Q&A: Are COVID-19, vaccine hesitance to blame for pertussis spike in US?
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Key takeaways:
- The number of reported pertussis cases has increased nearly fivefold in 2024 over the same period of 2023.
- Experts say the spike is part of a return to normal as the COVID-19 pandemic has eased.
The number of pertussis cases in the United States has quadrupled over the last 12 months, according to the CDC, raising questions as to what is behind the sudden, significant spike.
The CDC reports 17,579 cases of pertussis in 2024 as of Oct. 5, compared with 3,962 reported cases through the same date in 2023 — a nearly fivefold increase year over year — which the agency said is higher than was seen in 2019, before the COVID-19 pandemic.
In addition to outbreaks in the U.S., pertussis cases have also increased this year in Brazil, Mexico and Peru amid declines in vaccination coverage linked, at least partially, to the COVID-19 pandemic.
Pertussis cases had been steadily increasing in the U.S. since the 1980s, according to the CDC, with a peak of nearly 50,000 cases in 2012, before the start of the pandemic.
The agency has also previously noted rising vaccine hesitancy in the U.S. and speed bumps in national efforts to improve children’s access to routine vaccinations, including for pertussis.
We spoke with Georgina Peacock, MD, MPH, FAAP, director of the immunization services division of the CDC’s National Center for Immunization and Respiratory Diseases, about the recent spike in pertussis cases in the U.S. and whether it is connected to rising vaccine hesitancy in the country. Her answers have been edited lightly for clarity and length.
Healio: Pertussis cases have quadrupled in the last 12 months. Is a decline in vaccination at fault, is something else at work or is it both?
Peacock: The rise in pertussis cases, more commonly known as whooping cough, underscores the importance of vaccination.
Reports of whooping cough were lower than usual over the past few years, during and following the COVID-19 pandemic. It is likely that pandemic-era public health measures such as remote learning and masking lowered the spread of whooping cough. We are now seeing the U.S. return to pre-pandemic [pertussis] patterns, where more than 10,000 cases are typically reported each year. Whooping cough vaccination coverage has remained stable, overall, for children for over a decade. Despite coverage fluctuating slightly from year to year, there’s no evidence that these changes are contributing to the ongoing burden of whooping cough.
Vaccination is the best way to prevent whooping cough. However, as typical infection patterns return to the U.S., the CDC expects cases to increase both in unvaccinated and vaccinated populations — whooping cough occurs in vaccinated people since protection fades over time.
Healio: Did the pandemic shift some people’s thinking on childhood vaccines?
Peacock: A CDC survey conducted in 2023 found that concern about serious side effects was the most common reason reported by parents that they would consider not getting their child a routine vaccine.
In addition to concerns about side effects, it is important to address financial barriers, access issues, vaccine hesitancy and vaccine-related misinformation to help increase coverage, reduce disparities and protect all children from vaccine-preventable diseases.
Keeping up to date with recommended vaccines is one of the best things parents can do to protect their child from these diseases. We know childhood vaccination has been so successful in the U.S. [that] many of these diseases are now unheard of — we need to remain vigilant to keep it that way.
Healio: Have people forgotten about pertussis the way they’ve forgotten about polio?
Peacock: Childhood vaccination in the U.S. has been so successful in preventing illness and death that serious diseases such as diphtheria, mumps and rubella, once common in babies and children, are now practically unheard of. Let’s keep it that way.
According to a survey conducted in July by the CDC among 4,250 U.S. adults aged 18 years and older to gauge level of awareness of vaccine-preventable diseases, 67.2% of adults aged 18 to 49 years had heard of pertussis compared with 80.8% of adults aged 50 to 64 years and 89.3% of adults aged 65 years and older. Overall, older adults (aged 50 years or older) had much more awareness than younger adults (aged 18 to 49 years) on vaccine-preventable diseases.
Healio: How dangerous is the combination of people knowing little about vaccine-preventable diseases and the decline in childhood vaccination?
Peacock: Recent decreases in coverage with most of the recommended childhood vaccines could lead to a resurgence of vaccine-preventable diseases such as measles, mumps and varicella (chicken pox).
Children who are not protected by vaccines are more likely to get sick from vaccine-preventable diseases. These diseases can be very contagious and serious, especially for babies and young children.
It’s important to learn about vaccine-preventable diseases, including the serious complications and symptoms that can happen when a child is infected with them.
Healio: What can be done to reverse declines in childhood vaccination?
Peacock: Although the reasons for the declines are complex, everyone has a role to play in increasing routine childhood vaccinations, so it is crucial that we continue to work together to improve routine vaccination coverage in children. This includes community partners, health care providers, health departments, early care and education professionals and schools amplifying immunization messages, building confidence and connected families with access to vaccines.
While following evidence-based practices to improve vaccination coverage, providers could educate parents specifically about the safety and effectiveness of vaccinations required for early child care or school entry, and the risks of delayed, incomplete or nonvaccination to children, family members, classmates and the community.
We [the CDC] encourage parents to speak with a health care provider they trust with any concerns or questions.
References:
- CDC. Nationally notifiable infectious diseases and conditions, United States: Weekly tables (pertussis). https://wonder.cdc.gov/nndss/static/2024/40/2024-40-table990.html. Updated Oct. 5, 2024. Accessed Oct. 11, 2024.
- CDC. Whooping cough (pertussis): Pertussis surveillance and trends. https://www.cdc.gov/pertussis/php/surveillance/index.html. Updated Oct. 10, 2024. Accessed Oct. 11, 2024.
- CDC. Whooping cough (pertussis): Whooping cough vaccination. https://www.cdc.gov/pertussis/vaccines/index.html. Updated June 26, 2024. Accessed Oct. 11, 2024.
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