Matt Thomas, MD, discusses pertussis trends, early recognition, and risks for infants

Pertussis continues to appear in predictable cycles, often driven by seasonal congregation and gaps in immunization coverage, according to Matt Thomas, MD, a pediatric infectious diseases specialist at West Virginia University Golisano Children’s Hospital. Thomas noted that clinicians typically see “waves of pertussis coming through the communities, usually in cycles of like three to five years,” with outbreaks commonly occurring “after school has started, or in the winter months,” when people gather indoors more frequently.¹

In West Virginia, vaccination patterns appear to influence disease spread. Thomas explained that while immunization rates are relatively high among school-aged children due to school mandates, coverage is lower in younger populations. “Below kindergarten age, we have one of the lowest immunization rates in the country,” he said, adding that infants and young children who are not yet fully immunized may drive transmission. He also noted that adult vaccination may contribute, stating that adults are “frequently… not great at following up on their pertussis vaccines as they get older.”

Challenges of early diagnosis

Early pertussis can be difficult to recognize, particularly in infants. “The early weeks are hard because for little infants, [they] may not have a lot of additional symptoms other than a regular cold,” Thomas said. Patients may still be contagious during this period, even if symptoms appear mild.

One distinguishing feature is symptom duration. Thomas explained that most viral illnesses begin to improve within several days, whereas pertussis persists. “Most of our viral illnesses, you start to feel better around three, four days in,” he said, while pertussis symptoms often extend “into that week to 2-week period.” Fever, when present, tends to be low-grade compared with other infections.

Assessment should also include immunization status and potential exposure. Thomas emphasized the importance of asking whether patients have been around others with prolonged cough and staying aware of local outbreaks. “Knowing what your local community outbreaks are… and being aware of it early” can help prompt further evaluation.

Increased risk in infants

Infants face a higher risk due to smaller airways. “Babies are well known to develop what we call apnea with pertussis,” Thomas said, describing episodes in which infants stop breathing. These events can lead to hospitalization, respiratory failure, and the need for mechanical ventilation.

Apnea may also result in hypoxia, which can affect neurologic outcomes. Thomas noted that low oxygen levels “can impact the brain and have long-term implications for them having seizure disorders or developmental issues as they grow up.”

Importance of early treatment and prevention

Identifying pertussis during the early, cold-like stage is critical. Thomas emphasized that early treatment “may actually limit the progression of the disease into that really awful whooping cough,” potentially preventing hospitalization, particularly in infants. Early treatment also reduces transmission.

Once patients progress to the characteristic coughing stage, treatment does not shorten illness duration. “That cough is going to happen no matter what I do,” Thomas said, noting that symptoms can persist for months. However, treatment remains important to reduce spread.

Vaccination remains central to prevention. Because immunity wanes, repeat boosters are necessary throughout life. Thomas advised clinicians to review immunization status whenever patients enter the health care system and maintain a high index of suspicion. “It’s very easy to miss them in those early stages,” he said, underscoring the importance of early recognition and intervention.

Disclosure: Thomas reports no relevant disclosures.

Reference

1. Pertussis: (Week 53) Weekly cases* of notifiable diseases, United States, U.S. Territories, and Non-U.S. Residents week ending January 03, 2026. CDC. January 3, 2026. Accessed January 16, 2026. https://stacks.cdc.gov/view/cdc/251418