A chilling resurgence is underway. Across the nation, from Texas and Florida to California and Oregon, cases of whooping cough – a disease once relegated to history books – are climbing at an alarming rate. This isn’t a gradual increase; it’s a stark warning signal, echoing a time before widespread vaccination.
The root of the problem is a dangerous convergence of factors. Declining vaccination rates, waning immunity, and breakdowns in public health tracking are creating a perfect storm. Infants, too young to be fully vaccinated, are bearing the brunt of this escalating threat, facing the most severe consequences.
Before the advent of the whooping cough vaccine in the early 20th century, this highly contagious respiratory illness was a leading cause of infant mortality in the United States. The progress made over decades is now being jeopardized, as protective barriers weaken and the disease finds fertile ground to spread.
Children currently receive a series of DTaP vaccines starting at two months, with booster shots for adolescents and adults every ten years. For years, vaccination rates were high enough to keep the disease largely contained. But the landscape has shifted dramatically since the COVID-19 pandemic, with vaccination coverage slipping and exemptions increasing.
The numbers paint a grim picture. Texas alone recorded nearly 1,928 cases in 2024, skyrocketing to over 3,500 by October 2025. Nationally, the first three months of 2025 saw 6,600 reported cases – four times the rate of the previous year and a staggering 25 times the number recorded in 2023. States are reporting their highest case counts in a decade, signaling a widespread outbreak, not isolated incidents.
Recent legislative changes are exacerbating the problem. In Texas, new laws have made it easier for parents to claim non-medical exemptions from school vaccination requirements, bypassing traditional health department oversight. This shift in policy is creating blind spots in tracking and potentially accelerating the decline in vaccination rates.
Public health officials are observing a concerning trend: fewer families are seeking vaccinations. One county health director described a stark contrast to previous years, when vaccination clinics were overwhelmed during back-to-school season. This year, the clinics remained unusually quiet, a sign of growing hesitancy and potential vulnerability.
Adding another layer of complexity, fears surrounding immigration enforcement may be discouraging some families, particularly within the Hispanic community, from seeking medical care, including vaccinations. This creates a dangerous situation, as unvaccinated individuals unknowingly contribute to the spread of the disease.
The vaccines themselves, while effective, don’t provide lifelong immunity. Like the COVID-19 and flu vaccines, protection diminishes over time. A switch to “acellular” vaccines in the 1990s, designed to reduce side effects, offered a trade-off: less severe reactions, but also shorter-lasting immunity. Adults who received these vaccines as children may now be unknowingly carrying and transmitting the disease.
The consequences for infants are particularly devastating. Whooping cough can cause severe breathing difficulties, with some babies stopping breathing altogether during coughing fits. Hospitalization is often required, and one in five hospitalized infants develops pneumonia. Tragically, nearly one percent succumb to the illness.
Recognizing this heightened risk, the CDC strongly recommends that pregnant women receive a Tdap vaccine with each pregnancy, allowing protective antibodies to pass to the baby before birth. While the “cocooning” strategy – vaccinating everyone around the baby – proved difficult to implement consistently, vaccinating mothers and infants remains the most effective defense.
Improved diagnostic technology is also contributing to the increased case numbers. Modern PCR tests allow for more accurate and widespread detection of whooping cough, identifying cases that might have gone unnoticed in the past. However, the surge in hospitalizations and the scale of outbreaks confirm that the increase isn’t solely due to better detection; the disease is genuinely spreading more rapidly.
A looming threat adds another layer of urgency: antibiotic resistance. While antibiotics are typically used to treat whooping cough, resistance to common macrolide antibiotics is becoming increasingly prevalent in other parts of the world. Reports indicate this resistance is now emerging in Peru, and the CDC is closely monitoring the situation, fearing potential spread through international travel.
The resurgence of whooping cough isn’t a simple problem with a single solution. It’s a complex interplay of declining vaccination rates, waning immunity, improved diagnostics, and the potential for antibiotic resistance. Addressing this crisis requires a multifaceted approach, demanding vigilance and proactive measures.
Healthcare professionals are being urged to remain vigilant, considering whooping cough in patients presenting with persistent coughs, especially infants and those caring for newborns. Immediate medical attention is crucial for babies experiencing breathing difficulties or turning blue during coughing fits.
Obstetricians are encouraged to discuss the Tdap vaccine with every pregnant patient, and pediatricians and family doctors are urged to review booster shot schedules for adolescents and adults. Several states have issued health alerts, urging medical professionals to stay informed and prepared.
Protecting the most vulnerable requires a collective effort. As the holiday season approaches, families with newborns are advised to take extra precautions: ensure all family members are up-to-date on their vaccinations – including flu, COVID-19, and RSV – avoid contact with sick individuals, and seek immediate medical attention if a baby develops a cough or pauses in breathing.
