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Just how high will whooping cough prevalence increase?

Just how high will whooping cough prevalence increase?

Last updated on: October 21, 2025 at 9:07 pm by Jane the Actuary

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Just how high will whooping cough prevalence increase? 2025-10-21T21:07:23-06:00 Jane the Actuary

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My last post, I labelled as a “rediscovered draft.” But sometimes I click on an interesting-looking draft and am disappointed to learn that all I had done was write the title, yet you can guess by the title that this dated to the time when we had localized measles outbreaks and people were worried about antivax sentiment.

Of course, whooping cough isn’t measles, but somewhere along the way I stumbled upon a detail that surprised me. I recall seeing, when my children were young and we were at the pediatrician’s office frequently, signs encouraging family members of newborns to get the whooping cough vaccine booster to form a protective “cocoon” around the baby. But I recently learned that the newest version of the vaccine, in order to reduce the risk of side effects, is of a different type, that does not prevent transmission but merely protects against symptomatic illness.

Now, I tossed this blog-post question into my drafts but it’s always harder to find those bits of information again so I took a different approach this time: I asked Grok (the X version of ChatGPT) a series of questions about the pertussis vaccine. The whole conversation is at this link, and here’s a quick summary:

From the 1940s to the 1990s, a version of the pertussis vaccine called whole-cell DTP was used, which used killed Bordetella pertussis bacteria. It was highly effective at reducing transmission, but had higher rates of side effects like fevers. Beginning in the 1990s, it was replaced by acellular DTaP/Tdap, which uses purified bacterial components, and as a result there are fewer side effects but its effectiveness at reducing transmission is significantly diminished, and protection wanes in 5 – 10 years.

I asked Grok to summarize changes in the rate per 100,000 over time. In the 1970s and 1989s, it bounced around from 0.5 per 100,000 to 1.8 per 100,000. Then, as the proportion of the population with the whole-cell vaccine declined, the rate increased. Before covid, it was about 6 per 100,000 with spikes every couple years to 10 or 15. During covid there was another drop, but now we are seeing another significant jump in cases, to 10.4 per 100,000 for 2025 and an extrapolated estimate of 14.5 for 2025, though whether this is a new longer-term high or another periodic burst, isn’t clear. In any case, as the proportion of the population with the whole cell vaccine continues to shrink, the rate is projected to increase, ending up, in the very long term at about 45 cases per 100,000, which is definitely a lot higher than it was, but still a lot less than the 150 – 300 cases per 100,000 before the vaccine.

Finally, I asked Grok to identify which type of vaccine was better, given both the complications from pertussis and the risks of the whole-cell vaccine. Here’s the math:

The whole cell vaccine prevents 294 – 525 deaths and 7,350 – 10,500 hospitalizations compared to the acellular vaccine, at a time in the future when the US population is projected to be 420 million. At the same time, there would be 3,600 – 10,000 more febrile seizures and 200 – 1,600 instances of HHE (hypotonic-hyporesponsive episodes, where a child, for anywhere between a few minutes to a few hours, becomes limp, pale and unresponsive or less responsive). According to Grok, there were also “historical concerns about encephalopathy [which] led to the switch to acellular, but studies (e.g., 1990s) found no definitive link.”

With all that data in mind (and this sort of number crunching is where I believe Grok and other AIs are reliable), I did a quick search on the media reports on the rise of whooping cough. At the Boston University site, an article reported something unexpected: the switch to the acellular vaccine was not, as I had expected, based on an evaluation of the trade-offs of a less-effective vaccine with lower side-effects increasing the acceptability of the vaccine and increased vaccine take-up. Instead, scientists did not know, at the time, that the effectiveness of the new vaccine would in fact be lower. It was only after they discovered the increase in cases, and researched to find the cause, that they uncovered the waning protection and only partial protection against transmission.

So what does this add up to? Not much, in the end, except that this is yet one more instance of there just not being any simple answers to many challenges we face, including public health challenges such as whooping cough.

https://picryl.com/media/a-tetanus-diphtheria-pertussis-vaccination-is-prepared-637b07; public domain

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