Research and analysis

Laboratory confirmed cases of pertussis in England: annual report for 2024

Published 27 November 2025

Applies to England

Introduction

This report summarises data on laboratory-confirmed cases of pertussis reported in England in the calendar year 2024 ^{[footnote 1]}. The report covers confirmed case numbers and their distribution, information on deaths related to pertussis, and data on vaccination uptake through the childhood and prenatal programmes. It builds on summary data from previous monthly reports published by the UK Health Security Agency (UKHSA).

Pertussis is a cyclical disease, with increases occurring every 3 to 5 years, and seasonal activity usually peaking each year in quarter 3 (July to September). Prior to the COVID-19 pandemic the last major outbreak occurred in 2012 and cyclical increase in 2016. Intervention measures implemented to help control the spread of COVID-19 also had an impact on other infectious diseases, including pertussis (1).

Consequently, pertussis activity was exceptionally low across England from April 2020 and persisted at very low levels until summer 2023 when case numbers began to increase (figure 1). This increase continued into 2024 and was observed across all age groups, including vulnerable infants, and in every region in England. This led to the UKHSA declaring a national (standard) incident for pertussis in England in May 2024.

Laboratory confirmed cases and incidence

In England, there were 14,879 new laboratory confirmed cases of pertussis (tested via culture, PCR, serology or oral fluid reported to the UK Health Security Agency’s (UKHSA’s) pertussis enhanced surveillance programme in 2024 ^{[footnote 2]}. The number of laboratory-confirmed cases in 2024 were the highest reported since the introduction of the Pertussis Enhanced Surveillance Programme in 1994. There have been 11 reported deaths in infants who developed pertussis between January and December 2024 ^{[footnote 3]}.

The total number of samples (serum and oral fluid for antibody testing as well as PCR) submitted to UKHSA for testing was 4-fold higher in 2024 (36,472) than in 2023 (9,268) with a test positivity rate of 37.3% (13,519 of 36,274) in 2024 compared with 8.3% (767 of 9,252) in 2023.

The number of laboratory-confirmed cases rose across the first 5 months of 2024, as expected based on usual seasonal patterns, from 554 cases in January to 3,033 in May. Case numbers then decreased but remained elevated compared to recent pre-pandemic years between June and October (6,371 cases). 474 cases were confirmed in November and December 2024 and were similar to those observed in the same months in the years preceding the COVID-19 pandemic and lower than those in the last outbreak year in 2012.

The 14,879 confirmed cases in England in 2024 were substantially higher than the 857 cases reported in 2023 and 58.8% higher than the last major outbreak in 2012 when 9,367 cases were reported (figure 1).

There were 2,896 confirmed cases in quarter 1 of 2024; 7,554 cases in quarter 2; 3,451 cases in quarter 3 and 978 cases in quarter 4. Confirmed cases in the second quarter of 2024 were notably high, exceeding those in any quarter of the 2012 outbreak year (figure 1 and table 1).

The national incidence for all age groups, based on laboratory confirmed cases of pertussis in England and 2024 population estimates (2), increased in 2024 reaching 25.4 per 100,000. The incidence of pertussis in each age group was higher in 2024 than any year since 1998 (figure 2). Excluding the years with population measures to control COVID-19, incidence has remained elevated across all age groups other than infants since 2012.

Of the 14,879 cases confirmed between January and December 2024, 58.9% (8,757 cases) were in those aged 15 years or older with 18.2% in children aged between 10 and 14 years (2,706 cases) and 11.1% (1,656) in children aged 5 to 9 years. Children aged between 1 and 4 years accounted for 5.8% (867) of cases and infants aged under one year for 6.0% (893) (table 2).

