Because the early symptoms are hard to recognize until the patient has been contagious for a week or more, and because there is no rapid-turnaround test for whooping cough, the best public heath strategy is widespread vaccination. Health care-centered outbreaks are well documented. Health care workers, especially those exposed to children younger than 12 months or immune-compromised patients (i.e., all emergency physicians), are especially encouraged to renew their immunization.

Parents’ concerns about the dire side effects of vaccination are, for the most part, unfounded. They should discuss the rare episodes of high fever or other significant side effects associated with the vaccine with their pediatrician. However, reluctant moms and dads can no longer depend on “herd immunity.” The American Academy of Pediatrics and the Centers for Disease Control and Prevention recommend that, except for prior allergic reactions or other rare exceptions, all children be vaccinated with acellular pertussis as part of the “Tdap” combination with tetanus and diphtheria. Shots should be scheduled for 2, 4, 6, and 15-18 months. Low-grade fever for 1-2 days and local tenderness and irritation are expected at the injection site after the fourth or fifth inoculation.

Eleven- and 12-year-old children should get a booster of Tdap, the adult formulation that contains a lower dose of acellular pertussis vaccine. If they have not gotten their booster, wound-related vaccination in the emergency department should be with Tdap (rather than Td). Adults who have not received a Td in the last 10 years should receive one dose of Tdap and boosters of Td every 10 years thereafter. Pregnant women who are more than 10 years out from their last Td are approved to receive wound-related Td in the second or third trimester but otherwise should get Tdap in the immediate postpartum period to avoid contracting the disease and exposing their infants. Likewise, all health care workers with exposures should receive one dose of Tdap, even if their most recent Td was as late as 2 years ago.

Emergency physicians are 10 times as likely to get pertussis from an infected patient than they are to contract hepatitis C from a contaminated hollow-needle stick. A single booster can prevent 2-4 months of illness and lost work, and reduce the possibility of passing a potentially serious respiratory illness to patents.

Whooping cough is back, and it’s as bad as ever. We all should be fully engaged in diagnosing and treating this ­under-reported illness and in vaccinating our patients and ourselves against it.