{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T16:14:15Z","timestamp":1782231255788,"version":"3.54.5"},"reference-count":81,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2025,8,31]],"date-time":"2025-08-31T00:00:00Z","timestamp":1756598400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Jenny and Antti Wihuri Foundation"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Vaccines"],"abstract":"<jats:p>Elite athletes are at an increased risk of infections due to behavioral and social factors and frequent travel. Furthermore, heavy physical exercise may induce immunosuppression. Most infections in athletes are acute respiratory illnesses (ARIs) with various viral etiologies. Although athletes, as young, healthy adults, are not at risk for severe infections, a prolonged ARI may ruin a training season or a significant competition or may spread within a sports team. Many common infections are vaccine-preventable. This Opinion advocates for more active vaccination among athletes, although some of the vaccines are not officially recommended for young adults. New respiratory syncytial virus (RSV) protein vaccines are effective and well-tolerated. Yearly influenza and COVID-19 vaccinations are strongly recommended. Conjugated polyvalent pneumococcal vaccines are recommended because they may also induce protection against respiratory viral infections. Pertussis and measles outbreaks are occurring globally. The history of measles vaccination should be reviewed, and consideration should be given to a pertussis booster vaccination (Tdap). A recombinant vaccine can effectively prevent herpes zoster. The vaccination of elite athletes is a cost-effective and powerful tool, but it is currently underused. The sports medicine community can address vaccine hesitancy among athletes by listening to their concerns and giving accurate information.<\/jats:p>","DOI":"10.3390\/vaccines13090931","type":"journal-article","created":{"date-parts":[[2025,9,2]],"date-time":"2025-09-02T16:05:22Z","timestamp":1756829122000},"page":"931","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Vaccinations for Elite Athletes"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4354-1187","authenticated-orcid":false,"given":"Olli","family":"Ruuskanen","sequence":"first","affiliation":[{"name":"Department of Paediatrics and Adolescent Medicine, Turku University Hospital and University of Turku, PL 52, 20521 Turku, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maarit","family":"Valtonen","sequence":"additional","affiliation":[{"name":"Finnish Institute of High Performance Sport KIHU, 40700 Jyv\u00e4skyl\u00e4, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1722-1729","authenticated-orcid":false,"given":"Olli J.","family":"Heinonen","sequence":"additional","affiliation":[{"name":"Paavo Nurmi Centre and Unit for Health and Physical Activity, University of Turku, 20520 Turku, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6747-0889","authenticated-orcid":false,"given":"Matti","family":"Waris","sequence":"additional","affiliation":[{"name":"Institute of Biomedicine, University of Turku, 20520 Turku, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jussi","family":"Mertsola","sequence":"additional","affiliation":[{"name":"Institute of Biomedicine, University of Turku, 20520 Turku, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,8,31]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1361","DOI":"10.1007\/s40279-014-0217-3","article-title":"Vaccination in elite athletes","volume":"44","author":"Meyer","year":"2014","journal-title":"Sports Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"630","DOI":"10.1136\/bjsports-2021-104737","article-title":"Incidence of acute respiratory illnesses in athletes: A systematic review and meta-analysis by a subgroup of the IOC consensus on \u201cacute respiratory illness in the athlete\u201d","volume":"56","author":"Derman","year":"2022","journal-title":"Br. J. Sports Med."},{"key":"ref_3","unstructured":"Gr\u00f6nroos, W., Uhari, M., and Ruuskanen, O. (2025). Occurrence of acute respiratory illnesses in athletes: A systematic review and meta-analysis. Exerc. Immunol. Rev., in press."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"2653","DOI":"10.1111\/all.15328","article-title":"Physical exercise, immune response, and susceptibility to infections-current knowledge and growing research areas","volume":"77","author":"Kurowski","year":"2022","journal-title":"Allergy"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1710","DOI":"10.7326\/M21-2780","article-title":"Current insights into respiratory virus transmission and potential implications for infection control programs","volume":"174","author":"Klompas","year":"2021","journal-title":"Ann. Intern. