By Mary Gay Broderick and Katie Kerwin McCrimmon

Cases of whooping cough have quadrupled this year across the U.S. compared to the same period last year, prompting infectious disease experts to sound alarms and urge vaccines to protect vulnerable newborns, pregnant women, health care workers and immunocompromised adults.

As of late August of this year, health experts at the U.S. Centers for Disease Control and Prevention (CDC) have logged 12,353 cases of whooping cough, also known as pertussis. That’s up from 3,081 cases during the same period last year.

Whooping cough outbreaks and pertussis cases in the United States

CDC experts say cases of pertussis dropped sharply during the peak years of the COVID-19 pandemic but have spiked this year. Whooping cough infections dropped dramatically in the U.S. from the 1960s through the 1990s after the development of life-saving vaccines, but infections surged sharply in the 2000s as vaccine misinformation took hold. (View year-by-year cases of pertussis in the U.S.) During 2019, before COVID-19 hit, health experts reported more than 18,000 cases of whooping cough in the U.S. As people took precautions to prevent COVID-19, whooping cough cases dropped to a low of just over 2,000 cases in 2021 but have been climbing since then.

Pertussis can strike both children and adults. It’s especially dangerous and can cause hospitalizations — and death in rare cases — for unprotected newborns.

To learn more about pertussis and how people can protect themselves and their loved ones, we consulted with Lauren Bryan, infection prevention program manager at UCHealth Yampa Valley Medical Center in Steamboat Springs.

Getting vaccinated in the No. 1 way to prevent pertussis infections.

“The old saying ‘An ounce of prevention is worth a pound of cure’ is so true when it comes to protecting yourself and others,” Bryan said.

“Many people minimize the impact of vaccine-preventable illnesses like pertussis, but they can be devastating to others, especially the very young, the very old and people who are immunocompromised,” she said.

“Whooping cough is incredibly transmissible but very preventable if children are vaccinated,” Bryan said. “We saw declines in the state from 2013 to 2021, but sadly, that trend is now going the wrong way.”

What is pertussis?

Pertussis is a vaccine-preventable, contagious respiratory illness caused by the bacteria, Bordetella pertussis. These bacteria spread from person to person through the air. These bacteria attach to the cilia of the upper respiratory tract and release toxins that damage the cilia and cause the airway to swell. It is the toxin that really causes the harm. Cilia are hair-like projections lining the bronchus in our lungs that help move debris, mucus and germs toward our mouth so we can sneeze or cough them out of our body.

Why is whooping cough so dangerous?

Unfortunately, severe complications are common with pertussis. One in three babies with pertussis requires hospitalization, while one in five babies will develop pneumonia, and some will develop seizures or swelling of the brain. Teens and adults may develop pneumonia after having pertussis, Bryan said.

How contagious is whooping cough or pertussis? 

Pertussis is highly contagious. An estimated 80% of susceptible people will contract the illness after close exposure to someone who is infected. Once a person is exposed, it typically takes between 5-to-10 days for an infected person to develop symptoms, but it can take as long as 21 days.

How does pertussis spread? 

The bacteria that causes whooping cough or pertussis spreads through the air from one infected person to others. A person is contagious for a long time, at least two weeks after symptoms start.

“That means an infected person cannot go to work or school or take part in activities for at least two weeks if they get infected,” Bryan said. 

Why is the infection called whooping cough?

“The swelling of airways often causes a high pitched ‘whoop’ sound when the person inhales after a coughing fit,” Bryan said. “People often describe the cough as the worst of their lives. Some vomit after coughing fits, are very fatigued from coughing and struggle to sleep breathe, or even break a rib from such violent coughing.”

Why am I hearing about whooping cough or pertussis now?

Pertussis is in the news because cases are on the rise after a temporary reduction in cases during the pandemic.

What are the symptoms and stages of whooping cough? 

A whooping cough infection can last an average of 12 weeks.

There are generally three stages of whooping cough but the duration can vary widely from person to person, Bryan said.

• Early symptoms include a fever, runny nose and a mild cough, which can last from one to two weeks. Children and adults are most infectious during this phase.
• In the second stage, symptoms include the characteristic whooping cough when inhaling between fits of rapid exhausting coughing.
• The recovery stage lasts an additional two to three weeks where the coughing fits gradually decrease, but due to the cilia damage, a patient is at risk for other respiratory infections.

Who can get pertussis? 

Anyone can get pertussis including newborns, children and adults. But 70 percent of deaths are in newborns under two months of age, which is before they are eligible for their first vaccine.

Is there a vaccine to prevent pertussis or whooping cough?

