It starts as a tiny tickle. Maybe a runny nose. You’d swear it’s just another seasonal cold or that lingering cedar fever everyone’s complaining about on social media. But then, about ten days later, the coughing starts. It’s not just a normal hack; it’s a violent, rib-shaking spasm that leaves you gasping for air. That sound—that high-pitched "whoop" as you desperately try to pull oxygen back into your lungs—is unmistakable. It’s Pertussis. And honestly? Whooping cough on the rise isn’t just a headline anymore; it’s a reality hitting clinics from California to the UK.
We used to think of this as a Victorian-era relic, something relegated to the same history books as scurvy or polio. We were wrong.
In 2024 and 2025, data from the Centers for Disease Control and Prevention (CDC) showed a staggering spike, with cases in some U.S. regions jumping fivefold compared to the previous year. This isn't just a "vax vs. no-vax" debate, though that’s part of the noise. It’s actually way more complicated. It’s about waning immunity, the weird way bacteria evolve, and the fact that we basically stopped passing around normal germs during the pandemic lockdowns. Now, the "immunity debt" is coming due, and Bordetella pertussis is leading the charge.
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Why are we seeing whooping cough on the rise right now?
Biology is rarely simple. If you're looking for one single villain to blame for the resurgence, you won't find it. Instead, it’s a perfect storm of three or four different factors hitting at the exact same time.
First, let’s talk about the vaccines. Back in the 1990s, the U.S. switched from "whole-cell" vaccines to "acellular" ones (DTaP and Tdap). Why? Because the old ones sometimes caused fevers or localized swelling, and parents were rightfully concerned. The new versions are much "cleaner" and have fewer side effects, but there’s a catch. They don't last as long. Doctors call this "waning immunity." You might be fully covered at age six, but by the time you’re sixteen or thirty-five, that protection has basically evaporated. You’re a walking target for the bacteria, even if you followed the schedule as a kid.
Then there's the "post-COVID" effect. For two years, we wore masks, used heaps of hand sanitizer, and stayed six feet apart. It worked great for stopping flu and Pertussis, but it also meant our immune systems didn't get their natural "booster" shots from low-level exposure in the community. As soon as the masks came off and the music festivals started back up, the bacteria found a population with zero recent defenses.
The Evolution of the Bacteria Itself
Believe it or not, the bacteria are actually getting smarter. Research published in journals like The Journal of Infectious Diseases suggests that certain strains of Bordetella pertussis are evolving to lack "pertactin."
What’s pertactin?
It’s a specific protein that the current vaccine teaches your body to hunt down. If the bacteria stop producing that protein, they basically become invisible to the "search party" your immune system sends out. It’s a literal arms race. While the vaccine still prevents the most severe, life-threatening versions of the disease, it’s becoming less effective at stopping the spread entirely. That's a huge reason why we see whooping cough on the rise even in highly vaccinated communities.
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Identifying the "100-Day Cough"
In China, they call it the "100-day cough." That's not an exaggeration.
The progression of Pertussis is divided into three distinct stages, and knowing them can literally save a life, especially if there’s an infant in your house.
- The Catarrhal Stage: This lasts 1-2 weeks. It looks like a cold. Sneezing, mild cough, maybe a low fever. This is when you are most contagious. You’re shedding bacteria everywhere, thinking you just need some Vitamin C.
- The Paroxysmal Stage: This is the nightmare zone. The cough comes in "paroxysms"—rapid, violent bursts. Because your lungs are emptied of air, you take a massive, forced breath at the end that creates the "whoop" sound. Some people cough so hard they break ribs or burst blood vessels in their eyes.
- The Convalescent Stage: Recovery. It takes weeks or months. Your lungs are healing from the toxins the bacteria released, which paralyzed the tiny hairs (cilia) that usually clear out mucus.
It’s Not Just a Kids’ Disease
There is a dangerous myth that only babies get whooping cough. While it’s true that infants are the ones who end up in the ICU because their airways are tiny, adults are the primary "reservoirs" for the disease.
Most adults who get it just think they have a really bad, lingering bronchitis. They go to work, they go to the grocery store, and they go to the family Thanksgiving dinner. They "tough it out." Meanwhile, they’re unknowingly passing a potentially fatal respiratory infection to their niece or their elderly neighbor.
According to Dr. James Cherry, a prominent UCLA researcher and one of the world's leading experts on Pertussis, the actual number of adult cases is likely ten to twenty times higher than what is officially reported. We simply aren't testing for it enough. If you’ve been coughing for more than three weeks and it's getting worse at night, you probably don't have "allergies." You need a PCR swab.
The Reality of Treatment: Timing is Everything
Antibiotics like Azithromycin or Clarithromycin are the standard treatment. But here is the kicker: they only help you feel better if you take them in that first "cold-like" stage.
Once the violent coughing starts, the bacteria have already done their damage. They’ve released toxins that have basically "carpet-bombed" your respiratory lining. At that point, the antibiotics won't stop the cough, though they will stop you from being contagious to others. It’s a weird, frustrating paradox of modern medicine. You take the pills not to save yourself from the 100-day cough, but to save the person sitting next to you on the bus.
Actionable Steps to Protect Your Household
Since whooping cough is on the rise, sitting back and hoping for the best isn't a great strategy. You have to be proactive, especially because the "whoop" doesn't always show up in adults or very young infants (who might just stop breathing instead—a terrifying symptom called apnea).
Check your records for the "T" word. Don't just assume you're "up to date." If you haven't had a Tdap booster in the last ten years, you are effectively unprotected against Pertussis. If you are pregnant, getting the vaccine between weeks 27 and 36 is non-negotiable. It allows you to pass antibodies directly to the baby, giving them a "shield" before they are old enough to get their own shots at two months.
The 2-Week Rule. If anyone in your house has a cough that lasts more than two weeks, see a doctor. Specifically ask for a Pertussis test. Don't let them brush it off as "just a virus." Early detection allows for post-exposure prophylaxis—meaning the rest of the family can take a short course of antibiotics to keep the infection from taking hold in their own lungs.
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Purify the Air. While Pertussis is spread through droplets (coughing and sneezing), improving indoor ventilation helps reduce the viral and bacterial load in a room. Use HEPA filters if someone is sick, and for heaven's sake, teach your kids to cough into their elbow, not their hands.
Cocooning works. If you have a newborn, be the "mean" parent. Ask anyone who wants to hold the baby if they’ve had their Tdap booster recently. It feels awkward, sure. But it’s much less awkward than a trip to the pediatric emergency room.
We are living through a period where old diseases are finding new ways to circulate. The rise in cases isn't a fluke; it's a reminder that public health is a collective effort. Staying informed about the symptoms and keeping your boosters current is the only way to dampen the surge. If you're hacking so hard you can't catch your breath, stop searching your symptoms online and get to a clinic. It’s better to be wrong about a "cold" than right about whooping cough too late in the game.