Alabama and North Carolina are the latest U.S. states grappling with outbreaks of pertussis, also known as whooping cough, a disease that dates back to the Victorian era disease . Nationwide, the illness has been spreading for months, causing widespread concern among public health officials.
Currently, Alabama has reported 123 cases of pertussis, while North Carolina has recorded 525 cases. This highly contagious disease is caused by the Bordetella pertussis bacteria and leads to symptoms such as violent coughing, fever, sore eyes, and blue lips. Severe cases can result in vomiting, exhaustion, breathing difficulties, and even death, with about 1% of infected infants succumbing to the illness.
Rising Cases and Seasonal Concerns
The outbreak, which began in the spring, showed a brief decline over the summer before resurging in August. Experts warn that the situation may worsen during the colder months as flu season weakens immune systems and forces people indoors.
In 2024, the number of pertussis cases has already reached more than 16,000, a fivefold increase compared to 2023. The Centers for Disease Control and Prevention (CDC) has confirmed two deaths so far. States with the highest numbers of cases include Pennsylvania, New York, Illinois, California, Washington, Oregon, Massachusetts, and Arizona.
Public health officials attribute the increase in cases largely to a decline in vaccination rates since the pandemic.
Vaccination Gaps and Regional Impact
The CDC recommends children receive three doses of the Tdap vaccine by their first birthday. This vaccine is 98% effective at preventing the Victorian era disease in the year following immunization. However, vaccination rates have been declining nationwide, with only 80.4% of children vaccinated by age one. Some states report even lower rates, such as Idaho, where 12.1% of kindergartners have vaccine exemptions, and Arizona, where 7.4% of kindergarteners are unvaccinated.
In Alabama, cases have been identified at high schools in Trussville and Springville, as well as at the University of Alabama Huntsville. The state has seen a 300% increase in cases over the past year, rising from 41 to 123, according to the Alabama Department of Public Health.
North Carolina has also experienced a significant surge, particularly in Buncombe County, which is located in the western part of the state and has a population of approximately 275,900. After recording nearly 120 cases in the spring, the number of infections in North Carolina declined over the summer but has surged again in recent months. As of early November, the state has reported 525 cases, alongside new outbreaks of measles and pneumonia.
Vulnerable Populations and Modes of Transmission of Victorian Era Disease
Whooping cough is most commonly spread among children and teens, especially in settings like schools and daycare centers where close contact occurs daily. Children under one year old are particularly vulnerable due to their underdeveloped immune systems, putting them at higher risk of severe complications such as breathing difficulties.
The Victorian era disease spreads through airborne particles when an infected person coughs or sneezes. Once inhaled, the bacteria attach to tiny hairs in the throat and nose, releasing toxins that cause airway swelling. Symptoms typically begin about a week after infection, with early signs including a runny nose, mild cough, and low-grade fever. These symptoms can escalate into severe coughing fits, vomiting, and exhaustion.
Historical Context and Vaccination Recommendations
Pertussis was once a leading cause of death, killing thousands of children annually before the first vaccine was introduced in 1948. The CDC now recommends a series of vaccinations throughout a person’s life, beginning at two months of age. Booster doses are advised every 10 years to maintain immunity.
While the vaccine is not always 100% effective at preventing illness, vaccinated individuals tend to experience milder symptoms compared to those who are unvaccinated.
Addressing the Rise in Cases
Experts stress that declining vaccination rates and growing vaccine hesitancy are major contributors to the recent resurgence of whooping cough. Dr. Tina Tan, a pediatric infectious disease specialist, noted that vaccine hesitancy and misinformation remain significant barriers to improving immunization rates.
For those exposed to pertussis, doctors can prescribe antibiotics to prevent the spread of the disease. Early treatment is essential to managing symptoms and reducing transmission within communities.
As cases continue to rise, public health officials urge parents to ensure their children are up-to-date on vaccinations and emphasize the importance of maintaining good hygiene practices to limit the spread of the disease.
