Oregon health officials are concerned about a sharp increase in cases of pertussis — known as whooping cough — across nine counties and are encouraging people to get vaccinated against the disease.
As of May 29, 178 pertussis cases had been reported to Oregon Health Authority’s Public Health Division. That’s a 770 percent increase from the 20 cases reported by that date in 2023. However, the 2024 numbers are roughly in line with those seen during similar time frames in the immediate pre-pandemic years, including 2019, when there were 93 cases, and 2018, which saw 248 cases.
Pertussis is cyclical, and before the COVID-19 pandemic — when restrictions that included masking requirements and school closures were in effect — pertussis peaked every three to five years. In 2012, 910 cases were reported, the highest annual count since 1953.
“Our concern is with how quickly we jumped to such a high number of pertussis cases, which tell us that the disease is doing what it does best: spreading fast and taking a greater toll on under-vaccinated persons,” said Paul Cieslak, Oregon Public Health Division medical director for communicable diseases and immunizations.
By the numbers
Among the nine counties with reported pertussis to date in 2024, Lane County leads with 64 cases, followed by Multnomah (41), Clackamas (33), Deschutes (15), Washington (13), and Jefferson (8). Three other counties have also seen cases. School-aged children and adolescents account for 92 (52 percent) of cases. Among them, only 51 (55 percent) are up to date with recommended pertussis vaccinations.
In mid-May, Lane County Public Health (LCPH) declared a community-wide pertussis outbreak.
“We are seeing a number of cases in very young children and at-risk populations,” LCPH Deputy Health Officer, Dr. Lisandra Guzman said. “Their health depends on our actions, so now is the time to do everything we can to protect them.”
Infants are at highest risk of pertussis-related complications and death, and they have the highest reported incidence rate. Between 2003 and 2023, infants accounted for 12 percent of cases and 76 percent of pertussis hospitalizations. And Oregon pertussis deaths have been limited to infants — five have occurred since 2003.
Babies too young to have been fully vaccinated are most likely to be hospitalized with pertussis. Cieslak said pregnant women can protect their young babies by getting the Tdap vaccine — which protects a person against tetanus, diphtheria and pertussis — at 27–36 weeks’ gestation. The mothers will make antibodies and pass them to their babies. Among 16 infant cases reported in Oregon to date in 2024, only one mother had a documented dose of Tdap during the pregnancy.
When an infant or pregnant person is in the household of someone with pertussis, all household members should receive a course of antibiotics effective against Bordetella pertussis – typically, a five-day course of azithromycin.
Lane County Public Information officer Jason Davis said the outbreak is widespread.
“We do see a seasonal increase of cases among children each year,” he said. “What we typically don’t see, and we are seeing this year, are more cases in adults. So it has definitely spread from school age children into the adult population.”
COVID impact
According to Davis, ever since the COVID pandemic the vaccination rate has declined significantly.
“We are seeing more and more exceptions being claimed and that puts us at risk,” he said. “When we see our vaccination rate in school age children drop by two or three percent, that has significant ramifications and impacts our ability to stave off these outbreaks.”
Davis said since the pandemic, the exception rates have increase.
“We’ve always had about six percent of our school age children seek philosophical or medical exceptions but after the pandemic we saw the number of exceptions increase,” he said. “We believe that suggest mistrust of the vaccine coming out of the COVID vaccine. We’ve also seeing that in certain information circles, that vaccines are unsafe and some sort of ploy to buy into a program or an effort to mistrust the government.”
To overcome the misinformation challenge and slow the outbreak spread, Davis said the county is launching campaigns and community conversations to help the public understand that any child not up to date with their immunizations will be excluded from school.
“When the outbreak reaches a point of community spread, where we are seeing a significant outbreak outside of the school, and when we are seeing cases not linked together, than we will stop the exclusions,” he said. “That often times helps the parents understand we are not trying to punish them for having the exception.”
Symptoms also include prolonged coughing fits, often accompanied by a distinctive “whoop” sound during inhalation, gagging or vomiting while coughing, and exhaustion. Complications, if left untreated, especially in infants, can be severe and include pneumonia, dehydration, seizures, and even brain damage.
Call 9-1-1 immediately if you or your child is:
Struggling to breathe
Turning blue or purple
Recognizing the severity of pertussis, especially for vulnerable populations such as infants, pregnant people, young children, and individuals with underlying medical conditions, LCPH emphasizes the importance of getting tested at the earliest onset of symptoms, staying up to date with pertussis vaccinations, and practicing good respiratory hygiene.
Vaccination against pertussis is routinely recommended for infants, children, adolescents and adults. Children should receive the DTaP vaccine against diphtheria, tetanus and pertussis at 2, 4, 6 and 15 to 18 months, and again at age 4 to kindergarten age.
All persons ages 10 and older should receive a single dose of Tdap.
Personal protection
LCPH recommends practicing good hygiene to prevent the spread of the bacteria that cause pertussis and other respiratory illnesses:
Cover your mouth and nose with a tissue when coughing or sneezing.
Throw away used tissues in a waste basket right away.
Cough or sneeze into your upper sleeve or elbow if you don’t have a tissue. Never cough into your hands, as pertussis can be spread this way.
Wash your hands often with soap and water for at least 20 seconds.
Use an alcohol-based hand sanitizer if soap and water are not available.
Stay home when you are sick.
In the event of a pertussis diagnosis, adherence to prescribed antibiotics and isolation from others until you are no longer infectious is crucial. Individuals can transmit the bacteria from the onset of symptoms for up to three weeks after coughing fits begin.
Davis said the county recommends people use face masks to protect themselves from the pertussis outbreak, but that the county will not be pursuing any such mandate.
“We rely on the public trust to try to prevent the spread of this outbreak,” he said.
There are adequate supplies of the vaccines, both for children and for adults. He recommends that people call their pharmacy to check on the availability.
For more information about pertussis prevention and treatment, visit the LCPH website, at http://www.lanecountyor.gov/publichealth
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