Whooping cough is rapidly returning across the United States. Texas, Florida, California, Oregon, and many other states are now reporting sharp increases in cases.
Health officials say several issues are driving this rise: lower vaccination rates, fading immunity over time, and slower public health surveillance. Babies remain the most at risk.
“Pertussis cases rise in cycles because immunity fades,” said Dr. Demetre Daskalakis, former head of the CDC’s immunization program, in an interview with CBS News. “But strong vaccine coverage and clear communication can reduce the size of outbreaks and protect children who are too young to be vaccinated.”
Before vaccines became available in the early 1900s, whooping cough was one of the leading causes of childhood death in the United States.
Today, vaccination begins at 2 months of age and continues through adulthood with booster shots. However, vaccine uptake dropped during the pandemic, and nonmedical exemptions in some states have widened immunity gaps.
Texas shows how quickly the disease has spread. The state recorded 1,928 cases in 2024. By October 2025, the total had already surpassed 3,500.
National trends are also alarming. In the first three months of 2025, the U.S. reported 6,600 pertussis cases—four times the number from the same period in 2024 and 25 times the number in 2023. Outbreaks in Louisiana, South Dakota, and Idaho show the problem is widespread.
Texas recently made vaccine exemptions easier to access by allowing parents to download forms online. Dallas County Health Director Dr. Phil Huang says he is already seeing fewer families coming in for routine vaccinations. He also fears some families, especially within the county’s 40% Hispanic population, may avoid clinics due to immigration-related concerns.
Another challenge is waning immunity. The current “acellular” pertussis vaccine loses strength over time, leaving many adults without solid protection. Adults who are unknowingly infected can easily spread the illness to infants.
Babies face the greatest danger. According to the CDC, about one in five infants with pertussis develops pneumonia, and about 1% die from the infection. For this reason, the CDC urges pregnant women to get a Tdap vaccine during every pregnancy so newborns receive protective antibodies before birth.
More cases are also being detected because clinics now use modern PCR tests that screen for several respiratory infections at once. Even with better testing, rising infant hospitalizations show that true transmission is increasing.
Macrolide antibiotics are the standard treatment for pertussis. However, antibiotic-resistant strains have appeared in countries such as China and Peru. These strains are still rare in the United States, but experts warn that international travel could bring them in.
Health officials say the best defense is early detection and vaccination. Clinicians are being urged to consider pertussis in patients with a persistent cough, especially infants and caregivers.
Families are encouraged to ensure that children, teenagers, and adults are current on all vaccines and to keep sick visitors away from newborns.
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