In 2024, 433 laboratory confirmed cases were reported in infants aged under 3 months compared to 48 cases in 2023 and 407 cases in the 2012 outbreak year. Prior to 2024 there had been an overall decline in pertussis cases in infants under 3 months of age since the introduction of the prenatal vaccination programme in 2012 and estimates of prenatal vaccine effectiveness against confirmed infant disease have been consistently high with the latest estimate at 89% (95% CI, 86 to 91%) (3). As expected, the incidence of laboratory confirmed cases continues to be highest in infants aged less than 3 months, who are at most risk of serious disease and too young to be fully vaccinated (figure 2).

Similarly, the number of cases in infants aged 3 to 5 months increased from 23 cases in 2023 to 231 cases in 2024, higher than the 74 cases reported in 2012. In infants aged 6 to 11 months, 229 laboratory confirmed cases were reported in 2024 considerably higher than the 2016 cyclical peak year when 34 cases were reported and the previous outbreak year of 2012 when 27 cases were reported. Lower incidence in this infant age group compared to the younger age groups is consistent with protection from primary vaccination offered at 2, 3 and 4 months of age.

Laboratory confirmed case numbers in older children and adults were also higher than the 2016 cyclical peak year and the previous outbreak year of 2012 (table 2):

• the number of children aged 1 to 4 years confirmed with pertussis increased from 52 cases in 2023 to 867 cases in 2024 compared to 117 cases in 2016 and 103 cases in 2012
• in children aged 5 to 14 years, numbers of confirmed cases increased from 256 cases in 2023 to 4,362 cases in 2024 higher than the 2016 (809 cases) peak years and 2012 (981 cases) outbreak
• laboratory confirmed pertussis cases in individuals aged 15 years and older increased from 453 cases in 2023 to 8,757 cases in 2024. Total cases in this age group were higher than the previous peak years when 4,787 cases were reported in 2016 and 7,775 cases in 2012. Half (58.9%; 8,757 of 14,879 cases) of laboratory confirmed cases in England in 2024 occurred in individuals aged 15 years and older and 18.2% (2,706 cases) were in children aged 10 to 14 years

Ascertainment in those aged 5 to less than 17 years has improved with availability of oral fluid testing since 2013. From 1 May 2018, the availability of oral fluid testing was extended to all children aged from 2 up to and including 16-year-olds, which may underpin earlier increases observed in the 1 to 4 year age group. In 2024 oral fluid alone accounted for 59.4% (3,108 of 5,229) of cases in children aged between 1 and 14 years (table 3).

Deaths

In England, 14 deaths were reported in infants with confirmed pertussis in the 2012 outbreak year. Following the introduction of pertussis vaccination in pregnancy, there have been 32 deaths in babies with confirmed pertussis to the end of 2024. There were no reported deaths in infants with confirmed pertussis between 2020 and 2022, one death reported in 2023 and 11 reported deaths in infants who contracted pertussis in 2024.

All the deaths in 2012, and those that have occurred following the introduction of the prenatal programme to end December 2024, occurred in infants who were too young to be fully protected by their primary vaccinations, some with co-infections and/or underlying health complications. Of the 32 infants that died, 26 were born to mothers who were not vaccinated in pregnancy.

Estimated vaccine effectiveness against death in infants with pertussis whose mothers had been vaccinated, including recent deaths to the end of August 2024, is estimated to be very high at around 91% (unpublished UKHSA data).

In 2024, 11 people aged one year or older who died had a reported laboratory confirmation of pertussis and had pertussis listed as an ONS cause of death (4). Most of these cases were in individuals aged over 65 years of age (73%; 8 cases). In all cases, there was more than one cause of death documented in addition to pertussis. No pertussis-related deaths were reported in older children, adolescents and adults in 2023. This assessment is provisional as there can be delays to final confirmation of Office for National Statistics official cause of death (for example, in the event that an inquest is called).

Childhood vaccination uptake

The national vaccination schedule recommends pertussis vaccination at 8, 12 and 16 weeks of age and a pre-school booster at 3 years and 4 months.

