Whooping Cough Is Surging in China With Tens of Thousands of Cases and Over a Dozen Deaths

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Written By Robby Macaay

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Whooping cough is making a post-pandemic comeback in China, with cases surging more than 20-fold in the first two months of 2024.

The world’s second-most populous country reported a combined 32,380 cases of pertussis—more commonly known as whooping cough—in January and February, compared with 1,421 cases during the same period in 2023, according to the National Disease Control and Prevention Administration. There were 13 deaths.

The number of infections detected in the first 60 days of the year is near the full 2023 total, underscoring the risk of the highly contagious respiratory disease in China. The country endured a major respiratory disease outbreak in 2023 after pulling itself out of the Covid mire in late 2022, well after other nations had thrown open their borders and allowed pathogens to resume their traditional circulation patterns. 

China provides free vaccines for whooping cough, usually in a combined shot that also protects infants against diphtheria and tetanus. Experts say the vaccine-induced immunity tends to wane as kids reach adolescence. Chinese health authorities don’t mandate or provide booster shots to help shore up immunity.

Discussions are needed to determine if the country should update the vaccine it uses for the disease or adjust the immunization program, Shen Hongbing, director of the Chinese Center for Disease Control and Prevention, said at a conference in March. 

“It requires close attention to prevent and control the spread of whooping cough in China,” Shen said, according to local media reports.  

Vaccination woes

Whooping cough infections have been rising in China since 2014, with more than 30,000 in 2019, according to the Chinese CDC. After a respite during the Covid isolation days, they bounced back to almost 40,000 a year in 2022 and 2023, the agency reported.

Nuances around vaccination are contributing to the increase. Covid disruptions, waning protection and genetic changes may all be playing a role. 

Older patients can experience atypical symptoms, leading to misdiagnosis and allowing them to covertly carry and spread the infection. Meanwhile, genetic changes may help the bacteria elude an immune system primed to detect it, allowing the pathogen to continue sickening even the immunized, according to a Beijing Daily report.

Vaccination rates worldwide suffered during the pandemic. The percentage of children getting all three doses of the diphtheria, tetanus and pertussis shot plunged to 81% in 2021, the lowest level since 2008, according to the World Health Organization and the United Nations Children’s Fund.

Global issue

The disease caused by the bacterium Bordetella pertussis is transmitted through respiratory droplets. It’s a significant cause of infant death worldwide and continues to be a public health concern despite high vaccination rates, according to the WHO.

China isn’t alone in its comeback. Whooping cough is endemic and epidemic cycles are occurring every two-to-five years, despite vaccination programs, according to the WHO. 

Some European countries have posted rising cases since the middle of 2023, according to the European Center for Disease Prevention and Control. The Czech Republic is suffering its biggest outbreak since 1963, and both it and the Netherlands have reported whooping cough-related deaths.

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