Whooping Cough in Europe: Why Pertussis Cases Are Rising and What You Need to Know

 

Whooping Cough Is Surging Across Europe: Why a Preventable Disease Is Causing New Concern

For years, whooping cough was often viewed as a childhood disease that modern vaccination programmes had largely brought under control. But Europe has recently seen a major resurgence of pertussis, the bacterial infection commonly known as whooping cough.

The disease is not new, and vaccines against it have existed for decades. Yet the scale of recent transmission has surprised health authorities. In 2024 alone, 29 European Union and European Economic Area countries reported 209,674 cases of pertussis, according to the European Centre for Disease Prevention and Control (ECDC). The notification rate was more than eight times higher than in 2023.

The situation is particularly concerning because pertussis can be far more dangerous for very young babies than it appears to be in older children or adults. In some adults, the infection may look like nothing more than a persistent cough. Those adults can nevertheless pass the bacterium to infants who have not yet completed their primary vaccination course.

The recent European resurgence therefore raises an important question: Why is a vaccine-preventable disease causing so much trouble again?

What Is Pertussis?

Pertussis is a highly contagious bacterial infection of the respiratory tract. It is primarily caused by the bacterium Bordetella pertussis.

The infection usually begins quietly. During the first stage, symptoms can resemble an ordinary cold: a runny nose, sneezing, a mild fever and a relatively mild cough. This can make the infection difficult to recognise.

After approximately one to two weeks, however, the cough can become much more severe.

Patients may experience repeated, rapid coughing attacks. After a series of coughs, they may struggle to breathe and produce the characteristic high-pitched "whoop" when inhaling. Some patients also vomit after coughing.

The coughing attacks can continue for weeks and, in some cases, much longer. ECDC notes that severe coughing episodes can persist for one to two months, while recovery may take up to three months in some young infants.

This is why pertussis is sometimes called the "100-day cough."

Europe Has Experienced a Dramatic Increase

The scale of the European resurgence is one of the most important parts of the story.

According to ECDC's Annual Epidemiological Report published in April 2026, 209,674 pertussis cases were reported by 29 EU/EEA countries in 2024.

The notification rate reached 54.9 cases per 100,000 people.

That represented an increase of more than eight times compared with 2023, when the notification rate was 6.7 per 100,000. Compared with 2022, the rate was 78 times higher.

Three countries — Czechia, Poland and Spain — accounted for more than 46% of all reported cases in the EU/EEA surveillance data for 2024.

The European-wide situation was even broader when looking at the WHO European Region rather than only the EU/EEA. A joint statement from the European Commission, UNICEF and WHO said that more than 298,000 pertussis cases were reported across the WHO European Region in 2024, the highest number ever recorded for that region.

These figures should be interpreted carefully because testing practices and reporting systems differ between countries. Nevertheless, the increase is large enough that European health authorities have treated it as a significant public-health concern.

Who Is Being Affected?

Pertussis can infect people of any age, but European surveillance shows particularly high rates among certain age groups.

In 2024, the two age groups with the highest notification rates in the EU/EEA were:

• Infants under one year: 318.5 cases per 100,000
• Children aged 10–14 years: 204.2 cases per 100,000

Interestingly, people aged 15 years and older represented 53% of all reported cases.

This is important because pertussis is not simply a disease of small children.

Teenagers and adults can become infected and may experience a less obvious illness. They may continue going to school, work or social gatherings while coughing, without realising that they have pertussis.

That creates an opportunity for the bacterium to reach vulnerable people.

Why Babies Are at the Greatest Risk

The most worrying part of the current situation is its impact on very young infants.

Babies can develop severe complications from pertussis because their respiratory systems are vulnerable and they may not yet have received all the doses needed for strong protection.

Unlike older children and adults, young infants may not develop the classic "whooping" sound.

Instead, they may experience episodes in which their breathing temporarily stops.

This can cause dangerously low oxygen levels.

ECDC lists pneumonia, seizures, brain disorders and episodes of stopped breathing among possible complications. Severe pertussis can be fatal, and deaths in Europe are particularly associated with very young infants.

The danger is therefore not limited to the person with the cough.

A seemingly mild infection in a parent, older sibling or another household member can potentially become a serious infection for a newborn.

How Does Whooping Cough Spread?

Pertussis spreads mainly through respiratory droplets and close contact with infected people.

An infected person may spread the bacterium when coughing or sneezing.

One of the challenges is that people do not necessarily recognise that they are contagious.

During the early phase, the symptoms can look like an ordinary cold. Later, adolescents and adults may develop a prolonged cough without the dramatic symptoms people traditionally associate with whooping cough.

ECDC specifically notes that older children, adolescents and adults can have milder or atypical symptoms, making diagnosis more difficult.

In households, older siblings and parents can therefore become an important source of infection for babies.

Why Did Pertussis Return After COVID-19?

One explanation involves what happened during the COVID-19 pandemic.

Measures such as reduced social contact, school closures, masking and other restrictions reduced the circulation of many respiratory infections — including pertussis.

For several years, people had fewer opportunities to encounter the bacterium.

That sounds positive, but it also meant that natural immune boosting from exposure was reduced.

At the same time, some people missed or delayed routine vaccinations.

When normal social interaction returned, a larger pool of susceptible people was present.

ECDC says the recent rise likely reflects several factors, including the accumulation of susceptible people after prolonged COVID-19 control measures, incomplete vaccination, waning immunity and reduced natural immune boosting during the pandemic. Increased testing also contributed to the number of cases detected.