Yes. There are two different forms of the vaccine: DTaP is used to provide new immunity against diphtheria, tetanus and pertussis, whereas Tdap is used to boost that immunity, with the dose being lower than in the DTaP version. Both vaccines are safe and cause a person’s body to make antibodies that will provide protection if a person is exposed to pertussis.

I thought no one got whooping cough anymore?

It used to be true that very few people got whooping cough or pertussis. But misinformation about vaccines has reduced the number of people who are getting routine vaccinations or protecting their infants and children. And some vulnerable people are not eligible for vaccines. Newborns cannot get their first dose of the pertussis vaccine until after they are 2 months old. Adults need to get booster shots every 10 years.

What about pregnant women? Do they need pertussis booster shots?

Yes. Those who are pregnant should get a pertussis booster shot when they are 27 to 36 weeks pregnant. View pertussis recommendations for people of all ages.

Who is most susceptible to whooping cough?

Babies under a year old are at the greatest risk from whooping cough or from having severe complications from it. Other people can get very sick with pertussis or whooping cough. They include immunocompromised people including those with moderate to severe asthma.

Is it true that only infants and children get whooping cough?

No. Anyone of any age can get pertussis. Infections are typically most severe in newborns, older people and those who are immunocompromised. Pertussis, like other respiratory illnesses including COVID-19, is an opportunistic bacterial infection. It spreads through the air, which is why the cough is so dangerous. Even vaccinated people can get infected, but their illnesses will be far less severe than if they were not vaccinated.

Is my child safe from whooping cough if they are up to date on their vaccines?

Vaccines provide excellent protections, but it’s important that children and adults are up to date on their vaccine. Newborns can receive their first doses at 2 months of age. For children who are five to nine years old, DTaP vaccination provides 75% immunity that gradually wanes over time.

That is why we get booster shots as we age. And that’s also why it’s vital for as high a percentage of people of all ages in our community to get vaccinated. High vaccination rates create what experts call “herd immunity,” meaning most people are protected and viruses or bacteria will thus have a harder time spreading and taking hold.

When should children get pertussis vaccines?

DTaP is a five-dose series for children: at 2 months, 4 months, 6 months, 15-18 months and at 4-6 years.  Adolescents need a dose of Tdap at 11-12 years.  Adults need a dose every 10 years. Women need a Tdap during the third trimester of pregnancy.

Why should adults get pertussis vaccines?

Adults should stay up to date on all of their vaccines and should receive recommended Tdap boosters, which also protect against diphtheria and tetanus along with pertussis. Pertussis causes a terrible cough and can be life threating in some people. Plus adults will want to protect vulnerable loved ones from newborns to older people.

“No one wants to infect and potentially cause harm to a baby,” Bryan said.

Why should caregivers and health care workers get vaccinated that prevent pertussis?

It is important for caregivers and health care workers to be sure to stay up to date on Tdap vaccines so they can prevent the spread of pertussis.

Along with getting vaccinated for pertussis, what are the best ways to prevent the spread of the illness?

• Wash your hands often.
• Stay at home if you are sick.
• Don’t send sick children to school.
• If possible, self-isolate in your home and use separate towels for sick family members.
• Wear a mask if you need to be in public.

What are the treatments for whooping cough or pertussis?

Doctors can provide antibiotics during the early phase of the illness before the “whooping” cough develops. Of course, it’s hard to know that a person has whooping cough before trademark cough appears.

Antibiotics can reduce the impact from symptoms.

“Once the cilia have been damaged by the toxin released by the bacteria, antibiotics will not shorten the duration of the illness,” Bryan said. “Some people who have been exposed to a person with pertussis may need to take antibiotics to prevent them from developing infection.”

What precautions should I take if my child has whooping cough?  

Do not send babies or children to childcare, school or other activities.

“Any infected person needs to quarantine at home until a public health official tells them they are no longer infectious,” Bryan said.

I’m worried my child might have whooping cough. Should I take my child to the hospital?

“You should make an appointment with your doctor for any concerning symptoms. If the child has periods when they stop breathing (apnea), their coloring is very pale or turning blue, or they are not drinking sufficiently to have a normal number of wet diapers, they need to come to the ER immediately,” Bryan said.

If you do go see a provider, alert them ahead of time, or ensure that you and your child are wearing masks so you don’t inadvertently expose others in the waiting room.

Are there home treatments for whooping cough or pertussis?

Only certain antibiotics are effective against Bordetella pertussis, so it is important to see your doctor if you develop symptoms.

“Again, It’s important for caregivers to make sure their vaccinations are up to date, as babies are particularly vulnerable. While whooping cough presents like a cold in adults, it can be very severe in babies,’’ she said. “Being up to date on vaccines for people of all ages, from, is important for your whole health and total well-being.”