Pertussis cases in Texas have reached their highest point in over a decade. By October 2025, the state reported more than 3,500 confirmed cases, four times last year’s total, and the Texas Department of State Health Services has issued health alerts two years in a row.
Dallas County is not immune. Local health officials have already flagged declining vaccination rates as a compounding factor. If your child has a persistent cough that will not quit, here is what you need to know.
What’s Behind the Pertussis Cases Texas Surge?
Three factors are driving the current pertussis cases Texas surge:
- Waning vaccine immunity
- Post-pandemic rebound
- Falling vaccination coverage.
Pertussis vaccines do not provide lifetime protection. The DTaP series given in childhood offers strong early coverage, but immunity fades, typically within five to ten years. Without a Tdap booster, older children, teenagers, and adults become susceptible again, often without realizing it.
The pandemic suppressed transmission temporarily through masking and reduced contact. As those conditions reversed, cases rebounded sharply. Nationally, the U.S. logged more than 35,000 cases in 2024, over fivefold increase from 2023. Texas cases tripled that same year before surging again in 2025.
The more immediate concern for Dallas families is the vaccination coverage gap. Texas school data show that 93.48% of students hold current Tdap vaccination, just below the 95% threshold required for community immunity. A recent state law allowing parents to download vaccine exemption forms online, bypassing health departments, has made opting out easier. Dallas County Health Director Dr. Phil Huang has directly attributed further drops in routine vaccination visits to this change. That gap, less than two percentage points, is enough to let pertussis circulate freely, particularly among children too young to be fully vaccinated.
What Are the Pertussis Symptoms to Watch For?
Recognizing pertussis symptoms early is the most important factor in effective treatment. The illness moves through three distinct stages, and the most contagious stage is the one that looks least like whooping cough.
| Stage | Duration | Key Symptoms |
| Catarrhal | 1-2 weeks | Runny nose, mild cough, low-grade fever, nearly identical to a cold |
| Paroxysmal | 1-6 weeks | Violent coughing fits, high-pitched “whoop” on inhale, vomiting after fits, exhaustion |
| Convalescent | Weeks to months | Gradual improvement, but cough can linger for up to 100 days |
The catarrhal stage is when pertussis spreads most aggressively, precisely because it presents like a cold. By the time the paroxysmal fits appear, the infected person has typically already exposed others for a week or more.
Adults and older children are less likely to produce the distinctive “whoop.” They often present with a relentless, worsening cough that gets misread as bronchitis or a post-viral cough, which delays diagnosis and extends the contagious period considerably.
How Does Pertussis Affect Infants Differently?
In infants under six months, pertussis symptoms look nothing like the textbook presentation. Infants rarely produce the “whoop” because their airways are too narrow to generate it. Instead, they may simply stop breathing for several seconds, a condition called apnea, or turn blue from oxygen deprivation during a fit. They can also develop seizures as a result of sustained oxygen loss during prolonged coughing episodes.
This age group accounts for the most severe outcomes. Babies under six months are too young to be fully vaccinated, making them entirely dependent on the immunity of the people around them. DSHS data from 2025 confirm that approximately 85% of Texas pertussis cases this year have occurred in children, underscoring how heavily this outbreak has hit young families.
Nighttime coughing fits are particularly dangerous in infants since apnea episodes are harder to detect during sleep. Any sign of labored breathing, discoloration, or unusual stillness after a coughing episode in an infant should be treated as a pediatric emergency requiring immediate attention.
Pertussis Cases Texas: Who Else Is at Risk?
Beyond infants, pertussis cases in Texas this cycle have affected four groups that frequently go undiagnosed:
- Unvaccinated or under-vaccinated children: With Texas school vaccination rates just below the 95% herd immunity threshold, classroom transmission remains a real and ongoing risk.
- Teenagers and adults with lapsed Tdap boosters: Many adults go well beyond the recommended ten-year interval. Waning immunity allows them to carry and spread the bacteria even when their own symptoms appear mild.
- Pregnant women: Contracting pertussis during pregnancy carries the risk of passing it to a newborn before vaccination can begin. The CDC recommends Tdap between 27 and 36 weeks of every pregnancy.
- Immunocompromised individuals: Those with weakened immune systems face complication rates closer to those seen in infants, regardless of age.
The pattern across all four groups is consistent: vulnerability exists wherever vaccine protection has faded or was never established.
What Does Severe Cough Treatment Look Like at the ER?
