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The study protocol was approved by the Institutional Review Board of the Chinese Center for Disease Control and Prevention under the ethics approval for \u201cReal-World Study on Vaccine Effectiveness Against Pertussis and Other Diseases\u201d (approval number: 202455, approval date: December 30, 2024). As the lead institution of the program, the China CDC obtained the centralized ethical approval covering all collaborating units and participating sites. The IRB waived the requirement for informed consent as this study involved secondary analysis of anonymized individual-level data extracted from the Zhejiang Provincial Immunization Information System. All personal identifiers were removed prior to data extraction, and no direct participant contact was involved. 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