By Jennifer Fernandez
Whooping cough cases in North Carolina have risen sharply in 2024. There have been close to 600 reported cases — 6.4 times more than last year at this time.
Nationally, cases are 4.8 times higher, federal data shows.
The highly contagious respiratory illness tends to rise and fall in cycles as vaccines wear off and new children are born without immunity, experts said. In recent years, efforts to prevent the spread of COVID-19 played a role in lowering the number of whooping cough cases. People were isolating, and fewer children were congregating in schools.
The return to regular habits of socialization post-pandemic could account for much of the uptick, but vaccine hesitancy may be driving part of this latest spike, some experts warned.
“It is honestly a problem we deal with every day,” Suresh Nagappan, medical director of the Children’s Unit at Moses Cone Hospital in Greensboro, said about people debating whether to get vaccinated. “I think a lot of it is people have lost trust in authority.”
Fewer and fewer people are taking the word of public health experts or even the advice of their family doctors. To combat that loss of authority, doctors need to personalize the information they give to patients, such as sharing what they have read in recent studies or how vaccines have helped their other patients, Nagappan said.
Whooping cough cases in NC by Jennifer Fernandez
Peak in cases still ahead
As of the week ending Nov. 23, North Carolina had recorded 576 cases of whooping cough, up from 90 cases during the same time last year, according to data from the Centers for Disease Control and Prevention. Cases are expected to keep rising as whooping cough tends to peak during the fall and winter.
Whooping cough, also known as pertussis, is caused by a bacterial infection that can be life-threatening, especially for infants. The name “whooping cough” comes from the “whooping” sound made when people catch their breath after a prolonged fit of coughing.
That coughing, and the swelling in the airways associated with pertussis, is especially hard on infants, with their tiny airways.
During a 2012 outbreak in Winston-Salem, a 2-month-old died.
“They just can’t handle it in the same way” as an adult, Nagappan said.
Early symptoms can mimic a cold. Typically, it takes five to 10 days for symptoms to appear, although it can take as long as three weeks. The cough associated with pertussis can last for weeks, even months and can lead to pneumonia in children and adults. For some, the coughing is so severe that they can fracture ribs or faint.
About a third of babies younger than 12 months old who get whooping cough will end up in a hospital, the CDC said. One in five babies with whooping cough get pneumonia. About 1 percent, or one in 100, will die.
North Carolina requires that all children get immunized against several illnesses, such as measles, polio and whooping cough.
Nagappan said while the number of cases is trending in the wrong direction, the net number of cases “is not huge compared to what it was in recent memory.”
The country is trending toward a total of about 30,000 cases this year, if weekly counts remain steady. That’s well below the 48,277 cases in 2012, which was the highest in more than six decades.
Nagappan attributed the increase to the advent of a new version of the pertussis vaccine introduced in the early 1990s. It came with fewer side effects, which health care providers — and parents — welcomed, but this “acellular” vaccine is only about 85 percent effective and doesn’t provide protection for as long as the previous version.
Helene’s impact
From late 2018 through August 2023, North Carolina had 16 whooping cough outbreaks, according to the North Carolina Department of Health and Human Services. Before the remnants of Hurricane Helene hit western North Carolina, the area was experiencing another increase in cases of the illness, mainly in children, following an earlier outbreak in the spring, according to media reports.
In Buncombe County, cases have doubled since September, according to media reports and data from Buncombe County Health and Human Services.
In one of its advisories, NCDHHS warned that respiratory illnesses would be an issue after the storm. The agency encouraged vaccination not only for seasonal respiratory viruses, but also for whooping cough among those who have not been vaccinated, and “especially for individuals living in crowded living situations or shelters,” where respiratory infections can spread easily.
Under state law, children typically have to show proof of vaccination to attend school or child care. Students have 30 days from when they first start school or child care to provide proof of vaccination or show they are exempt. Students who miss that deadline can be suspended.
In response to Helene, state officials gave students affected by the storm more time to meet vaccination requirements. That could have allowed for spread too.
Return to pre-pandemic patterns
At one time, whooping cough was one of the most common childhood diseases and a major cause of death in children. Once a vaccine was developed in the 1940s, U.S. cases began to drop from 200,000 annually to fewer than 19,000 in 2019.
Cases plummeted during the COVID-19 pandemic to a low of 2,116 nationally in 2021, CDC data shows. Health officials said the decrease likely came from people isolating, masking and washing hands more during the pandemic. Preventing the spread of COVID also tamped down other respiratory illnesses, like whooping cough.
Those same practices can help prevent whooping cough from spreading now, health officials said.
The country is starting to return to pre-pandemic patterns of whooping cough, where more than 10,000 cases are typically reported each year, the CDC said — although experts believe much of the disease goes unrecognized and unreported.
The agency expects whooping cough cases to increase in vaccinated and unvaccinated populations this year.
US cases of whooping cough by Jennifer Fernandez
Vaccinations down, exemptions up
Overall vaccination coverage for kindergarteners has been dropping nationally and in North Carolina over the past decade.
In North Carolina, 93.5 percent of incoming kindergartners had received all required vaccinations last year, according to the most recent CDC data. That’s down two percentage points from the 2011-12 school year.
Nationally, coverage last school year ranged from 92.3 percent for the diphtheria, tetanus and acellular pertussis vaccine — more commonly known as DTaP — to 92.7 percent for the combined measles, mumps and rubella vaccine, according to the most recent CDC data available.
Meanwhile, the percentage of students claiming an exemption from getting vaccinated remains small, but continues to rise, driven mostly by non-medical reasons, data shows. Last school year, 2.9 percent of North Carolina kindergarteners received an exemption, below the 3.3 percent of kindergarten students exempted nationwide.
In North Carolina, the percentage of kindergartners exempted for any reason has more than tripled over the past 12 years. Nationally, that number doubled.
While there has been pushback on COVID-19 and measles vaccines, Nagappan said, he’s seen a lot of interest from parents in the new antibody treatment released last year for respiratory syncytial virus, or RSV. RSV, which is caused by a common virus, can be very dangerous for very young infants and for babies and young children who have certain health problems.
There have been enough bad seasons of RSV that many people know someone whose child ended up hospitalized, he said. And with several outbreaks of the illness, parents were inundated with warnings from day care centers about the dangers of RSV, so that “primed people that RSV was dangerous,” he said.
That response to a new treatment gives Nagappan hope.
“I think it’s not a wholesale rejection of vaccines,” he said. “I think it is people want specific recommendations and (are) basing it on their own experiences.”
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