Australia is experiencing its worst whooping cough epidemic on record, with more than 41,000 confirmed cases so far this year driven by school children as childhood vaccination rates dip.
Data from the National Notifiable Disease Surveillance System show a major spike in whooping cough (also known as pertussis) among children aged 10 to 14, accounting for almost 40 per cent of the 41,013 cases recorded in 2024, which surpasses the previous 2011 record of 38,748.
Cylas Livanes, 11, has whooping cough and struggles to breathe every night. His mother Tianni Becker says: “He is drowning in his sleep.”Credit: Rhett Wyman
Another 3193 cases in zero to four-year-olds and 8421 cases in five to nine-year-olds bring the total number of cases in children under 15 to 26,753.
Whooping cough is a highly contagious bacterial infection that attacks the airways, causing uncontrollable coughing and difficulty breathing. Young infants are most at risk of serious disease and death before they get their first dose of the pertussis vaccine at two months old.
But coughing fits in older children, adolescents and adults can be so severe that they cause vomiting, incontinence and broken ribs, and can lead to hospitalisation.
Whooping cough epidemics usually occur every three to four years in Australia. The last outbreak was in 2016, and surveillance teams anticipated an outbreak in 2020, but COVID restrictions effectively suppressed it until the second half of 2023.
NSW reported the bulk of infections (19,237), followed by Queensland (11,541) and Victoria (7527), and cases are expected to top 45,000 nationally by the end of the year, the Immunisation Foundations of Australia’s Whooping Cough Report Card, released on Friday, shows.
Meanwhile, childhood vaccination coverage rates declined for the third consecutive year, dropping by between one and two percentage points since 2020, the National Centre for Immunisation Research and Surveillance (NCIRS) reported.
One in four 13-year-olds who were due for their pertussis vaccine-containing booster did not get it last year, and the proportion of four-month-old babies getting their second dose on time (within 30 days of the recommended age) dropped by almost 7 percentage points (90.1 per cent to 83.5 per cent) between 2020 and 2023.
Dr Laurence Luu, a microbiologist and Chancellor’s Research Fellow at the University of Technology Sydney said experts expected whooping cough to return but had not predicted the magnitude of this epidemic.
“It really caught us by surprise, especially the 10- to 14-year-olds, since we historically see it in younger age groups,” Luu said.
Immunity from the pertussis vaccine wanes, particularly during the gap between a four-year-old vaccination and the next booster in year 7 (11 to 13-year-olds), and he speculated whether a newer strain – one that is better at evading the vaccine – could be causing the rise in cases.
“The vaccine is still protective against severe disease but might not wipe it out,” he said.
‘He stops breathing every night’
In the dead of night, 11-year-old Cylas sits bolt upright and tears at his throat. He can’t make a sound.
“He stops breathing every night,” Cylas’ mother, Tianni Becker said. “He is drowning in his sleep.”
Cylas was diagnosed with whooping cough in August after a few days of mild cold and flu-like symptoms. His coughs became so forceful that they gave him nosebleeds.
“His father and I take turns sleeping with him so that he can grab us, and we pat him on his back until he can breathe again,” Becker said. “It’s terrifying”.
Cylas is fully vaccinated and not due for his next booster until 2025. His GP said his case would have been significantly worse if he had not been vaccinated.
The proportion of 12-month-olds fully vaccinated was 92.8 per cent, 90.8 per cent for two-year-olds, and 93.3 per cent for five-year-olds.
However, in some areas, including the NSW North Coast and the Gold Coast, more than one in 10 12-month-olds were not fully vaccinated in 2023.
“A 1 or 2 per cent drop might not seem like much but whooping cough is a highly infectious disease. One infected person can spread it to up to 17 people if they are not vaccinated,” Luu said.
Associate Professor Frank Beard, associate director of surveillance, coverage, evaluation and social science at NCIRS, said it was difficult to determine how much of the rise was due to increased testing.
“But certainly, there are a lot of cases, and the reasons are likely to be the lack of exposure to pertussis since 2016, and the fact that the vaccine – while effective against serious illness – effectiveness against mild illness wanes over time,” he said.
Pertussis-containing vaccines are recommended for:
- Babies at two, four, six and 18 months old
- Children at four years old
- Adolescents at 11 to 13 years old (year 7)
- Adults at ages 50 years and 65 years
- Pregnant women, preferably between 20 and 32 weeks gestation
- Every 10 years for healthcare workers, early childhood educators and carers, and people in close contact with infants.
Catherine Hughes, director of the Immunisation Foundation of Australia, whose four-week-old son Riley died from whooping cough complications in 2015, said vaccines were the best defence against the disease throughout childhood and adulthood.
“We all have a role to play in controlling the spread of whooping cough and reducing the risk of infection in ourselves and others.”
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