Routine Immunisations and the triple antigen

The triple antigen doesn’t receive a lot of attention as a “travel vaccine”. More exotic vaccines like typhoid, yellow fever and Japanese encephalitis receive far more.

The triple antigen (tetanus, diphtheria and whooping cough) is a very important vaccine. It is a routine immunisation in childhood and adolescence.

Being current as an adult isn’t just about the tetanus component of the vaccine.

Boosters of the triple antigen vaccine

A booster dose of dTpa vaccine is recommended for women in the third trimester of pregnancy to provide enhanced protection for the infant against whooping cough and it is also recommended for partners, grandparents and other close contacts of infants as part of our “cocoon policy” to reduce exposure to whooping cough in a family setting.

The disease can have serious consequences for children under 6 months of age. Hospitalisation rates are high.

The whooping cough comeback

It also makes sense for travellers to consider whooping cough boosters as notifications have surged in many countries, including Australia, the United States and the UK in the post pandemic period.

More than 64,000 cases of whooping cough have been notified in Australia the past 12 months (to mid-April 2025). This is quite a deal higher than the 16,000 mean annual figure for the 5 years prior to the start of the pandemic in early 2020. Are we seeing a catch up of cases because of our isolation measures or is it due to lower herd immunity in the community.

Global diphtheria outbreaks

More recently, the third component of the vaccine, diphtheria, has also received some public health attention.

According to news reports, over 60 confirmed cases of diphtheria have been notified in South Africa since January 2024 (to April 2025). Most cases have come from Western Cape. Several cases have been reported in Cape Town since November 2024. Diphtheria cases are also being reported in other parts of Africa including Chad which has a cumulative total of 2,054 cases and 24 deaths from January 1, 2025). Almost 900 cases have been reported in Niger with 58 deaths.

Of particular interest is a recent report in the weekly bulletin of ECDC (European Centre for Disease Prevention and Control) of an outbreak of diphtheria amongst migrants in Germany. This strain of the disease was first identified in 2022. A total of 536 cases have been reported from the beginning of 2022 to the end of April 2025. The report noted that “the probability of developing the disease is very low for individuals residing in the community, provided they have an up-to-date immunisation status”.

Diphtheria is a notifiable disease in Australia.

There have been 15 cases notified in the past 12 months (to mid-April 2025).

The annual number of notifications is up from the period just prior to the pandemic years (only 45 cases reported between 2011 and 2019).

In 2022, 5 cases of diphtheria were identified in a remote aboriginal community in North Queensland. A mass immunisation program was undertaken in the community and no further cases have been reported.

Consider a triple antigen booster if you are travelling and not up to date.