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"eabd9149","DOI":"10.1126\/science.abd9149","article-title":"Airborne transmission of respiratory viruses","volume":"373","author":"Wang","year":"2021","journal-title":"Science"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Valtonen, M., Gr\u00f6nroos, W., Luoto, R., Waris, M., Uhari, M., Heinonen, O.J., and Ruuskanen, O. (2021). Increased risk of respiratory viral infections in elite athletes: A controlled study. PLoS ONE, 16.","DOI":"10.1371\/journal.pone.0250907"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Luoto, R., Laatikainen-Raussi, V., Mj\u00f6sund, K.E., Valtonen, M., Uhari, M., Ihalainen, J.K., Vuorinen, T., Hakanen, A., Waris, M., and Heinonen, O.J. (2025). Viral acute respiratory illnesses in elite athletes: A 12-month controlled follow-up study. PLoS ONE, 20.","DOI":"10.1371\/journal.pone.0322283"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"200","DOI":"10.1093\/occmed\/kqaa004","article-title":"Vaccination practices and influenza in professional football players in Greece","volume":"70","author":"Papagiannis","year":"2020","journal-title":"Occup. Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"e470","DOI":"10.1097\/JSM.0000000000000969","article-title":"Screening identifies suboptimal vaccination protection in illness-susceptible elite athletes","volume":"31","author":"Turner","year":"2021","journal-title":"Clin. J. Sport Med."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Marinos, G., Lamprinos, D., Georgakopoulos, P., Kavoukidis, N., Oikonomou, E., Zoumpoulis, G., Siasos, G., Schizas, D., Nikolopoulos, A., and Botonis, P.G. (2022). Evaluation of the perceptions, attitudes and practices among Greek non-professional athletes visiting a public hospital during March 2022, towards COVID-19 vaccination and its consequences on sports training and sports activity. Vaccines, 10.","DOI":"10.3390\/vaccines10111821"},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Ricco, M., and Peruzzi, S. (2022). Tetanus vaccination status and vaccine hesitancy in amateur basketball players (Italy, 2020). Vaccines, 10.","DOI":"10.3390\/vaccines10010131"},{"key":"ref_13","first-page":"448","article-title":"Prevalence of immunity to hepatitis B in NCAA athletes","volume":"65","author":"Shahi","year":"2024","journal-title":"J. Sports Med. Phys. Fit."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"2527448","DOI":"10.1080\/21645515.2025.2527448","article-title":"Vaccination coverage among adolescent athletes: Patterns, gaps, and implications for sports medicine","volume":"21","author":"Komici","year":"2025","journal-title":"Hum. Vaccines Immunother."},{"key":"ref_15","unstructured":"Center for Disease Control and Prevention (2023, December 28). Recommended Adult Immunisation Schedule for Ages 19 Years or Older, Available online: https:\/\/www.cdc.gov\/vaccines\/hcp\/imz-schedules\/adult-age.html."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1498","DOI":"10.1016\/S0140-6736(24)02150-0","article-title":"Real-world effectiveness studies of the benefit of RSV vaccines","volume":"404","author":"Branche","year":"2024","journal-title":"Lancet"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1732","DOI":"10.1093\/cid\/ciae010","article-title":"Efficacy and safety of respiratory syncytial virus (RSV) prefusion F protein vaccine (RSVPreF3 OA) in older adults over 2 RSV seasons","volume":"78","author":"Ison","year":"2024","journal-title":"Clin. Infect. Dis."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1015","DOI":"10.1016\/S1473-3099(24)00226-3","article-title":"Long-term efficacy and immunogenicity of Ad26.RSV.preF-RSV preF protein vaccine (CYPRESS): A randomised, double-blind, placebo-controlled, phase 2b study","volume":"24","author":"Falsey","year":"2024","journal-title":"Lancet Infect. Dis."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"e13236","DOI":"10.1111\/irv.13236","article-title":"The respiratory syncytial virus prefusion F protein vaccine attenuates the severity of respiratory syncytial virus-associated disease in breakthrough infections in adults \u226560 years of age","volume":"18","author":"Curran","year":"2024","journal-title":"Influenza Other Respir. Viruses"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e747","DOI":"10.1016\/S1473-3099(24)00455-9","article-title":"The respiratory syncytial virus vaccine and monoclonal antibody landscape: The road to global access","volume":"24","author":"Terstappen","year":"2024","journal-title":"Lancet Infect. Dis."