By Jennifer Fernandez
Most people likely know pertussis by its more common name — whooping cough, which comes from the “whoop” sound made as the person tries to catch their breath in between violent coughing spells.
The Corbin family in Chapel Hill is well acquainted with the other nickname for pertussis — the “100-day cough.” Earlier this year, 11-year-old Alex Corbin spent at least two months struggling with a cough that made him vomit, kept him up at night and left him breathless.
Months later, he still suffers from coughing fits, although they are nowhere near the intensity they were initially, said his mother, Jennifer Corbin.
A spate of whooping cough cases cropped up at Alex’s elementary school at the end of last school year, Corbin said. She was surprised when Alex became sick because he was vaccinated.
Whooping cough vaccine schedule
Because whooping cough is caused by a bacteria, not a virus, people need more frequent vaccination.
According to the CDC, kids should receive boosters on this schedule:
Babies need three shots to combat diphtheria, tetanus and pertussis (DTaP) to build up high levels of protection. That means a shot at 2 months, 4 months and 6 months.
Young children need two booster shots of DTaP between 15 and 18 months and between 4 and 6 years to maintain that protection through early childhood.
Preteens and teens should get one shot of Tdap (a different formulation of vaccines against all three diseases) between the ages of 11 and 12 years to boost their immunity. Teens who didn’t get Tdap as a preteen should get one shot the next time they visit their health care provider.
Cases are climbing across the state, including in Buncombe County in western North Carolina, and some of that is likely due to waning immunity in vaccinated kids, according to county health officials. They said the vaccine starts to wane around ages 3 to 4 and again around ages 9 to 10 years old, before children typically get the next booster shot.
Buncombe County had 84 whooping cough cases as of about mid-September 2025. That’s already higher than the 77 cases for all of 2024, said Nicole Santamaria, the county’s lead communicable disease nurse. The previous four years averaged six cases a year, Buncombe County officials said.
The highly contagious respiratory illness rises and falls in cycles as vaccines wear off and new children are born without immunity, experts said. It is on an upswing, with cases rising across the state and nation the past two years.
With masking and isolating from the pandemic no longer common, whooping cough returned at levels not seen in 70 years, the North Carolina Department of Health and Human Services said in an Aug. 4 news release that encouraged families to get children vaccinated before school started this fall.
“It’s always creeping out there a little bit,” said Susan Creede, nurse supervisor for Buncombe County’s communicable disease team. “But when we hit these big outbreaks … the spread is just so very hard to control.”
What is whooping cough?
Before a vaccine was developed in the 1940s, whooping cough was one of the most common childhood diseases and a major cause of death in children. With the introduction of a vaccine, cases began to drop from 200,000 annually to fewer than 19,000 in 2019.
Whooping cough is caused by the bacteria Bordetella pertussis, and it causes an infection that can be life-threatening, particularly for infants.
Babies are particularly vulnerable because of their small airways — smaller than the width of a pinkie finger — which can collapse after a bout of coughing. Babies also get sick with whooping cough at higher rates than older children.
The rate among North Carolina infants is 2.6 times higher than school-aged children this year, NCDHHS said. There are 51.1 infant cases of whooping cough per 100,000 North Carolinians compared with 20 cases in school-aged children per 100,000 residents, the agency said.
“Babies, especially, can die,” Creede said. “They can barely suck, swallow and breathe up to 3 months [old]. And then you add pertussis, and the cough is so intense.”
Babies can stop breathing and die, or survive but suffer brain damage, she said.
About a third of babies younger than 12 months old who get whooping cough will end up in a hospital, the U.S. Centers for Disease Control and Prevention said. One in five babies with whooping cough get pneumonia. About 1 percent, or one in 100, will die.
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 or months and can lead to pneumonia in children and even adults. For some patients, the coughing is so severe that they faint, vomit, burst blood vessels in their eyes or even fracture ribs.
It’s important to recognize early that the cough is more than just a typical cold, as antibiotics can reduce the severity of infection if identified early.
Corbin, who is a biomedical scientist, said she was surprised by how severe the symptoms were for an 11-year-old.
“It was really awful on him,” she said. “He hated having these coughing fits because he felt like he was dying. He couldn’t breathe. It was really scary.”
Early pertussis symptoms
Similar to a cold
Runny or stuffed-up nose
Low-grade fever (less than 100.4°F)
Mild, occasional cough
Babies may struggle to breathe.
