Whooping Cough Cases Surge in the U.S.—Here’s How to Protect Yourself and Others

Pertussis, better known as whooping cough, is on the rise in the U.S. Pertussis is the medical name used for the infection while whooping cough is the more common name that refers to the characteristic coughing sound that is made when someone has the infection.

More than 10,000 cases are typically reported in the U.S. each year. As of May 2025, over 9,000 cases have been reported. These numbers suggest a significant increase compared to cases in 2024. The Centers for Disease Control (CDC) states the best way to prevent pertussis is vaccination and postexposure prophylaxis.

Whooping cough is caused by the bacterium Bordetella pertussis; it is a highly contagious respiratory illness and is a serious lung infection. The disease is most dangerous to infants (less than 12 months), young children, and women in their third trimester of pregnancy. People with pre-existing health conditions are also at high risk of developing severe infections. Complications from whooping cough may include:

Pneumonia
Ear infection
Loss of appetite
Fainting
Dehydration
Seizures
Brief periods when breathing stops
Death

Whooping cough is spread from person to person through respiratory droplets or contact with airborne droplets. An infected person can pass it to others as soon as they experience cold-like symptoms. Symptoms usually appear within 10 days of exposure, but, in some cases, they may not appear for as long as 21 days. Infected people can also pass it to others for up to three weeks after they start coughing.

Antibiotics are available that will treat whooping cough. When an antibiotic is taken, the infected person will not spread the infection after five full days of treatment. Antibiotics are used to not only treat the infection but are also used to prevent infection. The antibiotics given are azithromycin, erythromycin, and clarithromycin. Trimethoprim sulfamethoxazole is also used.

Whooping cough has three stages. Stage one is the catarrhal stage and develops 1-2 weeks after infection. This stage can be indistinguishable from the symptoms of a mild respiratory infection. Symptoms during the catarrhal stage are:

Low-grade fever
Mild, occasional cough
Runny nose, congestion
Apnea (infants)

The second stage, known as the paroxysmal stage, is the longest stage. This stage lasts up to six weeks. For the first two weeks, paroxysmal attacks can be experienced for an average of 15 hours per day which stabilize in weeks two to three and gradually decrease. Symptoms of the paroxysmal stage are:

Sudden, violent, uncontrollable coughs (paroxysms)
Long cough with a “whoop” at the end
Exhaustion
Loss of oxygen, resulting in a bluish or purple discoloration of lips, skin
Post-tussive vomiting or vomiting induced by coughing

The final stage is the convalescent stage. This stage can last weeks to months. In this stage the patient will gradually recover and have less paroxysms coughs.

Prevention of whooping cough can be achieved through vaccination and postexposure prophylaxis. The CDC recommends vaccination for all ages. Healthcare personnel (HCP) should be vaccinated against whooping cough in accordance with Advisory Committee on Immunization Practices recommendations. Postexposure prophylaxis should be provided to household contacts, people at a high risk of developing severe infection, and those who encounter an infected person.

Other prevention strategies in a healthcare setting, along with vaccination and postexposure prophylaxis, are:

Droplet precautions, along with standard precautions
Rapidly diagnosing and treating patients with infection
Excluding potentially infectious personnel from work

Droplet precautions must be used in addition to standard precautions. Droplet precautions are infection control measures utilized to prevent the spread of infection from respiratory droplets. Respiratory droplets are transmitted when a person coughs, speaks, or sneezes. The following droplet precautions must be followed:

Source control – patient wears a mask
Ensure patient is placed in a single room if possible
Personal protective equipment (PPE) must be worn appropriately
Limit transport and movement of patients
Everyone, including HCP, must wash their hands before entering and exiting the room
Eyes, nose, and mouth must be fully covered before entering the room, and
Once you are three feet away from the patient, remove face protection before exiting the room

CDC has the following Infection Control recommendations for HCP exposed to pertussis:

For asymptomatic HCP, regardless of vaccination status, exposed to pertussis and are likely to interact with persons at increased risk for severe pertussis:

- Administer postexposure prophylaxis
- If not receiving postexposure prophylaxis, restrict from contact with patients and other persons at an increased risk for severe pertussis for 21 days

For asymptomatic HCP, regardless of vaccination status, exposed to pertussis and are not likely to interact with persons at an increased risk for severe pertussis:

- Administer postexposure prophylaxis
- Implement daily monitoring for 21 days for development of signs and symptoms of the illness

For asymptomatic HCP, regardless of vaccination status, exposed to pertussis and have preexisting health conditions that may be exacerbated by an infection:
- Administer postexposure prophylaxis
Exclude symptomatic HCP with known or suspected pertussis for 21 days from the onset of cough, or until five days after the start of effective antimicrobial therapy.
Work restrictions are not necessary for asymptomatic HCP who have exposure to pertussis and receive postexposure prophylaxis, regardless of their risk for interaction with patients/persons at increased risk of severe illness.

Whooping cough is reportable, always contact your state/local health departments.

Being diligent with vaccinations, post exposure prophylaxis, standard and droplet precautions will help decrease the risk of infection. This in turn will make a safe working and safe patient environment.