Along with other respiratory virus cases currently increasing across the country, pertussis cases are on the rise. Some states are seeing the most cases they’ve seen in over a decade, even though nationally 2024 was a bad year for pertussis cases, also called whooping cough.
Two experts spoke to Infectious Disease Special Edition on the conditions causing the rise in cases and what doctors can do to help best protect their patients.
Current U.S. Numbers
The most recent numbers from the CDC, released Dec. 20, show 27,871 cumulative year-to-date cases of pertussis in 2025. In comparison, 2024 had 41,922 cases in the same time period.
Although this is lower than 2024, last year was an incredibly high-case year, especially compared with pandemic years that saw a very low number of cases, possibly due to increased masking and isolation measures to reduce COVID-19 circulation. The years from 2020 to 2023 saw numbers in the low thousands, from 2,116 cases in 2021 to a high of 7,063 in 2023.
Prior to the pandemic, pertussis cases bounced between 10,000 and 30,000 from 2005 to 2019. Cases have been increasing since the 1980s, according to the CDC. They had precipitously dropped following the introducing of the first pertussis vaccines in the 1940s. Before the vaccines, annual numbers ranged from 100,000 to 200,000 cases per year.
This year, weekly number of pertussis cases have been creeping up week by week, with 125 new cases in the week ending in Nov. 22, up to now 187 in the most recent week reported (Dec. 20).
A Case of Two States
West Virginia is one state which has seen a steady increase of cases this year, according to Jeff Lancaster, MD, a pediatric hospitalist and the associate chief medical officer at WVU Medicine Golisano Children’s Hospital, in Morgantown, West Virginia. He told IDSE that the numbers reflect declining vaccination rates in his rural state. “We have seen a large increase in pertussis this year—and pertussis usually peaks every three to five years—but this is higher than we’ve seen for a long time,” Dr. Lancaster said. “The reason could be declining vaccination rates in West Virginia and nationwide.
And so, we’ve really tried hard to have a few campaigns that bring back the effectiveness and safety of vaccines, including pertussis.”
Dr. Lancaster said his state has also seen an increase in families applying for vaccination exemptions, and in turn, an increase in some vaccine-preventable disease, like pertussis. West Virginia is not alone in that. However, the state has fared better with measles cases than other states, he mentioned. “But we are still at as much risk as the other states who have had measles outbreaks,” he said.
New York state and Long Island have seen upticks but not the strong increase as other parts of the country, according to Sharon Nachman, MD, the division chief of pediatric infectious disease at Stony Brook Children’s Hospital, in New York. “And why is that?” she said. “Because in New York, there are no religious exemptions for school-age children for vaccines. That means kids that are going to schools are required to get their shots: six shots before reaching age 13 or four shots in the first two years.
“Are we seeing some cases? Yes, we are. But for the most part, those cases we’re seeing are in populations that are homeschooling their children,” she said. “I think the fact that we don’t have those exemptions in New York state is really helping protect us.”
There have also been pushes to vaccinate pregnant people and those caring for newborns, Dr. Nachman noted. And receiving a pertussis vaccine for adults is as easy as walking into a local pharmacy chain.
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Tips on Talking to Patients
Preparing for patients’ questions is a strategy both Drs. Lancaster and Nachman recommend for working with patients and their families who are vaccine hesitant. “Our job is to anticipate those questions and answer them honestly, using science and real data,” Dr. Lancaster told IDSE. Remind patients how devastating pertussis can be, especially for babies under 6 months of age, he said, and explain the science of the vaccines and the benefit they bring to both pregnant people and infants.
Dr. Nachman recommended creating “elevator pitches” on different subjects that might come up as questions, such as the use of thimerosal (which is not even included in pediatric shots, she added) or aluminum in vaccines. Talking points can make a "daunting" situation less stressful, she said. She also recommended repeating the discussions with patients and their families. “They may not hear you the first time or the second time, but maybe the third time you repeat the same elevator speech, it will help,” she said. “And you need to, in your head, practice that elevator speech.”
Using analogies for everyday life to explain the science behind vaccines, preservatives, adjuvants and the like can help make it understandable for your audience, she said, adding that maintaining eye contact and good body language is important. “Don’t do it while you’re typing at the computer. That’s never going to work,” she said. “Are they sitting there with their arms folded, looking way from you? Okay, you’re not reaching them. Are they leaning forward and listening to you? And you’re leaning forward and talking to them? Then you’re making a connection.”
All of this is in the goal of showing your expertise and doing what’s best for your patients, she explained. “You want to lean forward, look them in the face, and compliment them on doing a great job with their child, while you give them the information,” she said. “Because then you’ve established that you’re part of the team with them, not against them.”
Drs. Lancaster and Nachman reported no relevant financial disclosures.