Whooping Cough Is Surging: Signs Adults Keep Missing

It starts like every other cold: a runny nose, a scratchy throat, a mild cough you barely notice. A week passes, and instead of getting better, the cough gets worse. Then one night a coughing fit hits so hard you cannot catch your breath, and you make a sharp gasping sound trying to inhale. That sound has a name, and so does the illness behind it: whooping cough.

Whooping cough, or pertussis, is a bacterial infection caused by Bordetella pertussis. Most Americans think of it as a childhood disease, something handled by the shots kids get before kindergarten. But it is back in a big way, and adults are a major part of the story — both as patients and as the unknowing link in the chain that reaches newborn babies.

The surge is real, and it is not over

After nearly disappearing during the COVID-19 pandemic years, pertussis roared back. The Centers for Disease Control and Prevention (CDC) reported preliminary case counts above 35,000 in 2024, more than five times the roughly 7,000 cases recorded in 2023. It was the highest annual total in more than a decade, and cases stayed elevated through 2025, well above pre-pandemic levels.

Public health officials point to a few drivers. Pertussis naturally peaks every three to five years, and the pandemic years created an immunity gap: fewer infections circulating meant fewer natural immune boosts, while routine vaccination slipped. Kindergarten coverage for the DTaP vaccine fell to about 92 percent in the 2024-25 school year, down from 95 percent before the pandemic. For a disease as contagious as pertussis, that small dip leaves millions of extra openings.

Pertussis spreads through coughs and sneezes, and it is brutally efficient: an infected person can pass it to up to 80 percent of susceptible household contacts. People are most contagious in the first two weeks, when it looks exactly like a common cold.

Why adults keep missing it

Here is the trap: in adults, whooping cough often never whoops.

The illness moves through three stages. The first, catarrhal, lasts one to two weeks and is indistinguishable from a cold: runny nose, low-grade fever, mild occasional cough. The second, paroxysmal, is the signature phase: bursts of rapid coughs followed by a desperate inhale that produces the "whoop," sometimes with vomiting afterward. It can last up to 10 weeks. The third is a slow recovery over weeks or months. That months-long timeline is why pertussis is nicknamed the "100-day cough."

Adults and teens who were vaccinated as children often get a milder version. Their partial immunity blunts the disease, so they may never produce the whoop at all — just a stubborn cough that hangs on for weeks. That is why so many cases are mislabeled as bronchitis, allergies, or a cold that "just won't quit," and most never get tested.

The danger is not just to the coughing adult. Babies under one year old face the worst outcomes: about one in three infants hospitalized with pertussis needs intensive care, and the disease can cause pauses in breathing (apnea), pneumonia, seizures, and death. Most infants catch it from someone at home — often a parent, grandparent, or older sibling whose "mild cold" was pertussis all along.

How to tell it from an ordinary cough

See a clinician promptly if your cough fits this picture:

• It is getting worse, not better, after two weeks. Most colds peak within a few days and fade within 10. A cough that intensifies in week two or three is a red flag.
• It comes in fits. Coughing so hard you cannot get a breath in, or you vomit, gag, or feel faint afterward, is not a normal cold cough.
• There is a whoop or a gasp on inhale. Not everyone gets it, but when it is there, it is distinctive.
• It is worse at night. Pertussis fits often cluster at night, wrecking sleep for weeks.
• You have been around a confirmed case or a baby. Exposure plus a lingering cough should trigger testing.

Testing is simple: a swab from the back of the nose (a PCR test) can detect the bacteria, and it works best in the first three weeks of coughing. If you suspect pertussis, call ahead before visiting a clinic or urgent care and mention it, so staff can protect others in the waiting room.

Treatment: antibiotics help, but timing matters

Pertussis is treated with macrolide antibiotics, usually azithromycin, taken for five days. Here is the frustrating part: once the coughing fits have started, antibiotics generally do not shorten the cough much, because the damage to the airway lining is already done and takes weeks to heal. What they do accomplish is critical — they kill the bacteria and stop you from spreading it, usually within five days of starting treatment.

Antibiotics given in the first one to two weeks, before the fits begin, can actually lessen the severity of the illness. Household contacts, especially anyone living with a baby or a pregnant person, are often given preventive antibiotics too, even if they feel fine.

For symptom relief, the honest truth is that over-the-counter cough medicines do little for pertussis. Honey in warm tea and rest help you cope, but nothing over the counter shortens the 100-day cough.

The vaccine gap most adults do not know they have

Childhood DTaP vaccination wears off over time, which is why adults need a booster. The CDC recommends:

• One Tdap booster for every adult who has never had one, then a Td or Tdap booster every 10 years.
• Tdap during every pregnancy, ideally between weeks 27 and 36, so protective antibodies pass to the baby before birth.
• DTaP on schedule for children, with a booster at 4-6 years.

If you cannot remember your last tetanus shot, you are probably due — and that shot can be Tdap, covering pertussis at the same time. Most insurance plans cover it as preventive care at a doctor's office, pharmacy, or urgent care clinic. Grandparents and anyone who will hold a newborn should check their status before the baby arrives, ideally at least two weeks ahead, so immunity has time to build.

When to get help fast

Complications in adults include broken ribs from violent coughing, fainting, and pneumonia. Get urgent care if you cough up blood, pass out, cannot catch your breath between fits, or develop a high fever with worsening chest pain.

For babies, act faster. Seek emergency care immediately if an infant has pauses in breathing, turns blue or dusky around the lips, struggles to breathe, feeds poorly, or seems unusually limp or hard to wake.

The bottom line

A cough that lingers past two weeks, comes in exhausting fits, or keeps you up night after night is not "just a cold" — not during a national surge of a disease that is testable, treatable, and vaccine-preventable. Get tested early, stay home while you are contagious, and check whether your Tdap booster is up to date. That one shot protects you, and it may protect a baby who cannot yet protect herself.