},{"key":"ref_21","first-page":"734","article-title":"Respiratory syncytial virus infection and novel interventions","volume":"21","author":"Langedijk","year":"2023","journal-title":"Nat. Rev."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1093","DOI":"10.1136\/bjsports-2018-100487","article-title":"Common cold in Team Finland during 2018 Winter Olympic Games (PyeongChang): Epidemiology, diagnosis including molecular point-of-care testing (POCT) and treatment","volume":"53","author":"Valtonen","year":"2019","journal-title":"Br. J. Sports Med."},{"key":"ref_23","first-page":"10","article-title":"Respiratory syncytial virus outbreak in the basic military training camp of the Republic of Korea air force","volume":"48","author":"Park","year":"2015","journal-title":"J. Prev. Med. Public Health"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"ofu118","DOI":"10.1093\/ofid\/ofu118","article-title":"Transmission of respiratory syncytial virus infection within families","volume":"2","author":"Heikkinen","year":"2014","journal-title":"Open Forum Infect. Dis."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Cox, S.N., Roychoudhury, P., Frivold, C., Acker, Z., Babu, T.M., Boisvert, C.L., Carone, M., Ehmen, B., Englund, J.A., and Feldstein, L.R. (2025). Household transmission and genomic diversity of respiratory syncytial virus (RSV) in the United States, 2022\u20132023. Clin. Infect. Dis., ciaf048.","DOI":"10.1093\/cid\/ciaf048"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"439","DOI":"10.1016\/S2213-2600(23)00015-2","article-title":"Long-term effectiveness of COVID-19 vaccines against infections, hospitalisations, and mortality in adults: Findings from a rapid living systematic evidence synthesis and meta-analysis up to December, 2022","volume":"11","author":"Wu","year":"2023","journal-title":"Lancet Respir. Med."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"819","DOI":"10.15585\/mmwr.mm7337e2","article-title":"Use of COVID-19 vaccines from persons aged \u22656 months: Recommendations of the Advisory Committee on Immunization Practices\u2014United States, 2024\u20132025","volume":"73","author":"Panagiotakopoulos","year":"2024","journal-title":"MMWR. Morb. Mortal. Wkly. Rep."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"2484","DOI":"10.1056\/NEJMsb2506929","article-title":"An evidence-based approach to COVID-19 vaccination","volume":"392","author":"Prasad","year":"2025","journal-title":"N. Engl. J. Med."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"316","DOI":"10.1093\/cid\/ciae559","article-title":"Optimal annual COVID-19 vaccine boosting dates following previous booster vaccination or breakthrough infection","volume":"80","author":"Townsend","year":"2025","journal-title":"Clin. Infect. Dis."},{"key":"ref_30","first-page":"63","article-title":"Immune response to COVID-19 Vaccination in elite athletes","volume":"30","author":"Halmans","year":"2024","journal-title":"Exerc. Immunol. Rev."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"e5","DOI":"10.1016\/S2213-2600(21)00548-8","article-title":"Tolerability and impact of SARS-CoV-2 vaccination in elite athletes","volume":"10","author":"Hull","year":"2022","journal-title":"Lancet Respir. Med."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1327","DOI":"10.1093\/eurheartj\/ehae056","article-title":"Booster vaccination with SARS-CoV-2 mRNA vaccines and myocarditis in adolescents and young adults: A Nordic cohort study","volume":"45","author":"Hviid","year":"2024","journal-title":"Eur. Heart J."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1097\/JSM.0000000000001320","article-title":"Systematic review of COVID-19 and COVID-19 mRNA vaccine myocarditis in athletes: Incidence, diagnosis, prognosis, and return-to-play principles","volume":"35","author":"Mahneva","year":"2025","journal-title":"Clin. J. Sport Med."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"7745","DOI":"10.1038\/s41467-024-52038-6","article-title":"Influence of mRNA COVID-19 vaccine dosing interval on the risk of myocarditis","volume":"15","author":"Vu","year":"2024","journal-title":"Nat. Commun."