acute illness, hospitalisation, long-term disability or death, along with interrupted education and psychological and financial burdens for families. Economically, outbreaks divert resources from routine care into emergency response, contact tracing, post-exposure prophylaxis and catch-up campaigns. At the system level, failure to invest in surveillance, digital records, workforce training and tailored communication perpetuates a reactive cycle in which gaps are detected late, responses are mounted under pressure, and the same vulnerabilities recur. Beyond the return of disease itself, the academy warns that inaction erodes trust and resilience in preventive child-health systems.

A central technical recommendation concerns documentation. Across Europe, increasing cross-border mobility makes reliable vaccination records essential, yet documentation remains fragmented, often non-digital and non-interoperable, making immunity gaps difficult to detect when children move between health systems. The academy calls for a pan-European digital vaccination-record standard: not a single central database, but an agreed minimum interoperable dataset, mapped to national schedules, protected by data-governance safeguards, and usable in routine care and catch-up vaccination, especially for mobile children and displaced families. It likewise urges expansion of national Immunisation Information Systems capable of real-time or at least quarterly coverage monitoring, detection of missed doses, automated reminders and recalls, and rapid outbreak response. Higher-resource systems may expand such infrastructure directly, while more decentralised or resource-constrained systems may need a staged approach beginning with a core dataset, regional pilots and paper-to-digital transition plans.

Measurement of behavioural barriers is another priority. The academy recommends embedding the WHO Behavioural and Social Drivers of Vaccination tools, the European Centre for Disease Prevention and Control’s 2025 social and behavioural science toolkit, and the Vaccine Barriers Assessment Tool into routine programme assessments, so that interventions are tailored to measured confidence, social norms, practical obstacles and trust rather than generic campaigns. It proposes a minimum monitoring framework tracking coverage for MMR, DTP, polio, HPV and other recommended vaccines by age, geography and equity strata, alongside timeliness, zero-dose and under-immunised children, stock-outs, outbreak incidence, reasons for under-vaccination and the proportion of vaccinators trained in evidence-based communication. Similar proposals have suggested that countries be assessed on their capacity to use social and behavioural data as a fourth indicator in the Joint External Evaluation tool.

Because vaccination is delivered by different professionals across Europe, the recommendations extend beyond paediatricians to general practitioners, nurses, school-health services, public-health teams and community health workers. Preventive paediatric care remains highly heterogeneous across the continent, and not all professionals involved in vaccine delivery have received formal immunisation training. The academy calls for structured education in vaccinology, contraindications, safety communication, motivational interviewing, culturally competent care and outbreak communication, drawing on the WHO Regional Office communication training module and the WHO Pocket book of primary health care for children and adolescents. On the contested question of mandates, the paper holds that compulsory vaccination can be ethically defensible only under strict conditions: when voluntary approaches have failed, disease risk is substantial, access barriers have been addressed, the measure is proportionate, time-limited and legally authorised, and medical exemptions and transparent monitoring protect public trust. Empathetic, patient-centred communication remains the first-line response, supported by narratives of preventable complications that illustrate, but never replace, scientific evidence.

The position paper concludes with a call to shift from high-level advocacy to measurable implementation. It urges harmonised Europe-wide surveillance, interoperable digital records, routine measurement of behavioural and access barriers, equity-focused catch-up schedules that screen for missed doses at primary-care, emergency, school-entry and adolescent contacts, and outreach to migrants, refugees, underserved urban districts and remote rural areas. It also warns that recent legal, regulatory and political shifts, combined with the spread of misinformation, have weakened long-standing protections for immunisation programmes, and that policy choices diverging from scientific evidence can rapidly undermine public health gains. Grounding its appeal in the WHO/UNICEF strategy for child and adolescent health adopted by all 53 Member States of the European Region, the academy frames the issue as a matter of children’s fundamental rights: every child deserves scientifically proven, safe interventions that protect them from avoidable harm. Protecting children today, the paper argues, safeguards the health, trust and resilience of future generations.

Subject of Research: Barriers to paediatric immunisation coverage and strategies to restore childhood vaccination rates in Europe

Article Title: Improving paediatric immunisation coverage rates: a position paper of the European Academy of Paediatrics

Article References: Dornbusch, H. J., Pana, Z. D., Torso, S. D., Hadjipanayis, A., Brierley, J., Karara, N., De Guchtenaere, A., Buttigieg, M., Grossman, Z., Kantor, I., Titomanlio, L., Wyder, C., Jullien, S., Craig, B. J., Pastore, R., Benes, O., Heininger, U., & Koletzko, B. (2026). Improving paediatric immunisation coverage rates: a position paper of the European Academy of Paediatrics. The Lancet Regional Health – Europe, 70, Article 101851. https://doi.org/10.1016/j.lanepe.2026.101851

Image Credits: AI Generated

DOI: 10.1016/j.lanepe.2026.101851

Keywords: childhood vaccination, vaccine hesitancy, measles, pertussis, European Academy of Paediatrics, immunisation coverage, digital vaccination records, misinformation, vaccine equity, public health, migrant health, Immunisation Information Systems