The incidence of whooping cough, also known as pertussis, is is rapidly increasing In Texas, Florida, California, Oregon and other states and regions across the country.
These outbreaks are accelerating due to declining vaccination rates, declining immunity and delays in public health tracking systems, according to interviews with state and federal health officials. Babies who are too young to be fully vaccinated are most at risk.
“Pertussis cases increase periodically due to weakened immunity, but the scale of the outbreak and the likelihood of serious outcomes for children who cannot be vaccinated can be mitigated by high coverage and good communication with those at risk,” said Demetre Daskalakis, the former director of the Centers for Disease Control and Prevention’s immunization program who resigned in August.
Before the first pertussis vaccine was released, early 1900sWhooping cough was one of the most common childhood diseases. Leading Causes of Death in Children In America. Today, children receive a series of DTaP vaccinations (high-dose version) starting at 2 months of age, and adolescents and adults receive a Tdap booster (low-dose version) every 10 years. (Both vaccines target diphtheria and tetanus in addition to whooping cough.)
Until recently, 8 out of 10 infants Four doses of DTaP vaccine were administered by age 2 years, and the incidence was controlled. But since the COVID-19 pandemic, vaccine coverage has declined and state non-medical exemptions have increased, widening the immunization gap. This is when the proportion of immune individuals falls below the level needed to contain the spread.
texas records 1,928 cases of whooping cough In 2024. By October 2025, the state Exceeded 3,500 people. The country-specific figures are equally stark. In the first three months of 2025, the United States 6,600 cases — four times the pace last year and 25 times the pace in 2023. Several states are recording their highest case totals in a decade, and outbreaks from Louisiana to South Dakota and Idaho make it clear that the surge is not local. It’s everywhere.
Key factors behind these numbers
Texas lawmakers recently passed the following legislation: Made it easier Parents can request a non-medical exemption from school vaccine requirements by making an exemption form available for download online. These forms will now go directly to schools rather than the health department, making exceptions more difficult to track.
Dallas County Health and Human Services Director Phil Huang said the full impact of the new exemption rule is not yet known because it began this school year, but he expects it to further reduce vaccination rates at the school level.
He noted that vaccination rates have already fallen sharply. Typically during back-to-school season, “our whole front floor is full,” he said. “I haven’t seen anything like that this year.”
Hwang believes fears of immigration raids may prevent at least some families, especially Hispanic families, from getting vaccinated. Dallas County is about 40% Hispanic. “I think a lot of people are being held back by ICE activities,” he said, referring to Immigration and Customs Enforcement.
More complications: The vaccine protects against serious illness, but as is the case with coronavirus and influenza vaccines, protection against infection wanes over time.
The United States switched from whole-cell pertussis vaccines in the 1990s to “cell-free” vaccines, which have fewer but less long-lasting side effects. Because more adults today than in the past received acellular vaccines as children, many people lose immunity over time and may unknowingly pass infections to their babies.
Babies face the greatest risk
Whooping cough is especially dangerous for infants and toddlers under 1 year of age. Some people stop breathing during a coughing fit. Many people require hospital treatment. 1 out of 5 people Of these, pneumonia develops and approximately 1% die.
Because of this high risk, the CDC recommends that pregnant women get vaccinated. Tdap vaccination during pregnancy. This allows the mother’s antibodies to be passed on to the baby before birth.
Health authorities once promoted ‘cocooning’, vaccinating all family members and guardians around the baby, but that strategy was difficult to implement in reality. No longer widely recommended. Vaccination for pregnant women and babies as young as 2 months old remains the most powerful immunization.
Better testing finds more cases
modern PCR test also More cases of whooping cough discovered than in the past. Many clinics now routinely use this laboratory-based technology to test for multiple respiratory infections at once, including whooping cough. Ten years ago, these panels were not common.
CDC experts say this explains part of the increase in case numbers. However, the number of infant hospitalizations and the scale of outbreaks by country show that actual transmission has also increased.
A growing worry: antibiotic resistance
Doctors usually treat whooping cough with: macrolide antibioticsErythromycin, azithromycin, clarithromycin, etc. This medication is most effective early in the disease and helps stop it from spreading. Another drug, trimethoprim-sulfamethoxazole, is an option for some older infants and adults.
but Macrolide-resistant pertussis This has become common overseas, particularly in China, and recent reports suggest resistance is growing in Peru. Cases of resistance have been rare in the United States.
CDC officials warn that resistant strains could spread more easily through international travel. Health care workers are watching closely because treatment options are limited, especially for very young infants.
Huang said macrolide resistance has not yet emerged in Dallas County. But he is aware of national concerns.
what is happening now
There is no single cause for recurrences of whooping cough. Instead, several problems are occurring at once. About 60% These include decreased immunity, improved testing, and early signs of antibiotic resistance in pregnant women receiving Tdap.
Health experts say solutions must match the complexity of the problem.
Across the country, doctors are being told that pertussis is more likely to be suspected when patients, especially those caring for children or newborns, have a persistent cough or seizure followed by vomiting. A baby who stops breathing or whose face turns blue needs immediate medical attention.
Obstetricians are encouraged to discuss Tdap during every pregnancy. Pediatricians and family physicians are encouraged to check the booster vaccination status of adolescents and adults.
Several states have issued health advisories over the past two years, including: texasThis is warning issued We urge clinicians to remain vigilant in both 2024 and 2025.
Huang said Dallas County is trying to rebuild public health outreach programs that were cut short when COVID funding ended. But manpower is still limited. “There are a lot of different things that make it more difficult,” he said.
He also pointed out that tracking vaccine coverage is more difficult because Dallas County now only receives vaccination registration data once a month instead of daily. “We don’t have that yet…it’s not real-time,” he said.
protect the youngest
As the holiday season approaches, experts recommend that families with newborns take the following extra precautions:
- Make sure your infant or toddler is up to date on their childhood vaccines and that everyone in your household is up to date on vaccines for influenza, COVID-19, RSV, or respiratory syncytial virus.
- Stay away from sick visitors.
- If your infant coughs or stops breathing, seek medical attention quickly.
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