Later symptoms
Make high-pitched “whoop” sound when inhaling after coughing
Vomit during or after a fit of coughing
Feel tired after coughing (but seems well in-between fits)
Have hard time sleeping at night
Struggle to breathe
Cough hard enough to break a rib
Source: Centers for Disease Control and Prevention
Cases still rising
In recent years, efforts to prevent the spread of COVID-19 had the side benefit of lowering the number of whooping cough cases. People were isolating, and fewer children were congregating in schools.
Health officials said that fewer people following those protocols recently, and the natural ebb and flow of whooping cough, played a role in the spike in cases.
The state recorded 831 cases last year and appears on track to meet or exceed that amount this year. Nearly a third of the state’s cases last year were reported from September through December, according to an NC Health News analysis of preliminary state data compiled by the CDC.
North Carolina had 661 cases as of Sept. 1, NCDHHS told NC Health News in an email.
However, there are likely more cases that haven’t been identified due to misdiagnoses, underdiagnoses and fading immunity, according to the Children’s Hospital of Philadelphia.
Cases can be misdiagnosed because the bacteria that causes pertussis are only detectable at the beginning of an infection, and many people don’t seek help until later, the hospital said on its Vaccine Education Center page.
Some people don’t ever seek help, leading to underdiagnoses. And fading immunity plays a role, as people can get infected by pertussis more than once.
People who have been vaccinated should be wary about spreading whooping cough if they get sick, Creede said. Even though the vaccination will protect against severe illness, the person would still be infectious.
“You think you’re just coming down with a common cold kind of thing. You’ve got this tickle in your throat that just won’t go away, but it’s not really making you sick,” she said. “It spreads so easily like that.”
Whooping cough cases in NC 2025 by Jennifer Fernandez
Vaccination
Children get a series of vaccinations for whooping cough, with the first doses closely grouped together at 2 months old, 4 months old and 6 months old, with a final infant dose at 15 to 18 months old. Boosters are recommended between ages 4 to 6 and 11 to 12.
The shot young children get is a combination vaccination for diphtheria, tetanus and pertussis, often shortened to DTaP. Older children and adults get booster shots that include tetanus, diphtheria and pertussis, called Tdap.
Federal data show that DTaP vaccinations in North Carolina ticked up last school year to 94 percent, up from 93.5 percent the previous school year. Current data wasn’t available.
Meanwhile, non-medical vaccination exemptions keep climbing nationally and in North Carolina.
Last school year, 3.1 percent of kindergarten students requested an exemption for one or more vaccines for non-medical reasons, data show. A decade ago, 0.9 percent of kindergarten students sought a non-medical exemption.
Nationally, that’s increased from 2 percent to 3.4 percent in the same time period.
Keeping vaccination levels at a certain percentage — at least 92 to 94 percent for whooping cough — is important to help stop illnesses from spreading in a community, Creede said.
Letting that level drop for whooping cough could be deadly, she said.
“Unfortunately, we’ll lose babies. That’s what will happen,” Creede said. “We’ve got some herd immunity right now, and all of the work that we do is to protect those most vulnerable — those infants, the immunosuppressed and the very elderly.”
‘Due diligence’
More than 1,500 people in Buncombe County have been tested for whooping cough this year, Santamaria said.
“Part of that is because we know it’s in our community,” Creede said. “So the providers are doing due diligence and saying, ‘Well, let’s test this. I don’t hear a whoop or anything, but it just could be, because it’s a sneaky little cheeky monkey, and we’re going to test for you anyway.’”
In cases of school children getting whooping cough, the health department sends letters to every family with a child in that class, Creede said. It notifies families that there has been a case in their child’s class and advises that if anyone gets “so much as a runny nose or a little bit of a cough,” they need to be evaluated, Creede said.
Parents also get a letter to give their provider advising them of a case of whooping cough in their patient’s classroom.
“Because if you walk in and you’re not barking with the whoop, they may not think about it,” Creede said.
Corbin said she wouldn’t have known to get her son tested for whooping cough if she hadn’t gotten a letter from the school about him being in close contact with someone with the illness.
The entire family took prophylactic antibiotics as a precaution after her oldest son tested positive.
“If you do get a close contact notification and your kid has any symptoms at all … it’s worth getting them tested,” she said.
Source: N.C. Department of Health and Human Services
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