Pertussis Is Not Just a Childhood Disease: Why Lifelong Vaccination Matters More Than Ever

As the first World Pertussis Day approaches tomorrow on June 13, health care professionals are being reminded that pertussis, or whooping cough, remains a significant global public health challenge despite decades of vaccination efforts. While often viewed as a childhood illness, pertussis can affect people of all ages as immunity wanes over time, placing vulnerable infants at continued risk of severe complications, hospitalization, and death.

In this Q&A, Infection Control Today^® (ICT^®) speaks with Ulrich Heininger, MD, head of the Division of Pediatric Infectious Diseases and Vaccinology at the University of Basel Children's Hospital and a leading expert on Bordetella infections. He discusses common misconceptions about pertussis, the dangers the disease poses to young infants, the importance of vaccination during pregnancy, and why a life-course approach to immunization is critical for reducing transmission and protecting vulnerable populations. He also addresses the impact of vaccine fatigue and misinformation on global prevention efforts and shares key messages from the Global Pertussis Initiative ahead of World Pertussis Day.

ICT: Many people still think of pertussis, or whooping cough, as a childhood disease that was largely controlled through routine vaccination. Why does pertussis remain a significant global public health concern today, and what misconceptions do health care professionals and the public still have about the disease?

Prof. Ulrich Heininger, MD: Pertussis remains a global health problem because neither having had the disease nor vaccinations confer lifelong immunity. Therefore, it is possible to get the disease repeatedly. Furthermore, the vaccines’ effectiveness is not perfect, offering about 90% likelihood of protection. This means that, as with all other vaccines, even vaccinated individuals can still contract the disease. Many health care professionals and the general public believe that pertussis is a childhood illness. This is incorrect; it can affect people of all ages due to waning immunity after immunization and after the disease.

ICT: Infants are described as being among the most vulnerable populations because they are not yet fully vaccinated. Can you explain why pertussis can be especially dangerous in young infants, what complications clinicians are most concerned about, and how infection prevention strategies can help reduce severe outcomes in this age group?

UH: It is true that infants are particularly vulnerable to severe pertussis. When they become infected with the causative bacterium (Bordetella pertussis), they may experience respiratory arrest rather than coughing fits, potentially leading to suffocation. Additionally, the pertussis toxin produced by the bacterium can cause white blood cells to circulate in large numbers in the infant’s circulation. This can then lead to blocked lung capillaries and thus respiratory failure.

This so-called hyperleukocytosis is life-threatening and, along with death from respiratory arrest, is the most feared complication of pertussis. The best strategy to prevent serious pertussis in young infants is to vaccinate pregnant persons against pertussis during every pregnancy and then protect their infants with their own vaccination as soon as possible after birth, at the recommended time points usually beginning at 6 to 8 weeks of life.

ICT: The Global Pertussis Initiative emphasizes vaccination across the life course rather than focusing solely on childhood immunization. What does a life-course vaccination strategy look like in practice, and why is booster vaccination in adolescents, adults, pregnant individuals, and older adults increasingly important in preventing transmission to vulnerable infants?

UH: A lifelong vaccination strategy means that after the initial immunization in infancy, booster vaccinations are administered at regular intervals, for example, every 5 to 10 years. This is currently the optimal strategy for preventing cases of pertussis in all age groups. Vaccination in each pregnancy aims to protect the unborn child, as it then receives sufficient amounts of protective antibodies from its mother before being immunized itself after birth.

ICT: Infection preventionists and health care organizations continue to navigate vaccine fatigue, misinformation, and declining vaccination rates in the wake of the COVID-19 pandemic. How have these challenges affected pertussis prevention efforts globally, and what strategies do you believe are most effective in rebuilding public trust and improving vaccine uptake?

UH: The impact that COVID-19 had on immunization coverage in general varies considerably from country to country. In some countries, there has been no decline in general vaccine acceptance, while in others, there have been declines of 10% and more, which are slowly recovering now. Many local factors play a role here. It is important to continuously educate the public about the benefits of the recommended vaccinations. Health care professionals should also set an example and get vaccinated themselves, according to national recommendations, as this has a positive influence on public opinion.

ICT: With the first World Pertussis Day tomorrow on June 13, 2026, what are the most important messages the Global Pertussis Initiative hopes health care professionals, policymakers, and the public will take away regarding pertussis prevention, surveillance, and the long-term goal of reducing severe disease worldwide?

UH: The most important messages are as follows:

1. Pertussis is present everywhere, but it doesn't always manifest in its typical form. Atypical pertussis is difficult to recognize but contributes to the circulation of the bacteria.
2. Pertussis is particularly dangerous for young infants, who can become seriously ill, requiring hospitalization, or even die from it.
3. The best preventative measure is vaccination in every pregnancy and timely vaccination of all infants. Another focus is booster vaccinations during preschool age, ideally also for adolescents and adults at regular intervals, for example, every 5 to 10 years.