Vaccine coverage estimates for 2024/2025 financial year, evaluated between April 2024 to March 2025 for DTaP/IPV/Hib/HepB immunisation across England, was 91.3% for 3 doses at 12 months of age and 81.3% for the booster dose by 5 years of age (5). Coverage estimates for DTaP/IPV/Hib at 12 months of age were slightly higher than the coverage estimates for 2023/2024 when the proportion of children vaccinated at 12 months was 91.2% and coverage estimates were lower for the booster dose reported at 82.7% in the same period (5).

From January 2026, for children born on or after 1 July 2024 an additional (fourth dose) of DTaP/IPV/Hib/HepB (hexavalent) vaccine will be offered at new routine vaccination appointment at 18 months.

Prenatal vaccination programme

The prenatal pertussis immunisation programme (6, 7) was introduced in response to the 2012 outbreak. It became permanent from June 2019 (8) based on evidence of disease impact, high effectiveness and safety (9, 10,11,12). Women should normally receive their whooping cough vaccine around the time of their mid-pregnancy scan (usually 20 weeks) but can receive it from 16 weeks (8). To provide optimal protection to the baby the vaccine should be given before 32 weeks. Women can still have the vaccine later in pregnancy and those who miss prenatal vaccination can receive it up to the time their infant receives their first vaccines at 8 weeks of age.

The UKHSA reported that the proportion of mothers due to give birth in 2024 who had been immunised with a pertussis containing vaccine in pregnancy in England ranged from a monthly average of 58.9% (February, March and April) to 68.2% (December) compared to 2023 where monthly averages were lower ranging from 57.4% (July) to 60.8% (January) following a substantial decline during the pandemic period (13) ^{[footnote 4]}. Importantly, substantial improvements in prenatal coverage were seen over the course of 2024 nationally, with this trend to increasing coverage seen across all regions nationwide.

With the increase in pertussis activity, it is even more important that women are offered pertussis vaccination in pregnancy (ideally between 20 and 32 weeks), to optimise protection for their babies from birth, and for infants to complete the vaccination schedule on time.

Supplementary data tables from 1994 to 2024 are available to download.

Figure 1. Total number of laboratory-confirmed pertussis cases per evaluation quarter in England: 2011 to 2024

Figure 2. Incidence of laboratory confirmed pertussis cases by age group in England: 1998 to 2024

Table 1. Laboratory confirmed cases of pertussis by quarter and test method in England: 2024 [notes 1 and 2]

Quarter	Culture	PCR	Serology	Oral fluid	Not reported	Total
January to March	169	423	1,367	937	0	2,896
April to June	331	1,300	3,840	1,946	137	7,554
July to September	129	638	2,078	537	69	3,451
October to December	13	107	706	139	13	978
Total	642	2,468	7,991	3,559	219	14,879

Note 1: Culture confirmed cases may additionally have tested positive by any other method, PCR confirmed cases may have additionally tested positive by serology or oral fluid and serology confirmed cases may also have been confirmed by oral fluid. Cases are only represented once in the table. Submission of all presumptive B. pertussis isolates is encouraged for confirmation of identity and to allow further characterisation for epidemiological purposes.

Note 2: Details of test method were not reported.

Table 2. Total number of laboratory-confirmed pertussis cases per year and age group England: 2011 to 2024 [note 3]

Year	Under 3 months	3 to 5 months	6 to 11 months	1 to 4 years	5 to 9 years	10 to 14 years	15 years and over	Total
2011	164	32	9	16	18	113	699	1,051
2012	407	74	27	103	175	806	7,775	9,367
2013	85	24	7	65	99	429	3,912	4,621
2014	98	14	11	48	128	351	2,737	3,387
2015	130	32	13	70	218	437	3,291	4,191
2016	155	47	34	117	305	504	4,787	5,949
2017	115	37	16	75	198	370	3,529	4,340
2018	49	26	16	88	139	288	2,342	2,948
2019	83	32	21	147	222	467	2,706	3,680
2020	30	15	5	49	52	150	693	994
2021	1	1	0	3	2	3	39	49
2022	2	3	0	10	3	3	47	68
2023	48	23	25	52	78	178	453	857
2024	433	231	229	867	1,656	2,706	8,757	14,879

Note 3: 2019 total includes 2 cases where the age was not known.

