Whooping cough surges in US: How to protect yourself and others

Pertussis, better known as whooping cough, is on the rise in the US. Pertussis is the medical name for the infection, while whooping cough is the common name that refers to the coughing someone has with the infection.

Typically, more than 10,000 cases of whooping cough are reported in the US each year. As of May 2025, more than 9,000 cases had already been reported, a significant increase compared to 2024.

Whooping cough is caused by the bacterium Bordetella pertussis. It is a highly contagious respiratory illness and 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.¹

Complications from whooping cough may include pneumonia, ear infection, loss of appetite, fainting, dehydration, seizures, brief periods when breathing stops, and death.² Whooping cough is spread 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, infected people can pass it to others for up to three weeks after they start coughing.³

Whooping cough can be treated with antibiotics. An infected person will not spread the infection after five full days of taking the antibiotics, which are used to not only treat but prevent infection. The antibiotics usually prescribed are azithromycin, erythromycin, clarithromycin, trimethoprim, and sulfamethoxazole.⁴

The three stages of whooping cough

The first of whooping cough is the catarrhal stage, which develops one to two weeks after infection. This stage can be indistinguishable from the symptoms of a mild respiratory infection: low-grade fever, mild and occasional cough, runny nose and congestion, and apnea in infants.

The second and longest stage is the paroxysmal stage, which can last for up to six weeks. The first two weeks, paroxysmal attacks may be experienced for 15 hours per day. This stabilizes after two or three weeks and gradually decreases. Symptoms are sudden, violent, uncontrollable coughs (paroxysms); a long cough with a “whoop” at the end; exhaustion; loss of oxygen that results in a bluish or purple discoloration of lips and skin; and post-tussive vomiting or vomiting induced by coughing.

The final stage, the convalescent stage, can last weeks or months. The patient gradually recovers and has fewer paroxysmal coughs.⁵

How to prevent whooping cough

Prevention can be achieved through vaccination and postexposure prophylaxis, and the CDC recommends vaccination for all ages. Health-care personnel (HCP) should be vaccinated in accordance with Advisory Committee on Immunization Practices recommendations.⁶ 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 health-care setting are droplet precautions, along with standard precautions; rapidly diagnosing and treating patients with infection; and excluding potentially infectious personnel from work.⁷

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

• Source control—patient wears a mask
• Patient placed in a single room if possible
• Personal protective equipment (PPE)
• Limited transport and movement of patients
• Everyone, including HCP, wash hands before entering and exiting a room
• Eyes, nose, and mouth fully covered before entering the room
• When three feet from patient, remove face protection before exiting room⁸

Infection control recommendaitons for HCP

The CDC shares the following infection control recommendations for HCP who are exposed to pertussis:

1. Asymptomatic HCP, regardless of vaccination status, who are exposed to pertussis and are likely to interact with persons at increased risk for severe pertussis: administer postexposure prophylaxis; and if not receiving postexposure prophylaxis, restrict contact with patients and other persons at an increased risk for severe pertussis for 21 days.

2. Asymptomatic HCP, regardless of vaccination status, exposed to pertussis who are not likely to interact with persons at an increased risk for severe pertussis: administer postexposure prophylaxis; and implement daily monitoring for 21 days for development of signs and symptoms of the illness.

3. Asymptomatic HCP, regardless of vaccination status, exposed to pertussis and who have preexisting health conditions that may be exacerbated by an infection: administer postexposure prophylaxis.
4. 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.
5. Work restrictions are not necessary for asymptomatic HCP who are exposed to pertussis and receive postexposure prophylaxis, regardless of their risk for interaction with patients/persons at increased risk of severe illness.7

Whooping cough must be reported, so always contact your state and local health departments. HCPs can decrease the risk of infection by being diligent with vaccinations, post exposure prophylaxis, and standard and droplet precautions. This will lead to a safe working and patient environment.

References

1. AM Lauria, CP Zabbo. Pertussis. National Library of Medicine. Accessed August 20, 2025. https://www.ncbi.nlm.nih.gov/books/NBK519008/

2. Whooping cough (pertussis). Better Health Channel. Accessed August 20, 2025.

https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/whooping-cough

3. Pertussis: clinical features. Centers for Disease Control and Prevention. Accessed August 20, 2025. https://www.cdc.gov/pinkbook/hcp/table-of-contents/chapter-16-pertussis.html?CDC_AAref_Val=https://www.cdc.gov/vaccines/pubs/pinkbook/pert.html

4. Pertussis or whooping cough fact sheet: what is the treatment? New York State Department of Health. Accessed August 20, 2025. https://www.health.ny.gov/publications/2171/

5. Clinical features of pertussis. Centers for Disease Control and Prevention. Accessed August 20, 2025.  https://www.cdc.gov/pertussis/hcp/clinical-signs/index.html

6. Pertussis surveillance and trends. Centers for Disease Control and Prevention. Accessed August 20, 2025. https://www.cdc.gov/pertussis/php/surveillance/index.html

7. Infection control: Pertussis. Centers for Disease Control and Prevention. Accessed August 20, 2025. https://www.cdc.gov/infection-control/hcp/healthcare-personnel-epidemiology-control/pertussis.html

8. Precautions to prevent transmission of infectious agents. Centers for Disease Control and Prevention. Accessed August 21, 2025. https://www.cdc.gov/infection-control/hcp/isolation-precautions/precautions.html