Whooping Cough Is Coming Back
“Cases dropped during the pandemic, but are now climbing once more. Here’s what to know.
After a yearslong lull thanks to Covid-19 precautions like isolation and distancing, whooping cough cases are now climbing back to levels seen before the pandemic, according to data from the Centers for Disease Control and Prevention.
So far this year, there have been 10,865 cases of whooping cough, or pertussis, nationwide. That’s more than triple the number of cases documented by this time last year, and is also higher than what was seen at this time in 2019. Doctors say these estimates are most likely an undercount, as many people may not realize they have whooping cough and therefore are never tested.
The pandemic delayed routine childhood vaccinations, including those that protect against whooping cough, and led to fewer pregnant women getting vaccinated. Those factors have likely contributed to the current uptick in cases, said Dr. William Schaffner, an infectious disease specialist at Vanderbilt University Medical Center. Pertussis cases tend to peak in the summer and fall, he said, and so it’s particularly critical to be aware of the disease now, as children head back to school and respiratory illnesses pick up.
What are the symptoms?
The disease can cause sneezing, a runny nose, fever, watery eyes and fierce fits of coughing. Occasionally, these coughing spells can restrict breathing so intensely that people’s lips, tongues and nailbeds can turn blue from lack of oxygen.
Ideally, people would get tested when their symptoms are mild and they haven’t developed a cough, but it is extremely difficult, if not impossible, to distinguish between run-of-the-mill sniffles and the start of pertussis, said Dr. Aaron Milstone, a pediatric infectious disease specialist at the Johns Hopkins Children’s Center.
“Adults are having pertussis all the time, but they’re not being recognized as pertussis,” said Dr. James Cherry, a distinguished professor of pediatrics at the David Geffen School of Medicine at U.C.L.A. who has studied whooping cough. “Only a very small percentage of them ever get diagnosed.”
Doctors can take nasal swabs and run lab tests to diagnose the condition.
Infants are most at risk for getting seriously sick, particularly in their first months. They gasp for breath — the telltale “whoop” — between fits of coughing. Adults can also develop a violent cough that can come on “while you’re eating, while you’re sleeping,” Dr. Schaffner said. In severe cases, he said, people can faint from struggling to breathe or break ribs from coughing so intensely.
How does it spread?
Pertussis spreads easily when infected people sneeze or cough, and those around them breathe in tiny particles that contain bacteria. “Cough etiquette is just such a fundamental,” Dr. Milstone said. Cover your mouth when you cough or sneeze, and, because contaminated droplets can land on surfaces, wash your hands frequently.
People can be contagious for around a day before their symptoms start, and for up to three weeks after they start coughing, he said.
How do you treat whooping cough?
Doctors typically prescribe antibiotics, but people need to take them in the first three weeks of an infection. Antibiotics might shorten symptoms if people take the medication before a cough starts. But once you have a cough, “treatment doesn’t actually make that cough go away any faster,” Dr. Milstone said. “But it makes you contagious for a lot less time.”
People who get seriously sick from whooping cough may end up in the hospital, but most people can manage symptoms at home. Doctors often recommend people drink plenty of fluids to avoid becoming dehydrated, and use a humidifier to loosen mucus and ease coughs.
Pertussis is sometimes referred to as “the hundred-day cough” — and doctors say there’s some truth to that name. Even with treatment, symptoms can persist for weeks or even months.
“This is one where prevention really is worth a whole lot more than treatment,” Dr. Schaffner said.
How can you protect yourself?
The vaccines that protect against pertussis also protect against diphtheria and tetanus. The shots are widely considered safe and effective. Among childrenwho have received all their doses on schedule, 98 percent are fully protected from pertussis a year after their last shot, and around 71 percent are fully protected five years after their last dose.
Health officials recommend women be vaccinated during every pregnancy. The vaccine produces antibodies that are transferred to the fetus; this will protect newborns before they are old enough to get their first dose as part of routine vaccinations, at 2 months old. “By vaccinating pregnant women, you can prevent virtually all deaths from pertussis,” Dr. Cherry said. Research shows vaccination during pregnancy prevents roughly 78 percent of pertussis cases and about 90 percent of hospitalizations in infants younger than 2 months.
Anyone who is around a newborn — grandparents, babysitters, nannies — should be up-to-date on their vaccination, said Dr. Sean O’Leary, a professor of pediatrics-infectious diseases at the University of Colorado School of Medicine.
The C.D.C. recommends additional doses throughout early childhood, with five doses total by age 6, as well as a booster dose starting at age 11.
Adults 19 and older should get another shot every 10 years, health officials say. Technically, this can be a shot that protects against tetanus, diphtheria and pertussis, or a shot that just protects against tetanus and diphtheria. But Dr. Milstone said he recommended getting the shot that protects against all three, to minimize the risk of getting sick with whooping cough or spreading the disease to vulnerable infants.
Immunity wanes over time, with some estimates showing that the vaccines become less effective after a few years.
If you’re not sure if you’ve been vaccinated, or how long it’s been since your last vaccine, ask your health provider or try checking local or regional immunization registries, which keep records of some shots.
If you are an adult who has never been vaccinated, the C.D.C. says you should get a dose as soon as possible.
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