This does not mean COVID-19 itself caused pertussis.

Rather, the pandemic changed the conditions under which pertussis circulated and affected vaccination and immunity patterns.

Immunity Does Not Last Forever

Another important issue is that protection against pertussis can decrease over time.

This can happen after vaccination, and previous infection does not necessarily provide lifelong protection.

A 2026 study published in Nature Communications examined the large pertussis outbreak that occurred in the Netherlands between 2023 and 2024. Researchers found evidence that waning immunity played an important role in the resurgence.

The Dutch study found particularly high evidence of infection among children aged 6–18 during the study period, while also highlighting the importance of declining antibody levels.

This helps explain why pertussis can return even in countries with established vaccination programmes.

Vaccination remains highly important, but protection needs to be maintained according to national schedules.

The Netherlands Provides an Important Example

The Netherlands experienced what researchers described as its largest pertussis outbreak in decades during 2023–2024.

The 2026 Nature Communications study found that notifications increased from May 2023 and continued rising through September 2024.

Researchers estimated a cumulative infection incidence of approximately 35% among children aged 6–18 during the study period in their serological analysis.

The study also reported that prolonged coughing occurred in a portion of infected participants.

However, the researchers emphasised an important distinction: infection does not always mean severe disease.

Vaccinated people can sometimes become infected but experience milder or even unrecognised illness.

That is one reason why transmission can be difficult to detect.

Why Vaccination Still Matters

Pertussis vaccines remain one of the most important tools available to reduce severe disease.

Vaccination does not make every infection impossible, and immunity can decline over time. But maintaining recommended vaccination coverage is particularly important for protecting babies from severe disease.

European vaccination programmes differ in their schedules.

According to ECDC's 2026 report, by April 2026:

• 26 European countries had maternal pertussis immunisation programmes.
• 25 countries had introduced adolescent booster doses.
• 10 countries recommended booster doses for adults.

These programmes are designed to address different stages of life and different patterns of vulnerability.

Maternal vaccination can be particularly important because antibodies can provide protection to newborns during the period before they have completed their own primary vaccination series.

What Happens If Someone Gets Pertussis?

Treatment depends on the individual and the stage of illness.

Antibiotics are used to treat pertussis. According to ECDC, treatment is most effective when started early, preferably within the first two weeks after symptoms begin.

Early antibiotic treatment can help eliminate the bacteria from the respiratory tract and reduce the risk of passing the infection to other people.

However, antibiotics do not necessarily make an established cough disappear immediately.

The intense coughing phase can continue because the respiratory system may remain irritated even after the bacterial infection is being controlled.

Severe cases, especially among very young infants, may require hospital care and close monitoring.

The Hidden Problem: The Long Cough

One of the reasons pertussis can be disruptive is the duration of the illness.

A normal cold may improve within several days.

Pertussis can be very different.

A person may experience repeated coughing attacks for weeks. The cough can interfere with sleep, eating, work and school.

In severe cases, repeated coughing can even cause vomiting, dehydration, breathing problems and other complications.

For families with a newborn baby, the consequences can be particularly frightening.

A parent who has been coughing for weeks may initially believe that it is simply a stubborn cold, while the actual infection may be pertussis.

What Can People Do?

The most important step is to follow the vaccination schedule recommended by the relevant national health authority.

People who are unsure about their vaccination history can discuss it with a healthcare professional.

Anyone who develops a prolonged or severe cough, especially after contact with a confirmed pertussis case, should seek medical advice.

People who suspect pertussis should also tell the healthcare facility before arriving when possible. This allows healthcare workers to take precautions to reduce exposure to other patients.

ECDC advises people with suspected pertussis to avoid contact with young children and infants until they have received appropriate treatment.

A Disease That Should Not Be Ignored

The return of pertussis across Europe is a reminder that infectious diseases can regain momentum even after years of relatively low visibility.

The recent increase does not mean that every European country is experiencing the same level of transmission. Surveillance systems, vaccination coverage and testing practices vary between countries.

But the overall numbers are significant.

More than 209,000 cases were reported in the EU/EEA in 2024, while more than 298,000 were reported across the broader WHO European Region.

The groups that deserve particular attention include infants, children, adolescents and people whose vaccination protection is incomplete or has weakened over time.

For adults, the illness may sometimes appear to be nothing more than a persistent cough.

For a young infant, the same infection can become a medical emergency.

That difference is what makes the current European pertussis resurgence so important.

Conclusion

Whooping cough is not a forgotten disease.

It is a highly contagious bacterial infection that continues to circulate in Europe, and recent surveillance shows that its burden increased dramatically after the COVID-19 pandemic.

The 2024 European figures were particularly striking: more than 209,000 cases in the EU/EEA, with infants and adolescents among the most affected groups.

The resurgence appears to have several contributing factors, including waning immunity, vaccination gaps, reduced circulation during the pandemic and changes in testing and surveillance.

For most healthy adults, pertussis may not initially look dangerous. But the infection becomes much more serious when it reaches a young baby.

That is why vaccination, early recognition, appropriate treatment and protection of vulnerable infants remain central to controlling the disease.

Europe's recent experience with pertussis shows that even diseases controlled for decades can return when immunity gaps develop.

The long cough may begin like an ordinary cold — but for some patients, especially the youngest, it can become a serious and potentially life-threatening illness.

Sources: European Centre for Disease Prevention and Control (ECDC); World Health Organization Regional Office for Europe; European Commission/UNICEF/WHO joint statements; Nature Communications research on the Netherlands' pertussis resurgence.