Table 3. Age distribution of laboratory confirmed cases of pertussis by test method in England: 2024 [notes 4 and 5]

Age group	Culture	PCR	Serology	Oral fluid only	Not reported	Total
Under 3 months	100	303	4	0	26	433
3 to 5 months	43	172	2	2	12	231
6 to 11 months	34	173	5	0	17	229
1 to 4 years	68	391	59	313	36	867
5 to 9 years	60	245	228	1,096	27	1,656
10 to 14 years	74	240	680	1,699	13	2,706
15 years and over	263	944	7,013	449	88	8,757
Total	642	2,468	7,991	3,559	219	14,879

Note 4: Culture confirmed cases may additionally have tested positive by any other method, PCR confirmed cases may have additionally tested positive by serology or oral fluid and serology confirmed cases may also have been confirmed by oral fluid. Cases are only represented once in the table. Submission of all presumptive B. pertussis isolates is encouraged for confirmation of identity and to allow further characterisation for epidemiological purposes.

Note 5: Details of test method were not reported.

References

1. E Tessier, and others (2022). Impact of the COVID-19 pandemic on Bordetella pertussis infections in England. BMC Public Health.

2. Office for National Statistics, 2024 population estimates.

3. G Amirthalingam, and others (2023). Optimization of Timing of Maternal Pertussis Immunization From 6 Years of Postimplementation Surveillance Data in England. Clinical Infectious Diseases.

4. C Alber, and others (2025). The impact of multiplex panel testing on ascertainment of pertussis-attributable deaths: national surveillance from England. medRxiv.

5. Vaccination coverage statistics for children aged up to 5 years, England (COVER programme) report: April 2024 to March 2025.  UK Health Security Agency, August 2025.

6. Confirmed pertussis in England and Wales continues to increase. Health Protection Report volume 6 number 15, 13 April 2012.

7. Department of Health (2012). Pregnant women to be offered whooping cough vaccine (website news story, 28 September).

8. Joint Committee on Vaccination and Immunisation (JCVI) (2014). Minutes of the meeting on 4 June 2014.

9. G Amirthalingam, and others (2014). Effectiveness of maternal pertussis vaccination in England: an observational study. The Lancet.

10. Dabrera G, and others (2014). A case-control study to estimate the effectiveness of maternal pertussis vaccination in protecting newborn infants in England and Wales, 2012 to 2013. Clinical Infectious Diseases.

11. Donegan K, and others (2014). Safety of pertussis vaccination in pregnant women in UK: observational study. British Medical Journal.

12. Amirthalingam G, and others (2016). Sustained effectiveness of the maternal pertussis immunization program in England three years following introduction. Clinical Infectious Diseases.

13. Pertussis vaccination programme for pregnant women update: vaccine coverage in England, October to December 2024. Health Protection Report volume 19 number 4, 24 April 2025.

1. Data for each of the first 2 quarters of 2025 has been published. ↩

2. The number of laboratory confirmed cases presented are provisional and can decrease as follow-up of vaccination status continues.  Cases who are confirmed as vaccinated within a year of a positive serology or oral fluid test are excluded: both recent vaccination and/or recent infection will give a positive result using these test methods. ↩

3. Deaths are reported to the UKHSA pertussis enhanced surveillance programme from Health Protection Teams, Office of National Statistics or Patient Demographic Service. These are also provisional as there can be delays in reporting of deaths in babies with whooping cough. ↩

4. A new point of care app developed by NHSE to record vaccination events was introduced in September 2024. The Record a Vaccination service (RAVs) has improved prenatal vaccination dataflows into general practice, which may partially account for the increase in coverage reported since its introduction. ↩