vaccination

More than 3,500 cases of pertussis, or whooping cough, cases have been reported in Texas so far this year, already reaching a 11-year high even though two more highly infectious months are left in the year, according to the Texas Department of State Health Services.

The uptick in whooping cough, which is especially contagious in children, has coincided with a decline in vaccination rates for the illness, according to disease experts who urge the best way to control the spread is to get vaccinated. They also say whooping cough tends to spike every few years and that there isn’t a way to completely wipe out the disease.

“We practitioners and public health professionals are concerned because we are seeing a year-after-year trend of a significant increase in cases when this is preventable,” said Hector Ocaranza, a pediatrician and member of the Texas Medical Association’s Council on Science and Health Promotion. “Especially a disease that can have such a severe effect on infants, older people, and those who have chronic conditions.”

The Texas Department of State Health Services reported more than 3,500 cases of whooping cough through October, quadruple the number of cases during the same period last year, which saw a total of 1,907 cases, according to provisional data. The total so far is also 10 times the number of cases for all of 2023. This is the second consecutive year the state’s health agency has had to issue a health alert.

The agency’s most recent alert, published Nov. 3, noted that more than half of last year’s cases occurred in November and December, suggesting whooping cough cases will continue to climb.

Jason Bowling, professor and infectious disease specialist at UT Health San Antonio, the academic health center of The University of Texas at San Antonio, said this spike is aligning with the holiday season, further increasing the risk of whooping cough spreading.

“Oftentimes parents with a newborn infant don’t feel comfortable telling people to wash their hands or not to visit if they have a cough during the holidays, but they need to feel empowered and comfortable to do that right now,” he said.

Leilani Valdes, the chair of Pathology and Laboratory Medicine at Citizens Medical Center in Victoria, and a spokesperson for the College of American Pathologists, said this year’s spike is noticeably different.

“While an increase isn’t completely unexpected, the size of this one is unusual and something public health officials are keeping a close eye on,” she said.

Valdes said multiple factors are contributing to the increase. She said immunity from the whooping cough vaccine fades over time, and if people aren’t getting their booster shots, they can catch and spread it.

“Some families have also fallen behind on vaccinations, which adds to the problem. And finally, better testing and awareness mean more cases are being identified and reported,” Valdes said.

Whooping cough cases in Texas and the United States were lower than usual during and after the COVID-19 pandemic, but activity has quickly rebounded over the last few years.

“We were not near each other during COVID-19, which meant fewer opportunities for the bacteria to move from person to person,” said Joshua Sharfstein, a pediatric medical provider and a public health professor at Johns Hopkins University. “What is concerning with this spike is the number of small children being affected.”

The recent rise in whooping cough in Texas follows a national trend. In 2024, there were more than 35,000 documented cases, a significant jump from 7,063 in 2023. Two babies have died from the disease in Louisiana this year, as well as a child in South Dakota and an adult in Idaho.

Preliminary data from the Texas health agency indicate that approximately 85% of whooping cough cases in Texas this year have occurred in children, but no deaths have been reported.

What is whooping cough?

Whooping cough is a highly contagious illness caused by the bacteria Bordetella pertussis. These contagious respiratory illnesses occur when bacteria attach to the upper respiratory tract, leading to swelling of the airways.

“The interesting thing about this bacterial infection is that it lasts for a long time. In China, it’s known as the 100-day cough for this reason. It’s a disease that is really split into three phases,” said Bowling.

The disease usually starts off looking like a regular cold, with a runny nose, a fever and a mild cough. This is the most transmissible phase of the disease. An estimated 80% people will contract the illness after close exposure to someone who is infected.

But after a week or two, that cough can turn into prolonged, intense coughing fits that can make it hard to breathe.

“In adolescents and adults, it’s just a really bad cough. In babies, it’s a cough related to the struggle to breathe, and it makes this huge gasp sound like a whoop, and that is why it’s known as a whooping cough,” said Sharfstein.

The final phase, known as the recovery stage, can last several weeks, during which the cough gradually fades. Still, the person remains at risk of other respiratory infections due to airway damage, and the cough can return, sometimes for several months.

Who is vulnerable?

Babies under six months are most at risk because they’re too young to be fully vaccinated. One in three babies with whooping cough requires hospitalization, while one in five will develop pneumonia, and some will develop seizures or brain swelling. Many infants with the illness don’t cough at all but gag, and have skin, lips, or nails that turn blue or purple because of a pause in breathing that lasts longer than 20 seconds, often known as life-threatening apnea.

“You have to be fast and test quickly if you think your baby has been exposed. The challenge is that the further along in the disease when the coughing and spasms appear, the damage is already done, and it’s too late to treat the bacteria,” said Sharfstein. “If you have a 10-year-old who has been coughing all the time, and you notice the newborn baby now has a cold, I would test right away.”

Healthy teens and adults can also catch whooping cough and may develop pneumonia. The coughing fits may cause vomiting, fatigue, and even broken ribs. Still, the risk of death significantly drops compared to infants.

If caught early enough, antibiotics can help make the illness milder and stop it from spreading.

“One of the worst things I have witnessed in my pediatric career is the helplessness of parents as they watch their young one struggle to breathe from pertussis. It’s awful, but it’s preventable,” said Sharfstein.

How to protect yourself?

DSHS states in its health alert that the best way to protect against whooping cough is immunization, and that parents should ensure children are up to date on pertussis immunizations.

The tetanus, diphtheria, pertussis vaccine, better known as Tdap, is for children 7 years old and older, adolescents, and adults, while the diphtheria, tetanus, acellular pertussis vaccine, known as DTaP, is for children between 6 weeks and 6 years of age.

It’s also recommended that pregnant women receive the DTaP vaccine during each pregnancy to pass protection to their newborns. Optimal timing is between 27 and 36 weeks of gestation, preferably during the earlier part of this period.

The Centers for Disease Control and Prevention also recommends that everyone around the infant be up to date with their booster shots, which are recommended every 10 years. The majority of whooping cough cases in infants are transmitted by parents, grandparents, or other family members.

“Unfortunately, many adults believe they don’t need vaccinations anymore and don’t get the boosters,” said Ocaranza. “But the best practice shows that those young people who are about to start a family and those around them need to be updated on their vaccinations.”

While the vaccine is the best way to prevent the spread of the disease, various regions across the state are experiencing low vaccination rates in schools, increasing the risk of an outbreak among children.

“The measles outbreak in Texas was a warning bell ringing that people weren’t getting vaccinated enough,” said Sharfstein.

In Texas schools that report immunization rates to DSHS, 93.4% of seventh graders were fully vaccinated with Tdap in the 2024-25 school year, and 92.9% of kindergarteners were fully vaccinated with the DTaP. Coverage rates for those and other vaccines required for school admission have declined in recent years.

“Simple steps like washing your hands, covering your cough, and keeping distance from babies when ill can go a long way in preventing the spread,” Valdes said.

Immunized children and adults can also still get the disease. The immunized may present with milder symptoms and lack the classic “whoop” sound during coughing. Someone suspected of having whooping cough should stay home until they have completed five days of antibiotics.

Disclosure: Texas Medical Association and University of Texas at San Antonio have been financial supporters of The Texas Tribune, a nonprofit, nonpartisan news organization that is funded in part by donations from members, foundations and corporate sponsors. Financial supporters play no role in the Tribune’s journalism. Find a complete list of them here.