Severe cough treatment for pertussis starts with an accurate diagnosis. The illness is frequently mistaken for other respiratory illnesses in its early stages, which is why confirmation matters. ER of Dallas uses rapid lab testing, including PCR analysis, to confirm the presence of Bordetella pertussis bacteria. Treatment is most effective when started early, before the paroxysmal stage is fully established.
With pertussis cases in Texas reaching record levels, prompt evaluation is more important than ever. Once confirmed, treatment at our facility includes:
- Antibiotics: Most effective in the first one to two weeks. They shorten the contagious period and can reduce severity when started promptly.
- Oxygen therapy: Administered for patients with labored breathing or low oxygen saturation during or between coughing fits.
- IV fluids: Repeated vomiting after coughing fits causes rapid dehydration in children and infants. IV rehydration restores fluid and electrolyte balance when oral intake is not sufficient.
- Continuous monitoring: Observation for apnea, oxygen levels, and recovery between fits, particularly critical for infants and young children.
As a freestanding emergency room, ER of Dallas provides hospital-level diagnostic capability and emergency intervention without the hospital wait. Infants with severe complications are stabilized on-site before transfer to a pediatric inpatient facility when needed.
When Should You Go to the ER for Breathing Problems?
Visiting the ER for breathing problems related to pertussis is the right call whenever symptoms move beyond manageable coughing fits. The threshold is lower for infants and young children than for older patients.
Go to the ER immediately if:
- Lips, fingertips, or skin turn blue or gray during or after a coughing fit
- Breathing stops for any period following a coughing episode (apnea)
- Coughing fits last longer than one minute without a recovery breath
- Vomiting after every fit is causing signs of dehydration, such as no tears, dry mouth, or no urination
- Any breathing difficulty occurs between fits, not only during them
- A coughing fit is followed by limpness or loss of consciousness
For older children and adults, go to the ER if:
- Coughing fits are intensifying after two weeks rather than leveling off
- Breathing becomes labored at rest, not just during fits
- Chest pain develops from the force of repeated coughing
ER of Dallas is open 24 hours a day, seven days a week, with a no-wait ER model and no appointment required. If you need an ER near you in the Dallas area, we have on-site labs, imaging, and emergency physicians to evaluate and treat from the moment you walk in.
Cost concerns should never delay a pertussis evaluation. We offer flexible payment plans for self-pay patients and those with high deductible plans. For parents, a children’s ER visit at our facility means board-certified emergency physicians, pediatric-focused care, and parents permitted to stay throughout.
How Can You Protect Your Family Against Pertussis?
The most reliable protection against pertussis is keeping vaccinations current across the entire household, not just for children.
- Infants and children: The DTaP series is given at 2, 4, 6, and 15-18 months, with a booster between ages 4 and 6.
- Preteens: A Tdap booster at 11-12 years restores fading immunity before high school and increased social contact raise exposure risk.
- Adults: Tdap every 10 years. If you cannot recall your last booster, treat it as overdue.
- Pregnant women: Tdap between 27 and 36 weeks of every pregnancy transfers protective antibodies to the newborn before vaccination can begin.
- Caregivers of newborns: Anyone in close contact with a newborn should have a current Tdap before the baby arrives, including grandparents, siblings, and regular visitors.
If you or a family member has been directly exposed to a confirmed pertussis case, post-exposure antibiotics may reduce the risk of infection. Do not wait for symptoms to appear before seeking evaluation, as the treatment window narrows significantly once the paroxysmal stage begins.
FAQs
1. Is whooping cough still a concern in Texas?
Yes. Pertussis cases in Texas exceeded 3,500 in 2025, the highest total since 2013, with 85% occurring in children. DSHS has issued health alerts two consecutive years.
2. What are the earliest pertussis symptoms?
Early pertussis symptoms include runny nose, mild fever, and a light cough that closely mimics a cold. This phase lasts one to two weeks and is the most contagious period of the illness.
3. Can vaccinated adults still get whooping cough?
Yes. Adults whose last Tdap booster was more than 10 years ago are vulnerable. Their pertussis symptoms are often milder, making the infection easy to overlook and unknowingly spread.
4. What does severe cough treatment for pertussis involve?
Severe cough treatment includes antibiotics to reduce contagion and severity, oxygen therapy for breathing difficulty, and IV fluids to address dehydration caused by vomiting after coughing fits.
5. When does whooping cough require ER care for breathing problems?
Seek ER care for breathing problems immediately if a child turns blue, stops breathing after a coughing fit, or cannot recover between episodes. In infants, any breathing irregularity after coughing requires immediate evaluation.
