The incidence rate of whooping cough, also known as whooping cough, grow in Texas, Florida, California, Oregon and other states and localities across the country.
The outbreaks are being driven by falling vaccination rates, waning immunity and delays in public health tracking systems, according to interviews with state and federal health officials. Children who are too young to be fully vaccinated are at greatest risk.
“Cases of whooping cough increase in a cyclical pattern driven by weakening immunity, but the size of the outbreak and the potential for severe outcomes in children who cannot be vaccinated can be mitigated by broad coverage and good communication with people at risk,” said Demetre Daskalakis, the former director of the immunization program at the Centers for Disease Control and Prevention, who retired in August.
Before the first whooping cough vaccine became available in early 1900sWhooping cough was one of the most common childhood diseases and leading cause of child mortality in the United States. Today, children receive a series of DTaP (full-dose version) shots starting at 2 months, and adolescents and adults receive Tdap (lower-dose version) boosters every 10 years. (Both vaccines target not only whooping cough, but also diphtheria and tetanus.)
Until recently 8 out of 10 kids received four doses of DTaP vaccine by 2 years of age and disease rates were under control. But vaccination coverage has fallen since the Covid pandemic, and increases in non-medical exemptions in states have led to a widening immunity gap, which is when the proportion of people who are immune falls below the level needed to contain the spread.
Texas registered 1928 cases of whooping cough in 2024. By October 2025, the state had exceeded 3500. The national numbers are equally astounding: in the first three months of 2025, the US counted 6600 cases – four times more than last year and 25 times in 2023. Several states are reporting their highest case totals in a decade, and outbreaks from Louisiana to South Dakota to Idaho make it clear that the surge is not regional. It's everywhere.
Key factors behind these numbers
Texas lawmakers recently passed legislation that made it easier so that parents can claim non-medical exemptions from school vaccination requirements by allowing them to upload exemption forms online. These forms now go directly to schools rather than health departments, making exceptions difficult to track.
Dallas County Health and Human Services Director Phil Huang said the full impact of the new vaccine exemption rule is not yet known as it began this school year, but he expects it will lead to an even greater decline in vaccination rates at the school level.
He has already noted a sharp decline in the number of vaccinations. Typically during school holidays, “the whole front area downstairs is packed,” he said. “We haven’t seen that this year.”
Huang believes fear of immigration enforcement may be keeping at least some families, especially Latino families, from getting vaccinated. Dallas County is about 40% Hispanic. “We think a lot of them are put off by ICE,” he said, referring to Immigration and Customs Enforcement.
Additional complications: These vaccines protect against severe disease, but the protection against infection wanes over time, as is the case with the Covid and flu vaccines.
In the 1990s, the United States switched from whole-cell pertussis vaccines to “acellular” vaccines, which cause fewer side effects but do not last as long. Because more adults today than in the past received the acellular vaccine as children, many have lost immunity over time and may unknowingly pass the infection to infants.
Infants are at greatest risk
Whooping cough is especially dangerous for children under one year of age. Some people stop breathing during coughing attacks. Many require hospital care, approx. 1 of 5 of these develop pneumonia, and about 1% of them die.
Because of this high risk, the CDC urges pregnant women to undergo Tdap vaccine during every pregnancy. This allows the mother's antibodies to be passed on to the baby before birth.
Health officials once promoted the idea of ”cocooning,” vaccinating all family members and caregivers, but the strategy was difficult to implement in real life and no longer widely recommended. Vaccination of pregnant women and children at 2 months of age remains the strongest protection.
Better testing finds more cases
Modern PCR testing Also detection of new cases of whooping cough than in the past. Many clinics now routinely use this laboratory technology to simultaneously test for multiple respiratory infections, including whooping cough. Ten years ago, such panels were rare.
CDC experts say that partly explains the rise in cases. But the high number of infant hospitalizations and the size of outbreaks in states indicate that true transmission has also increased.
Growing Concern: Antibiotic Resistance
Doctors usually treat whooping cough with macrolide antibioticssuch as erythromycin, azithromycin and clarithromycin. These drugs work best in the early stages of the disease and help stop the spread. Another drug, trimethoprim-sulfamethoxazole, may be used in some older children and adults.
But macrolide-resistant whooping cough has become commonplace abroad, especially in China, and recent reports show growing resistance in Peru. In the United States, cases of resistance have been rare.
CDC officials warn that resistant strains may spread more easily through international travel. Because treatment options are limited, especially for very young children, health officials are watching closely.
Huang said macrolide resistance has not yet been observed in Dallas County. But he is aware of the national concern.
What's happening now
The recurrence of whooping cough does not have a single cause. Instead, several problems arise at once: a drop in vaccination coverage, about 60% Pregnant women receiving Tdap experience decreased immunity, improved testing, and early signs of antibiotic resistance.
Health experts say solutions must match the complexity of the problem.
Across the country, doctors are told they are more likely to suspect whooping cough when they see patients, especially children or caregivers of newborns, with a persistent cough or coughing spells followed by vomiting. Babies who stop breathing or turn blue need immediate help.
Obstetricians are encouraged to discuss Tdap during each pregnancy. Pediatricians and family physicians are strongly encouraged to check the vaccination status of adolescents and adults.
Over the past two years, several states have issued health guidelines, including Texaswhich has issued alerts in both 2024 and 2025, urging doctors to remain vigilant.
Huang said Dallas County is trying to rebuild public health programs that were cut when Covid funding ran out. But the staff is still limited. “There are a lot of different things that make it difficult,” he said.
He also noted that Dallas County now receives vaccination registry data only once a month instead of daily, making it difficult to track vaccine coverage. “We don’t have that yet… It’s not the right time,” he said.
Protecting the little ones
As the holiday season approaches, experts urge families with newborns to take extra care:
- Ensure that infants and children are up to date on their childhood vaccines, and that all family members are up to date with vaccines against influenza, covid and RSV or respiratory syncytial virus.
- Keep sick visitors away.
- Get help right away if your child coughs or stops breathing.
