Whooping cough outbreaks occur in highly vaccinated school populations due to waning immunity
Multiple studies and reviews confirm that whooping cough outbreaks frequently occur in highly vaccinated school populations primarily due to the natural waning of vaccine-induced immunity over time.
The retrieved literature consistently supports the claim that pertussis outbreaks occur in vaccinated populations due to the waning of vaccine-induced immunity, particularly with acellular vaccines. Multiple epidemiological studies, reviews, and mathematical models (e.g., papers 0, 1, 2, 5, 6, 7, 9, 11) highlight waning immunity as a primary driver of the resurgence in highly vaccinated school-aged populations and older groups. No papers refute this mechanism, although some mention additional contributing factors such as pathogen adaptation or temporary disruptions in natural boosting.
F. R. MOOI, N. A. T. VAN DER MAAS, H. E. De MELKER. Pertussis resurgence: waning immunity and pathogen adaptation – two sides of the same coin. 2013. https://doi.org/10.1017/s0950268813000071
States that the increase in pertussis is mainly found in age groups in which immunity has waned.
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Biswas R, Roy A, Kayal T, Basu S, Ghosh S, Ramaiah S, Anbarasu A. Waning immunity and the future of booster vaccination strategies in global vaccine programs post COVID-19.. 2026. https://doi.org/10.1080/21645515.2026.2626088
Lists pertussis immunity as waning within 4-12 years as a major global concern.
Vargas-Zambrano JC, Abrudan S, Macina D. Understanding the Epidemiology and Contributing Factors of Post-COVID-19 Pertussis Outbreaks: A Narrative Review.. 2026. https://doi.org/10.1007/s40121-025-01277-1
Identifies waning vaccine-derived immunity and lack of lifelong protection as contributing factors to periodic outbreaks.
Han W, Kimm H, Yang YS, Kwon JW, Son E. Sudden pertussis outbreaks in Guro-gu, Seoul: epidemiological characteristics and contributing factors in 2024.. 2026. https://doi.org/10.4094/chnr.2025.058
Notes that pertussis cases occurring despite age-appropriate vaccination suggest waning immunity in school-aged children.
Qiao Y, Zhao J. Study on the resurgence of pertussis based on a stage-structured dynamic model.. 2026. https://doi.org/10.1016/j.idm.2025.12.007
Demonstrates through dynamic models that vaccine-induced immunity wanes over time, contributing to resurgence.
Zhang S, Xu Y, Xiao Y. Revisiting Whooping Cough: Global Drivers and Implications of Pertussis Resurgence in the Acellular Vaccine Era.. 2025. https://doi.org/10.3390/vaccines14010035
Identifies waning and non-sterilizing acellular vaccine-induced immunity as a primary driver of the pertussis resurgence.
Sadeghimoghadam P, Sattarpour R, Noori M, Sattarpour N, Afkhaminia A, Sinaeifar Z, Naddaf A, Omidi Z. Pertussis resurgence in iran: A systematic review and meta-analysis of seroimmunity and diagnostic evidence.. 2025. https://doi.org/10.1186/s12879-025-11522-0
Attributes the increased incidence of pertussis primarily to the waning of vaccine-induced immunity in adolescents and adults.
Choi YH, van Leeuwen E, Miller E. Exploring the cause of the pertussis resurgence in England following the COVID-19 pandemic: a mathematical modelling study.. 2026. https://doi.org/10.1186/s12879-026-12521-5
Implicates the short duration of protection from acellular vaccines as a key factor in outbreaks among vaccinated populations.
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