TRURO — Pertussis, more commonly known as whooping cough for the piercing inhalations or “whoops” that punctuate its painful coughing attacks, has re-emerged in New England this year after four years of few infections, and Cape Cod cases are rising as well.
There were 28 cases of whooping cough on Cape Cod from mid-June to mid-December 2024, according to Lea Hamner, an epidemiologist for the Cape and Islands. One of those cases was a young child who had to be hospitalized, Hamner said — the only case that has resulted in hospitalization so far.
In addition to being painful, the disease can be lethal for infants who are less able to clear their lungs of mucus and fluid, Hamner said.
As is common with whooping cough, most of those cases have been in people ages 10 to 19, Hamner said. There’s been one case at Nauset Regional High School, according to a notification sent to parents by the Nauset School District on Jan. 2.
There had been no cases at all on Cape Cod for four and a half years, as the disease was effectively shut down by the intense measures taken to fight the Covid pandemic, according to Hamner. Those respiratory precautions worked on this disease, but now it’s coming back, she said.
That same pattern is playing out nationwide: case numbers that had been low for four years are now about double what they were in 2019, before the pandemic, according to state-by-state data from the Centers for Disease Control.
The disease’s re-emergence has been especially pronounced in New England. According to CDC data, the numbers jumped from 14 cases of pertussis in Massachusetts in 2023 to 841 cases in 2024. Rhode Island, Connecticut, and Vermont reported similarly sharp increases last year.
Pertussis typically begins with unremarkable symptoms, including sniffles, sneezing, and a persistent runny nose; that mild phase can last for two weeks.
“Unfortunately, that’s when people are most infectious and pertussis does its dirty work,” Hamner said.
People often do not realize they have a serious illness until the next phase of the bacterial infection, when coughing fits become so severe that patients can vomit from the intense chest spasms. A five-day course of antibiotics is sufficient to tame the infection in children and adults, but infants cannot clear their airways and often develop pneumonia even when treated, Hamner said.
“In infants, pertussis often doesn’t look like a cough — it looks like they’re struggling to breathe,” she said. “People are quick to take their babies to the doctor when they see that.”
But even with hospitalization, “it’s a really dire situation for those babies,” Hamner said. “We want to avoid pertussis getting to infants altogether.”
Fighting the Disease
Because pertussis is most contagious during its early “runny nose” phase, public awareness of an outbreak is an important strategy for combating it, Hamner said. “If pertussis is going unrecognized because people are so used to having other respiratory diseases at this time of year, then it’s not being caught and there are more opportunities for it to spread.”
Antibiotics can not only cure whooping cough — they can also prevent it from developing in someone who has been exposed to the disease.
If you develop whooping cough, and you’ve been around other people, it’s important to tell them that you’ve become sick, Hamner said. “With pertussis, they could talk to their doctor and potentially get treatment so they don’t get sick at all. And if you’ve been around your friend who’s about to go visit her newborn niece — that’s a person who really should know.”
Because pertussis is so contagious in its mild phase, vaccination is the key strategy for staying ahead of outbreaks and lessening the severity of illnesses, Hamner said.
“Vaccination has done the most for reducing pertussis morbidity and mortality — that is, how many people get sick and how many die from this disease — more than any strategy ever in human existence,” Hamner said. “If you look at the 100-year history of pertussis, the greatest reduction in disease ever has been because of vaccination.”
All 50 states require at least four doses of the pertussis vaccine for children entering kindergarten. Another dose of vaccine is required for students entering the sixth or seventh grade, and the CDC recommends that women in the last two months of pregnancy receive another dose to impart some immunity to their fetuses. Adults who live with infants are now advised to get an adult booster of the pertussis vaccine, Hamner said, to better protect their youngest family members.
Local Vaccinations
In addition to requiring the pertussis vaccine for children in child care or grade school, the state Dept. of Public Health is recommending that more adults get a booster shot, often in conjunction with adult tetanus boosters, said Dr. Marie Andrine Constant, chief population health officer at Outer Cape Health Services.
“Along with people who are in regular contact with infants, people who have other health conditions may want to get an adult pertussis vaccine,” said Constant. People with diabetes or COPD or who are immunosuppressed are more likely to get seriously ill from infections like pertussis, she said.
The clinic has plenty of pertussis vaccines on hand, and patients can ask their provider during regular appointments or call to make a vaccination appointment, Constant said.
Angie Stagakis, the nurse at the Provincetown Schools, said that when her now-six-month-old child was born, she asked family members including grandparents to get an adult pertussis vaccine booster.
Vaccination rates at kindergartens across the Outer Cape have lagged behind the rates at mid- and upper-Cape schools, and Stagakis said that getting families into compliance with the state’s vaccine requirements involves “a lot of reaching out.”
“We have a lot of hard-working families, and reaching parents during business hours isn’t always easy, so we continue reaching out,” said Stagakis. “We also work closely with Barnstable County, which has free immunizations and a vaccine phone line,” which is 508-375-6617.
Perhaps as worrisome as the uneven rates of vaccination among Cape Cod’s kindergartners is that the issue hasn’t resolved by middle school. Nauset Regional Middle School had the lowest rate of tetanus-diphtheria-pertussis (TDAP) vaccination among all the public middle schools on Cape Cod during the 2023-2024 school year, with just 81 percent of 7th-graders vaccinated.
At the Provincetown Schools, the combined numbers for this year’s 6th, 7th, and 8th grades came to 89 percent of students with a current TDAP vaccine, according to Supt. Gerry Goyette. (The state does not report data for 7th-grade classes with fewer than 30 students.)
At Barnstable Middle School, 87 percent of 7th-graders were current for TDAP last year, while at Monomoy Regional Middle School in Chatham the number was 97 percent. Bourne Middle School led Cape Cod’s public middle schools with a 98 percent TDAP vaccination rate among 7th-graders.
The situation in Cape Cod’s high schools is generally better, according to state data. At Nauset Regional High School, the TDAP vaccination rate for 12th-graders is 96 percent, while at Cape Cod Tech it is 99 percent.
