Whooping cough is on the rise

Pertussis is having its moment. We hear plenty about measles cases surging due to vaccine hesitancy, but not so much about pertussis, or whooping cough as it’s commonly known. 

Most people associate whooping cough with children, easily recognizable from the characteristic noise that accompanies the infection.  Lately it has become more common in adults, mostly associated with an episodic uncontrollable cough, that is so hard that it may cause vomiting.  Pneumonia can result, which is the cause of most of the associated deaths.  At highest risk of serious outcomes are infants under 1 year old, adults over 65, pregnant women, and those with lung disease, such as COPD or asthma.  

The rate of pertussis infection in the United States decreased after the vaccine was introduced in 1948, until about 2012.  After it rose, it remained elevated until 2020, when all respiratory infections decreased as a result of COVID precautions.  However, there has been a steep rise in cases since 2023, resulting in 35,000 cases last year.  That number is likely to more than double in 2025, resulting in the highest number of cases since the vaccine was introduced.  Some of that increase may be due to better reporting of this ‘nationally notifiable disease’, and the fact that we are more aware of and more likely to test for it.  However, it may also be increasing because of vaccine hesitancy and because we are using a weaker version of the vaccine in order to limit side effects from it.  

Children receive a series of pertussis vaccines during their routine physicals, with an additional booster usually at about 11-12 years old.  Even that immunity may wane by the time they are in their older teens.  In the United States, one pertussis booster is recommended after age 18, and during every pregnancy, as well as potentially an update every 10 years, along with their tetanus booster (Tdap contains tetanus, diphtheria and acellular pertussis).  

Most often over the past few decades, when patients were treated in an emergency room for an injury, they received the form without pertussis. Some insurance companies previously only covered the tetanus booster without pertussis so even if you’re up to date with your tetanus vaccine through your primary care provider, you should check which form you received.  

In Europe, Tdap is recommended every 10 years for all adults.  Any adults in the U.S., especially those working with infants or in health care, should discuss adhering to this latter recommendation with their physician.  

If someone is diagnosed with pertussis, the most common treatment is 5 days of azithromycin, which will decrease the chances of sharing it with others.  They should avoid close contact with others for that time. For the cough, dextromethorphan (DM) is an over-the-counter suppressant.  Also potentially helpful: drink plenty of fluids, avoid irritants (pollen, smoke, pollution …), and eat small meals to decrease the risk of vomiting. 

Adults who are exposed to a patient face-to-face or to their mucus or other bodily fluids, and are at high risk of complications can talk to their doctor about having preventative treatment with azithromycin as well.  If this medication interacts with your other medications, there are alternatives. 

Since 2020, vaccination rates in kindergarten-age children have been decreasing, including for MMR (mumps, measles and rubella), dTap (diphtheria, tetanus and pertussis), hepatitis B and polio, more significantly in some geographic areas than in others.  Recent cuts in Health and Human Services include layoffs of people involved in state and local public health agencies who educate people about vaccines, run vaccination clinics and study the spread of disease, among other services, so we may be looking at even lower vaccination rates in the near future.  

Each one of us can decrease the overall risk regarding the spread of disease by keeping our own vaccinations up to date and encouraging others to do so as well.  For more information, see the CDC website.