The incidence rate of whooping cough, also known as whooping cough or whooping cough, increase in Texas, Florida, California, Oregon and other cities and states across the country.
The outbreaks are being driven by falling vaccination rates, weakening immunity and delays in public health systems, according to interviews with state and federal health officials. Children who have not yet received their full vaccination schedule are most at risk.
“Cases of whooping cough increase cyclically due to weakened immunity, but the size of the outbreak and the risk of serious consequences in children who cannot be vaccinated can be reduced by ensuring high 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 (CDC), who retired in August.
Before the first whooping cough vaccine was available, at the beginning of the 20th centurythis disease was one of the most common in childhood and leading cause of infant mortality in the United States.
Today, children receive the DTaP (full dose version) series of vaccines starting at 2 months of age, and adolescents and adults receive a Tdap (lower dose version) booster shot every 10 years. (Both vaccines also protect against diphtheria and tetanus.)
Until recently 8 out of 10 young children By the time they were two years old, they had received four doses of the DTaP vaccine and the cases were under control. But coverage has declined since the Covid pandemic, and increases in non-medical exemptions in several states have led to widening immunity gaps, which occur when the proportion of people with immunity falls below the level needed to slow the spread.
Texas registered 1928 cases whooping cough in 2024. By October 2025 the state has already exceeded 3500. At the national level, the numbers are no less alarming: in the first three months of 2025. 6600 caseswhich is four times the rate of last year and 25 times the rate in 2023. Several states are reporting their highest numbers in a decade, and outbreaks from Louisiana to South Dakota to Idaho make it clear the rise is not regional. It is generalized.
Key factors for increase
Texas lawmakers recently passed legislation that makes it easier for parents to request an exemption for non-medical reasons school immunization requirements, allowing forms to be downloaded from the Internet. These forms are now sent directly to schools rather than health departments, making them difficult to track.
Phil Huang, director of the Dallas County Department of Health and Human Services, said the full impact of this new rule is not yet known since it began this school year, but he expects school vaccination rates to continue to decline.
You have already noticed a significant decrease in the number of vaccinations. Typically during school holidays, “the whole area in front of the house downstairs would be full,” he said. “It wasn’t like that this year.”
Huang said fear of immigration enforcement may be why some families, especially Latinos, are avoiding vaccinations. In Dallas County, the Hispanic population is about 40%. “We think a lot of people are put off by ICE,” he said, referring to Immigration and Customs Enforcement.
There are other complications: These vaccines protect against severe disease, but their protection against infection wanes over time, as is the case with 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 provide shorter-lasting protection. Because those who are adults today received the acellular vaccine as children, they have lost immunity over time and may unknowingly infect infants.
Babies are at greater risk
Whooping cough is especially dangerous for babies under one year old. Some people stop breathing during coughing attacks. Many require hospitalization; of them, 1 of 5 pneumonia develops and about 1% die.
Due to the high risk, the CDC recommends that pregnant women receive Tdap vaccine during every pregnancy. This allows the mother's antibodies to be passed on to the baby before birth.
In the past, health authorities have promoted a “cocooning” strategy (vaccinating all family members and caregivers), but this has been difficult to implement in practice and no longer recommended as a general rule. Vaccination of pregnant women and children over 2 months of age continues to be the strongest protection.
Improved technology allows more cases to be detected
Modern tests PCR help detect more cases of whooping cough than in the past. Many medical centers now routinely use this laboratory technology to detect multiple respiratory infections simultaneously. Ten years ago, such tests 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 actual transmission has also increased.
Antibiotic resistance is a concern
Doctors usually treat whooping cough with macrolide antibioticssuch as erythromycin, azithromycin and clarithromycin. These medications work best in the early stages of the disease and help prevent it from spreading. Another drug, trimethoprim-sulfamethoxazole, may be used in some infants and adults.
But macrolide-resistant whooping cough This has become common in other countries, especially China, and recent reports indicate that resistance is growing in Peru. In the United States, resistant cases remain rare.
CDC officials warn that resistant strains may spread more easily through international travel. Because treatment options are limited, especially for young children, medical personnel are closely monitoring the situation.
Huang said no cases of resistance have yet been identified in Dallas County. But he is aware of the national concern.
So what now?
The recurrence of whooping cough does not have a single cause. A combination of several factors: a decrease in vaccination coverage, only and 60% pregnant women receive Tdap, decreased immunity, better diagnostic tools, and early signs of antibiotic resistance.
Health experts say solutions must be as complex as the problem itself.
Across the country, doctors are being asked to be alert to the possibility of whooping cough if they see patients — especially children or people caring for newborns — with a persistent cough or coughing spells followed by vomiting. Babies who stop breathing or turn purple should be treated immediately.
Obstetricians are encouraged to discuss Tdap vaccine administration in each pregnancy. Pediatricians and family physicians are also urged to review the revaccination status of adolescents and adults.
Over the past two years, several states have launched health warnings, including Texaswhich issued alerts in 2024 and 2025, doctors are asked to remain vigilant.
Huang said Dallas County is trying to rebuild its outreach programs, which were cut when Covid funding dried up. But staff remains limited. “There are many factors that complicate the situation,” he said.
He also noted that the county now only receives immunization registry data once a month instead of every day, making it difficult to monitor coverage. “We don’t have it yet… It’s not the present time,” he said.
How to protect babies
As the holiday season approaches, experts recommend that families with newborns take additional precautions:
- Make sure babies and children are up to date on their vaccinations, and all family members have received flu, Covid and respiratory syncytial virus (RSV) vaccinations.
- Do not accept sick visitors.
- Seek immediate medical attention if your child has a cough or pauses in breathing.