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1367","DOI":"10.1001\/jama.2024.16380","article-title":"Long-term prognosis of patients with myocarditis attributed to COVID-10 mRNA vaccination, SARS-CoV-2 infection, and conventional etiologies","volume":"332","author":"Semenzato","year":"2024","journal-title":"JAMA"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"713","DOI":"10.1007\/s40279-024-02153-7","article-title":"Causes of COVID-19 outbreaks during sports and exercise: A systematic review","volume":"55","author":"Machida","year":"2025","journal-title":"Sports Med."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"941","DOI":"10.1136\/bjsports-2022-105583","article-title":"Acute and post-acute COVID-19 presentations in athletes: A systematic review and meta-analysis","volume":"56","author":"Lemes","year":"2022","journal-title":"Br. J. Sports Med."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"528","DOI":"10.1016\/j.jsams.2023.07.011","article-title":"Recovery from COVID-19 in athletes and impact on sporting participation","volume":"26","author":"Hull","year":"2023","journal-title":"J. Sci. Med. Sport"},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Monosilio, S., Prosperi, S., Squeo, M.R., Spataro, S., Spataro, A., and Maestrini, V. (2023). Short and long-term cardiovascular sequelae after SARS-CoV-2 infection: A narrative review focusing on athletes. Viruses, 15.","DOI":"10.3390\/v15020493"},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Tsampasian, V., Androulakis, E., Catumbela, R., Gati, S., Papadakis, M., and Vassiliou, V.S. (2024). Prevalence of abnormal cardiovascular magnetic resonance findings in athletes recovered from COVID-19 infection: A systematic review and meta-analysis. J. Clin. Med., 13.","DOI":"10.3390\/jcm13113290"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"452","DOI":"10.1080\/00913847.2024.2321629","article-title":"Long-term manifestations of COVID-19 in athletes: A narrative review","volume":"52","author":"Ribeiro","year":"2024","journal-title":"Physician Sports Med."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"793","DOI":"10.15585\/mmwr.mm7336a3","article-title":"Use of 21-valent pneumococcal conjugate vaccine among U.S. adults: Recommendations of the Advisory Committee on Immunization Practices-United States, 2024","volume":"73","author":"Kobayashi","year":"2024","journal-title":"MMWR Morb. Mortal. Wkly. Rep."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1590","DOI":"10.1093\/infdis\/jiaa558","article-title":"Dynamics of pneumococcal carriage in adults: A new look at an old paradigm","volume":"223","author":"Almeida","year":"2021","journal-title":"J. Infect. Dis."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1608","DOI":"10.1016\/j.chom.2024.07.024","article-title":"RSV and rhinovirus increase pneumococcal carriage acquisition and density, whereas nasal inflammation is associated with bacterial shedding","volume":"32","author":"Mitsi","year":"2024","journal-title":"Cell Host Microbe"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"915","DOI":"10.1016\/S2213-2600(24)00148-6","article-title":"Interactions between respiratory syncytial virus and Streptococcus pneumoniae in the pathogenesis of childhood respiratory infections: A systematic review","volume":"12","author":"Besterman","year":"2024","journal-title":"Lancet Respir. Med."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"2040","DOI":"10.3201\/eid2511.190157","article-title":"Nasopharyngeal pneumococcal density during asymptomatic respiratory virus infection and risk for subsequent acute respiratory illness","volume":"25","author":"Howard","year":"2019","journal-title":"Emerg. Infect. Dis."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"e657","DOI":"10.1093\/infdis\/jiae125","article-title":"Effect of pneumococcal conjugate vaccines on viral respiratory infections: A systematic review","volume":"230","author":"Dunne","year":"2024","journal-title":"J. Infect. Dis."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"811","DOI":"10.1038\/nm1077","article-title":"The Vaccine Trialist Group. A role for Streptococcus pneumoniae in virus-associated pneumonia","volume":"10","author":"Madhi","year":"2004","journal-title":"Nat. Med."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"498","DOI":"10.1093\/infdis\/jiac098","article-title":"Effectiveness of pneumococcal conjugate Vaccination against virus-associated lower respiratory tract infection among adults: A case-control study","volume":"227","author":"Lewnard","year":"2023","journal-title":"J. Infect. Dis."