The nation is in the midst of the largest pertussis (whooping cough) outbreak in a decade, and it hasn’t shown signs of slowing. CDC data from late November show weekly cases at six times the rate seen during the same week in 2023.
The nationwide outbreak, topping 28,000 cases as of November 30, reflects a return to pre-pandemic levels, but with enough additional cases to make up for all the ones we didn’t have during the main pandemic years.
Plenty of excellent stories have already been covering this outbreak at STAT, Washington Post, NPR, Fortune, and plenty of local outlets. So what more should reporters be doing as the cases continue? There are more angles than just reporting the numbers, and this tip sheet offers some ideas.
Emphasize the groups most at risk and accompanying vaccine recommendations
Pertussis isn’t fun at any age — it can involve literal months of constant coughing — but it’s most dangerous for infants under 2 months old and older adults. An Alaskan infant died in September, and infants have also died in England and Australia, which are similarly experiencing nationwide upsurges in cases.
But children do not receive their first vaccine against pertussis until 2 months old, and that one is a priming vaccine that doesn’t become as effective until their 4-month dose.
Therefore, people should be advised to follow the CDC recommendation to get the Tdap vaccine during pregnancy so that antibodies transferred across the placenta can protect infants in their first few months of life. It’s not a bad idea for everyone in a household expecting a baby to get a Tdap booster, a strategy called cocooning.
Outside of pregnancy, all adults are recommended to receive a Tdap booster against tetanus and diphtheria every 10 years, but those with certain conditions, such as asthma, a chronic lung disease, an immune-compromising condition, or other chronic illnesses, may opt to get one more frequently.
Individuals should consult their primary care providers or local health departments to determine whether getting a booster is advisable for them, though insurance may or may not cover it outside of CDC recommended doses.
Finally, of course, those who are unvaccinated are at higher risk for both the disease and worse cases of it. NBC did a great job of emphasizing even in the headline that unvaccinated teens are part of the spikes in cases.
Tell personal stories about pertussis
Pertussis cases are in most U.S. states and territories right now, so there’s a good chance that reporters could find a somewhat-local family to tell their story. Journalists can also contact families with past cases of pertussis to tell their story now when the context is relevant. Plenty of hospitals, state health departments, and other organizations, such as the parent advocacy group Voices for Vaccines, have stories and may be able to connect journalists with families.
Journalists can also report on how the outbreak is affecting social events, such as this story on a college football game cancelled due to a case of whooping cough.
Familiarize yourself with the history of pertussis outbreaks and vaccines
Nearly every time I write about pertussis — which has been at least 100 stories in the past 15 years — I link to this CDC page: Pertussis Cases by Year (1922-2022). That’s because this chart of historical pertussis cases tells the disease’s story so effectively. It reveals the three- to five-year cyclical pattern of the disease, but it also tells the story of pertussis vaccines.
The first pertussis vaccine, developed in 1914, wasn’t very effective or widely used, with about 6,000 U.S. children still dying annually from whooping cough in the 1920s. Further refinement and testing of a pertussis vaccine in the 1930s led to the more effective whole-cell pertussis vaccine, combined with the diphtheria and tetanus vaccines (DTP), that the U.S. then used through the 1990s. Hence the chart showing a decline in cases starting in the late 1940s that reaches the lower thousands in the 1970s. But then note what happened in the 1980s — cases start increasing. And then they really shot up in the early 2000s. What happened?
The whole-cell pertussis vaccine in DTP was more reactive than most other childhood vaccines, with higher rates of swelling and pain as well as fevers, some of which caused febrile seizures. Febrile seizures can occur with other vaccines but occurred at a higher rate with DTP vaccines.
Studies in the 1990s clarified that febrile seizures do not cause long-term problems, but such evidence was thin in the 1980s. (More recently, research has found that children with an already-existing underlying brain issue, such as epilepsy that has not yet manifested, appear more likely to have febrile seizures as toddlers. Febrile seizures therefore may be a possible early sign of a later problem, but they still are not the cause of the problem.)
Fears about these seizures reached a boiling point in the 1980s, especially after a 1982 TV documentary advertised them and led to the formation of a parent group that grew into today’s anti-vaccine National Vaccine Information Center. The increasing cases in the 1980s-1990s likely reflects lower uptake of the vaccine in light of these fears.
A positive result of all this was a 1986 vaccine law that built today’s extensive vaccine safety monitoring infrastructure and injury compensation program. Another result was the development of new “acellular” pertussis vaccines that contain a handful of protein antigens instead of the full bacterial cell. Acellular pertussis vaccines, packaged with diphtheria and tetanus vaccines in the DTaP and Tdap vaccines, were far less reactive and replaced all DTP vaccines in the U.S. in the 1990s (though DTP is still the primary pertussis vaccine used outside the U.S.). All seemed well — at first.
A new problem became evident two decades later. Note in that chart how rates begin shooting up in the 2000s. Researchers learned in 2014 that the acellular (DTaP/Tdap) pertussis vaccines are less effective than the whole-cell (DTP) ones. The CDC’s Advisory Committee on Immunization Practice updated its recommendations, such as recommending pertussis vaccination during pregnancy, to reflect the reduced effectiveness of the newer vaccines. But we’re likely stuck with less effective vaccines and therefore more cases with the usual 3-5-year outbreak cycles than we had with the earlier vaccine.
The chart also shows the dramatic drop in cases in 2020, when pandemic containment measures reduced incidence of nearly all infectious diseases. But vaccination rates also fell during the pandemic, and they haven’t fully recovered. Hesitancy about childhood vaccines, from spillover of COVID-19 vaccine concerns, has also increased, all of which is contributing to the current outbreak.
While readers, listeners and viewers may not need all of this historical context, it’s helpful for reporters to know it and weave in relevant aspects of it as appropriate in their coverage. It’s also helpful for journalists to know if they receive correspondence, online comments or social media reactions that include misinformation about the disease or vaccine.
