Whooping Cough’s Return

Q: Why is whooping cough resurging in various parts of the world, and what can we do about it?

Whooping cough, also known as pertussis, is a highly contagious respiratory infection caused by the Bordetella pertussis bacterium. Once nearly eradicated in many parts of the world because of widespread vaccination, whooping cough has resurged in recent years. This has been observed in such high-income areas as the United States, parts of Europe, and Australia, as well as lower-income regions.

Reasons for the Resurgence 

The current vaccine used in many countries is an acellular pertussis vaccine (DTaP for children and Tdap for adolescents and adults), which replaced the earlier whole-cell vaccine (DTwP) in the 1990s. The acellular vaccine causes fewer side effects but provides less durable immunity compared to the whole-cell vaccine. Immunity from the acellular vaccine wanes after about five to 10 years, leaving individuals vulnerable to infection.

In some regions the drop in vaccination coverage is a result of vaccine hesitancy. Misinformation about vaccines, often spread through social media and anti-vaccine movements, has led to decreased trust in vaccines. In areas in which vaccination rates drop below the threshold needed for herd (community) immunity, outbreaks of whooping cough become more likely. In many low- and middle-income countries, logistical, infrastructure, or economic challenges may hinder access to vaccines, resulting in periodic epidemics. 

Pertussis has a natural cyclical pattern of reemergence, even in highly vaccinated populations. Outbreaks tend to occur every three to five years, driven partly by vaccinated individuals’ waning immunity.

In high-income countries pertussis has come back because of a combination of waning immunity from acellular vaccines and vaccine hesitancy. In low- and middle-income countries the resurgence of whooping cough is often linked to incomplete vaccination coverage through infrastructure, poverty, or even conflict, resulting in periodic pertussis outbreaks.

What Can Be Done?

Expanding global vaccine coverage is critical, particularly in low- and middle-income countries. International health organizations, governments, and nongovernmental organizations must collaborate to improve access to vaccines for all.

Since immunity from the acellular pertussis vaccine wanes over time, booster shots for adolescents and adults are essential. This will help reduce the transmission of the disease from adults to infants, who are the most vulnerable. Some countries already recommend booster doses of the Tdap vaccine for pregnant women, health-care workers, and people in close contact with infants.

Public health campaigns are needed to combat misinformation and vaccine hesitancy, educating the public about the safety and efficacy of vaccines. Governments and health organizations need to invest in communication strategies to rebuild trust in vaccines.

Developing new vaccines that provide longer-lasting immunity than the current acellular vaccines could be another long-term solution. 

This multifaceted problem requires an intentional approach to reduce and ultimately eradicate the spread of whooping cough. The Seventh-day Adventist Church has an important role in preventing diseases through consistent messaging on healthy lifestyle; promoting appropriate immunization programs by our clinics, dispensaries, and hospitals; sharing wholeness; and serving all.