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"e1082","DOI":"10.1093\/infdis\/jiae387","article-title":"Association of pneumococcal conjugate Vaccination with severe acute respiratory syndrome coronavirus 2 infection among older adult recipients of coronavirus disease 2019 vaccines: A longitudinal cohort study","volume":"230","author":"Lewnard","year":"2024","journal-title":"J. Infect. Dis."},{"key":"ref_51","doi-asserted-by":"crossref","unstructured":"Marra, F., Yip, M., Cragg, J.J., and Vadlamudi, N.K. (2024). Systematic review and meta-analysis of recombinant herpes zoster vaccine in immunocompromised populations. PLoS ONE, 19.","DOI":"10.1371\/journal.pone.0313889"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"104893","DOI":"10.1016\/j.idnow.2024.104893","article-title":"Sports and immunity, from the recreational to the elite athlete","volume":"54","author":"Baskerville","year":"2024","journal-title":"Infect. Dis. Now"},{"key":"ref_53","first-page":"28","article-title":"Immunometabolism-fit: How exercise and training can modify T cell and macrophage metabolism in health and disease","volume":"28","author":"Lira","year":"2022","journal-title":"Exerc. Immunol. Rev."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1056\/NEJMcp1302674","article-title":"Herpes zoster","volume":"369","author":"Cohen","year":"2013","journal-title":"N. Engl. J. Med."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"693","DOI":"10.1016\/S0140-6736(22)00982-5","article-title":"Influenza","volume":"400","author":"Uyeki","year":"2022","journal-title":"Lancet"},{"key":"ref_56","doi-asserted-by":"crossref","unstructured":"Clark, T.W., Trgoning, J.S., Lister, H., Poletti, T., Amin, F., and Nguyen-Van-Tam, J.S. (2024). Recent advances in the influence virus vaccine landscape: A comprehensive overview of technologies and trials. Clin. Microbiol. Rev., 37.","DOI":"10.1128\/cmr.00025-24"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"893","DOI":"10.1093\/cid\/ciae491","article-title":"Influenza vaccine effectiveness against illness and asymptomatic infection in 2022\u20132023: A prospective cohort study","volume":"80","author":"White","year":"2025","journal-title":"Clin. Infect. Dis."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1016\/S1473-3099(22)00493-5","article-title":"Severity of influenza illness by seasonal influenza vaccination status among hospitalised patients in four South American countries, 2013\u201319: A surveillance-based cohort study","volume":"23","author":"Regan","year":"2023","journal-title":"Lancet Infect. Dis."},{"key":"ref_59","doi-asserted-by":"crossref","unstructured":"Bohn-Goldbaum, E., Owen, K.B., Lee, V.Y., Booy, R., and Edwards, M. (2022). Physical activity and acute exercise benefit influenza vaccination response: A systematic review with individual data meta-analysis. PLoS ONE, 17.","DOI":"10.1371\/journal.pone.0268625"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"1285","DOI":"10.1016\/S0140-6736(17)33293-2","article-title":"Estimates of global seasonal influenza-associated respiratory mortality: A modelling study","volume":"391","author":"Iuliano","year":"2018","journal-title":"Lancet"},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1093\/infdis\/jiaa690","article-title":"Point-of-care influenza testing impacts clinical decision, patient flow, and length of stay in hospitalised adults","volume":"226","author":"Fjellveit","year":"2022","journal-title":"J. Infect. Dis."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"144","DOI":"10.3201\/eid1201.050645","article-title":"Influenza, Winter Olympiad, 2002","volume":"12","author":"Gundlapalli","year":"2006","journal-title":"Emerg. Infect. Dis."},{"key":"ref_63","doi-asserted-by":"crossref","unstructured":"Lindblad, N., H\u00e4nninen, T., Valtonen, M., Heinonen, O.J., Waris, M., and Ruuskanen, O. (2022). Influenza A outbreaks in two professional ice hockey teams during COVID-19 epidemic. Viruses, 14.","DOI":"10.3390\/v14122730"},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"722","DOI":"10.1038\/s41579-024-01064-8","article-title":"Pertussis vaccines, epidemiology and evolution","volume":"22","author":"Rohani","year":"2024","journal-title":"Nat. Rev. Microbiol."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"557","DOI":"10.1016\/S1473-3099(11)70007-X","article-title":"Rationale for pertussis booster vaccination throughout life in Europe","volume":"11","author":"Zepp","year":"2011","journal-title":"Lancet Infect. Dis."