Whooping cough is not just a childhood disease.
Recent Australian research reveals an average annual diagnosis rate of 76.9 per 100,000 adults in primary care, with 2024 marking Australia’s largest pertussis, or whooping cough epidemic on record.
There were more than 57,000 notified cases, more than 70 per cent of these occurring in older children and adults.
This surge represents the highest level in 35 years, with cases continuing to rise in 2025.
Pertussis typically produces outbreaks every three to four years, but the current epidemic has broken that pattern.
During the COVID-19 pandemic (from years 2020 to 2022), whooping cough cases plummeted due to lockdowns, masks and social distancing.
As these measures eased, a dramatic resurgence followed — a phenomenon epidemiologists call ‘immunity debt’, where reduced exposure to common pathogens during lockdowns leaves populations more vulnerable when restrictions lift.
Your patients
Flu season is a critical opportunity because patients presenting for influenza vaccination are often the same individuals at heightened risk of pertussis complications.
Research shows 58.7 per cent of adults diagnosed with pertussis had underlying comorbidities, with asthma and chronic obstructive pulmonary disease the most prevalent at 24.9 per cent.
These patients were six times more likely to have comorbidities than the general population.
One Australian study found adults aged 50 and over with asthma contracted whooping cough at about 160 cases per 100,000 people each year, compared with about 90 cases per 100,000 in people the same age without asthma.
These are the patients who present every autumn and winter — those with chronic respiratory conditions, older Australians and individuals managing multiple health concerns. They trust pharmacists with their flu shot.
Pharmacists can also play a key role in discussing pertussis protection.
Not to be ignored
The data paints a sobering picture.
Among adults with a documented pertussis diagnosis in primary care, only 14 per cent had received a pertussis vaccination — despite the Australian Immunisation Handbook recommending a pertussis-containing booster at 50 and 65 years of age.
This low vaccination rate persists despite these patients having visited their GP at least three times in the previous two years, highlighting significant missed opportunities for prevention.
The economic impact is also substantial. Conservative estimates place the cost of each whooping cough case between AUD473 and AUD909 in primary care alone — excluding hospitalisations and emergency presentations.
For the 2024 epidemic year, this represents approximately AUD27 million in primary care costs.
Diagnostic challenges
Whooping cough in adults often presents atypically, with a nonspecific cough rather than the classic ‘whoop’ seen in children.
Only 34.1 per cent of diagnosed cases had laboratory confirmation, suggesting significant under-diagnosis.
Additionally, 4.1 per cent of adults had an unspecified coughing illness during the study period — potentially representing undiagnosed pertussis.
The right questions
This flu season, consider adding simple pertussis questions to vaccination consultations, such as:
- “When did you last have a whooping cough booster?”
- “Do you have asthma, COPD or other chronic conditions?”
- “Are you in regular contact with infants or young children?”
These questions take moments but could prevent weeks of debilitating illness. Whooping cough in adults often presents as a persistent, exhausting cough lasting months — affecting work, sleep and quality of life.
Closing the gap
With more than 428 million patient visits annually, community pharmacies are Australia’s most accessible healthcare touchpoint.
The infrastructure for vaccination is already in place — consultation rooms, cold chain and trusted relationships.
Unlike influenza vaccination, pertussis vaccination is not funded under the National Immunisation Program for most adults (except pregnant women).
This funding gap, combined with low awareness, contributes to persistently low vaccination rates.
By integrating whooping cough awareness into flu consultations, pharmacists have a genuine opportunity to reduce the burden of a preventable disease.
Pertussis and influenza vaccines can be safely coadministered, making it easy to offer both in a single visit.
The current epidemic shows that pertussis remains a significant public health challenge — one that pharmacists are uniquely positioned to address through opportunistic vaccination discussions.
