THIS IS AN OFFICIAL WEST VIRGINIA HEALTH ADVISORY #231
Distributed via the WV Health Alert Network – November 6, 2025
Summary:
The West Virginia Bureau for Public Health (BPH) has identified an increase in reported pertussis
(whooping cough) cases. Since January 1, 2025, a total of 126 cases have been identified across
West Virginia; an increase of this magnitude not seen since 2010. Cases have been identified
statewide, with the highest concentration in the western region. The median age of cases is 12 years;
23 (18%) are infants ≤12 months of age, and 28 (22%) have been hospitalized.

Pertussis follows cyclical peaks every 3–5 years. Recent data indicate a shift from infant cases to
older adolescents and adults, primarily due to waning Tdap immunity, which can decline within one to
two years after vaccination (routinely given at ages 11–12).

Requested Actions
Consider pertussis in any patient with compatible symptoms regardless of vaccination history,
particularly if there has been potential exposure.

Suspect pertussis in anyone with:
• Cough illness of any duration with paroxysms, inspiratory whoop, post-tussive
vomiting/gagging, or apnea (with or without cyanosis) and known exposure; or
• Cough illness lasting ≥2 weeks with these symptoms even without a known exposure.
In infants, apnea may be the only symptom, with little or no cough. In adolescents and adults, illness
is often milder and may lack the classic “whoop.” Maintain a low threshold for testing and treatment
if the patient has close contact with infants or others at high risk for pertussis complications.

Testing
Pertussis may be misdiagnosed as asthma, bronchitis, sinusitis with persistent cough, or pneumonia.
Symptoms in the first stage can resemble a common cold, and vaccinated individuals may experience
only a prolonged cough; yet remain contagious.
• PCR testing is most sensitive within 3–4 weeks after cough onset.
• Culture is most sensitive within the first 2 weeks after cough onset.
• Testing outside these timeframes increases the likelihood of false negatives.

Providers may submit pertussis specimens (nasopharyngeal or aspirate) to the West Virginia Office
of Laboratory Services for PCR and culture confirmation (free of charge). For test kits, collection
instructions, and submission forms, visit: https://dhhr.wv.gov/ols/labs/Pages/Bacteriology.aspx.

Treatment and Control
• Individuals with pertussis are contagious for the first 21 days of cough or until five days of
appropriate antibiotic therapy have been completed.
• Begin empiric treatment immediately without waiting for test results and advise patients to
remain home until five days of antibiotics are completed.
• Post-exposure prophylaxis (PEP) is recommended for all household and other close contacts,
regardless of vaccination status.
• Prioritize high-risk contacts for treatment: infants, pregnant individuals, immunocompromised
persons, and those with moderate to severe asthma.

• If >21 days have passed since cough onset, the person is no longer infectious and treatment
will not alter the course of illness.

• Symptomatic contacts should be evaluated for pertussis; asymptomatic contacts receiving PEP
do not need to be excluded from school or work and asymptomatic contacts who refuse PEP
do not need to be excluded from school or work unless they are likely to interact with persons
at increased risk for severe pertussis (e.g. healthcare personnel).
• Under-immunized contacts should be brought up to date with vaccinations.

Reporting
Pertussis is a reportable condition in West Virginia and must be reported to the local health department
within 24 hours of diagnosis. Two or more epidemiologically linked cases from different households
with symptom onset within 42 days constitute an outbreak and should be reported immediately.
For further information, contact OEPS at (304) 558-5358, ext. 1, or our website at:
https://oeps.wv.gov/pertussis/pages/default.aspx.