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"639","DOI":"10.1080\/14787210.2025.2516556","article-title":"Challenges associated with pertussis detection, monitoring, and vaccination in adults","volume":"23","author":"Regan","year":"2025","journal-title":"Expert Rev. Anti-Infect. Ther."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"359","DOI":"10.1016\/S0022-3476(83)80403-X","article-title":"Intrafamilial spread of pertussis","volume":"103","author":"Mertsola","year":"1983","journal-title":"J. Pediatr."},{"key":"ref_68","first-page":"285","article-title":"Measles 2025","volume":"4","author":"Do","year":"2025","journal-title":"N. Engl. J. Med."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1016\/S0022-3476(78)80597-6","article-title":"Measles vaccination after exposure to natural measles","volume":"93","author":"Ruuskanen","year":"1978","journal-title":"J. Pediatr."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"1565","DOI":"10.1016\/S0140-6736(25)00675-0","article-title":"Measles: The urgent need for global immunisation and preparedness","volume":"405","author":"Kuppalli","year":"2025","journal-title":"Lancet"},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"102388","DOI":"10.1016\/j.ttbdis.2024.102388","article-title":"Publicly available surveillance data on tick-borne encephalitis in Europe, 2023","volume":"15","author":"Angulo","year":"2024","journal-title":"Ticks Ticks Borne Dis."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"1861","DOI":"10.1016\/S0140-6736(08)60800-4","article-title":"Tick-borne encephalitis","volume":"371","author":"Lindqvist","year":"2008","journal-title":"Lancet"},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"ofaf317","DOI":"10.1093\/ofid\/ofaf317","article-title":"Clinical spectrum of dynamics and sequelae following tick-borne encephalitis virus infection: A systematic literature review","volume":"12","author":"Halsby","year":"2025","journal-title":"Open Forum Infect. Dis."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"891","DOI":"10.1016\/S0140-6736(25)01458-8","article-title":"Chikungunya virus disease returns to Europe: A turning point for the global arboviral landscape","volume":"406","author":"Zumla","year":"2025","journal-title":"Lancet"},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"2342","DOI":"10.1038\/s41591-025-03703-w","article-title":"Global burden of chikungunya virus infections and the potential benefit of vaccination campaigns","volume":"31","author":"Jawed","year":"2025","journal-title":"Nat. Med."},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"2335","DOI":"10.1038\/s41591-025-03684-w","article-title":"Modeling the impact of vaccine campaigns on the epidemic transmission dynamics of chikungynya virus outbreaks","volume":"31","author":"Cauchemez","year":"2025","journal-title":"Nat. Med."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1056\/NEJMra2106441","article-title":"The vaccine-hesitant moment","volume":"387","author":"Larson","year":"2022","journal-title":"N. Engl. J. Med."},{"key":"ref_78","first-page":"28991","article-title":"How to speak to a vaccine sceptic: Research reveals what works","volume":"624","author":"Pearson","year":"2025","journal-title":"Nature"},{"key":"ref_79","doi-asserted-by":"crossref","unstructured":"Sobierajski, T., Krzywanski, J., Mikulski, T., Pokrywka, A., Krysztofiak, H., and Kuchar, E. (2022). Sports elite means vaccine elite? Concerns and beliefs related to COVID-19 vaccines among Olympians and elite athletes. Vaccines, 10.","DOI":"10.3390\/vaccines10101676"},{"key":"ref_80","first-page":"1603","article-title":"Timing of vaccination after training: Immune response and side effects in athletes","volume":"52","author":"Stenger","year":"2020","journal-title":"Med. Sci. Sports Med."},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"274","DOI":"10.1093\/infdis\/jiaf239","article-title":"Trust, a key to counter vaccine hesitancy","volume":"232","author":"Abdelkader","year":"2025","journal-title":"J. Infect. Dis."}],"container-title":["Vaccines"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-393X\/13\/9\/931\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:36:25Z","timestamp":1760034985000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-393X\/13\/9\/931"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,31]]},"references-count":81,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2025,9]]}},"alternative-id":["vaccines13090931"],"URL":"https:\/\/doi.org\/10.3390\/vaccines13090931","relation":{},"ISSN":["2076-393X"],"issn-type":[{"value":"2076-393X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,31]]}}}