Whooping cough, a highly contagious respiratory infection also known as pertussis, is once again on the rise in the United States, posing a threat particularly to babies and young children.
This bacterial infection, known for causing severe coughing fits followed by a distinctive “whooping” sound as sufferers gasp for air, is a public health concern due to its rapid transmission and potentially life-threatening complications in vulnerable populations.
In fact, the U.S. Food and Drug Administration (FDA) even released an audio recording to show just how difficult the cough can be.
The infection’s resurgence after a period of decline has health experts concerned and underscores the importance of vaccination and preventive measures to control its spread.
The Return of Whooping Cough: Rising Case Numbers Post-Pandemic
Over recent years, the incidence of whooping cough cases had been relatively low, partly due to the increased hygiene and isolation practices implemented during the COVID-19 pandemic. However, with these protective measures no longer as prevalent, cases of whooping cough have surged.
As of October 2023, the Centers for Disease Control and Prevention (CDC) reported an alarming rise in pertussis cases, with nearly 17,600 cases recorded compared to about 4,000 cases at the same time the previous year.
“We’re now beginning to return to pre-pandemic levels, where we typically see more than 10,000 cases of people with whooping cough each year,” the CDC stated.
This rise in pertussis cases is likely due to a combination of factors, including relaxed preventive measures, decreased vaccination rates, and improvements in diagnostic methods, which make it easier to detect and report cases.
Understanding Whooping Cough and Its Symptoms
Whooping cough is caused by the bacterium Bordetella pertussis, which attaches itself to the cilia, or hair-like structures, in the upper respiratory tract. Once there, it releases toxins that cause inflammation and swelling in the airways, making it difficult to breathe and leading to the characteristic severe coughing fits.
Initially, pertussis symptoms may resemble those of the common cold—runny nose, mild cough, and low-grade fever—which makes it challenging to identify early on. However, after about one to two weeks, symptoms escalate to intense coughing spells as the body tries to clear mucus from the lungs.
In severe cases, these coughing fits can be debilitating and long-lasting, sometimes persisting for up to three months, hence its nickname, the “cough of 1,000 days.”
Dr. Stephen Aronoff, a pediatric infectious disease specialist, recounts this persistent nature, explaining, “One of my professors used to refer to pertussis as the cough of 1,000 days, because people can have these prolonged, chronic coughs.”
For babies, pertussis is particularly dangerous. The infection can cause life-threatening pauses in breathing, and statistics show that about one in three infants under one year old who contract pertussis require hospitalization.
Why Is Whooping Cough Making a Comeback?
The recent uptick in whooping cough cases may be due in part to the easing of COVID-19-related health measures such as masking, social distancing, and rigorous hygiene practices, which had previously contributed to lowering rates of many respiratory infections.
“We certainly saw traditional respiratory viruses in kids basically disappear in 2021 and 2022, and it wasn’t until everything got back to normal that we started to see resurgences of those viruses,” Dr. Aronoff noted.
As society has returned to regular patterns of interaction, such respiratory illnesses are reemerging, and whooping cough has taken advantage of the relaxed environment to spread more freely.
Compounding the issue, vaccination rates have also dropped. Routine vaccinations for children decreased during the COVID-19 pandemic due to disruptions in healthcare access, changes in health priorities, and, in some cases, vaccine hesitancy.
According to the National Council of State Legislatures, vaccination rates among kindergarteners declined during the 2020-21 and 2021-22 school years, failing to recover to pre-pandemic levels even during the 2022-23 school year. This decline in routine immunizations leaves more children susceptible to infections like pertussis.
The waning effectiveness of the pertussis vaccine over time further complicates the situation, as immunity gradually diminishes. This has led to breakthrough cases even among vaccinated individuals, though these cases are typically less severe.
Despite this waning immunity, the CDC stresses that vaccination remains the best defense against whooping cough and is crucial to minimizing outbreaks.
The Role of Vaccination in Protecting Against Whooping Cough
Vaccination remains the most effective tool in preventing whooping cough, particularly among young children and infants who are most vulnerable to severe complications.
The DTaP vaccine, which provides immunity against diphtheria, tetanus, and pertussis, is recommended in a series of doses beginning at 2 months old, followed by additional doses at 4, 6, 15 to 18 months, and 4 to 6 years.
A booster vaccine, Tdap, which contains a lower dose of the pertussis component, is recommended for older children and adults to maintain immunity.
Dr. Alex Sette, a professor of biological sciences, emphasizes the importance of vaccination for public health. “There is a lot of concern in the medical scientific community about misinformation and the whole polarization associated with vaccine acceptance,” he says.
“People may not be as diligent in providing childhood vaccination to their children, which is very concerning because if more people are not properly vaccinated, that is potentially a leading factor in the increased circulation of pertussis.”
Vaccination during pregnancy can offer added protection to newborns. The CDC recommends that pregnant individuals receive a Tdap vaccine in their third trimester, which enables the mother to pass protective antibodies to the baby before birth.
As Sette explains, “By vaccinating the pregnant mother-to-be, you boost her level of antibodies and that passes on and protects the child in the first few months when it’s most vulnerable.”
The Impact of Whooping Cough: Why Prevention is Critical
Whooping cough is not just an uncomfortable illness; it can have severe and lasting health impacts. Infants and young children are particularly susceptible, with the infection posing a high risk of complications, including pneumonia, convulsions, and even death.
In the absence of a vaccine, pertussis was once a leading cause of childhood mortality in the United States, with more than 200,000 cases reported annually before the 1940s. The widespread implementation of the pertussis vaccine has dramatically reduced these numbers, but the resurgence of cases highlights the need for continued vigilance.
For adults, whooping cough can also be a challenging illness, causing coughing fits that disrupt daily life and last for weeks. While less dangerous than in young children, adults who contract pertussis can unknowingly transmit the bacteria to unvaccinated or vulnerable children.
Dr. Aronoff points out the risks of unknowingly spreading pertussis, saying, “Grandpa may have a nasty cough and not think twice about it when he’s holding his 2-month-old grandchild, but then the grandchild gets infected.”
Treatment and Prevention Measures for Whooping Cough
Once pertussis is diagnosed, early treatment with antibiotics can help prevent the infection from worsening and limit its spread to others. However, pertussis is often challenging to detect in its initial stages due to its similarity to the common cold, meaning that many individuals may not receive treatment until the cough has already become severe.
Because whooping cough spreads easily through respiratory droplets, it is crucial for adults and caregivers to take preventive measures, particularly around babies who are unvaccinated or too young for vaccination. This can include wearing masks, maintaining good hygiene, and avoiding close contact if experiencing symptoms of a respiratory infection.
Strengthening Community Immunity Through Vaccination
The resurgence of whooping cough serves as a reminder of the importance of vaccination and public health measures in controlling infectious diseases.
As Dr. Aronoff advises, “Vaccines work, and the data show that when we don’t vaccinate, we have outbreaks.”
Ensuring that children receive their scheduled vaccinations and that adults stay up-to-date with boosters is critical in preventing further outbreaks of pertussis and safeguarding the health of vulnerable populations.
With increased public awareness and adherence to vaccination guidelines, the risk of whooping cough and other vaccine-preventable diseases can be minimized, protecting both individual health and the community at large.
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