When there's an outbreak of a vaccine-preventable disease, state health officials typically take certain steps to alert residents and issue public updates about the growing threat.
That's standard practice, public health and infectious disease experts told NPR and KFF Health News. The goal is to keep as many other vulnerable people as possible from getting sick and to remind the public about the benefits of vaccinations.
But in Louisiana this year, public health officials appeared not to have followed that playbook during the state's worst whooping cough outbreak in 35 years.
Whooping cough, also called pertussis, is a highly contagious vaccine-preventable disease that's particularly dangerous for the youngest infants. It can cause vomiting and trouble breathing, and serious infections can lead to pneumonia, seizures and, rarely, death.
Dr. Madison Flake, a pediatric resident in Baton Rouge, La., cared for a baby who was hospitalized during this year's outbreak. At less than 2 months old, he was sent to the intensive care unit.
"He would have these bouts of very dramatic coughing spells," Flake said. "He would stop breathing for several seconds to almost a minute."
Infants are not eligible for their first pertussis vaccine until they're 2 months old, but they can acquire immunity if their mother was immunized while pregnant.
By late January 2025, two babies had died in Louisiana.
But the Louisiana Department of Health waited two months to send out a social media post suggesting people talk to their doctors about getting vaccinated.
The department took even longer to issue a statewide health alert to physicians, send out a press release or hold a press conference.
Those delays are not typical, according to Dr. Georges Benjamin, the executive director of the American Public Health Association.
"Particularly for these childhood diseases, we usually jump all over these," said Benjamin, who has led health departments in Maryland and the District of Columbia. "These are preventable diseases and preventable deaths."
Because infectious diseases spread exponentially, if officials don't alert the public quickly, they lose a key chance to prevent further infections, said Dr. Abraar Karan, an instructor on infectious diseases at Stanford University who has worked on COVID-19 and mpox outbreaks.
"Time is perhaps one of the most important currencies that you have," he added.
Amid outbreak, state surgeon general stopped state promotion of all vaccines
Because pertussis vaccine immunity wanes over time, cases can ebb and flow over time. But in September 2024, Louisiana health officials started seeing a "substantial" increase in whooping cough cases, part of a national increase in cases.
In late January 2025, physicians inside one Louisiana hospital warned their colleagues that two infants had died in the outbreak.
On Feb. 13, the state's surgeon general, Ralph Abraham, sent a memo to staff ending the general promotion of vaccines and community vaccine events.
He sent that email a few hours after Robert F. Kennedy Jr., an anti-vaccine activist, won Senate confirmation as the new U.S. health and human services secretary.
Also that day, Abraham posted a public memo on the Louisiana Department of Health's website. In it, he said public health had overstepped with vaccine recommendations, which, he said, are driven by "a one-size-fits-all, collectivist mentality." Abraham has called COVID-19 vaccines "dangerous" and has been a vocal supporter of Kennedy.
Four days later, in response to a request from a TV news station in New Orleans, the Louisiana Department of Health confirmed the deaths of two infants from whooping cough for the first time, in an email. WVUE Fox 8 then published the news.
But the Louisiana Department of Health sent out no alerts, according to a review of external and internal communications by NPR and KFF Health News.
Over the next month, two more infants were hospitalized for whooping cough, according to internal health department emails, obtained through a public records request.
In March, after inquiries from NPR and KFF Health News about the growing number of pertussis cases, the health department put out its first social media communications about the outbreak and offered interviews to other journalists.
Then in May — at least three months after the second infant death — the health department issued what appears to be its first and so far only official alert to physicians. It put out its first press release, and it then held a press conference about pertussis on May 14.
By then, 42 people, three-quarters of whom were not up to date on their whooping cough immunizations, had been hospitalized for whooping cough since the outbreak began, according to the Louisiana Department of Health.
More than two-thirds of those hospitalized were babies under age 1.
Throughout the summer, cases of pertussis continued to climb in Louisiana. But there were no further public communications from the Louisiana Department of Health.
NPR and KFF contacted the department for comment on Sept. 25. A spokeswoman did not answer specific questions about the lack of communications but referred to a Sept. 30 post on X by the state surgeon general.
In the post, Abraham said the department "consistently reported cases of pertussis and provided guidance to help residents stay protected" in 2025. He called the pertussis vaccine "one of the least controversial" and said he recommends it to his patients.
The post on X included a year-by-year graphic of pertussis cases that omitted 2024 and 2025. The post also acknowledged for the first time that one of the infant deaths occurred in late 2024.
A "train wreck" of cases and hospitalizations
Louisiana should have started warning the public within days or a week of the first infant's death, instead of waiting months, said Stanford's Karan.
"At minimum, it should be like heavy promotion of, 'Hey, infants are at high risk. They get infected by people who have waning immunity. If you haven't gotten vaccinated, get vaccinated. If you have these symptoms, get tested,'" Karan said.
While deaths from a vaccine-preventable illness are tragic, they can also serve as an opportunity to educate the public about the benefits of vaccines and try to save lives, according to Dr. Joshua Sharfstein, a former health secretary for Maryland, and a professor at the Johns Hopkins Bloomberg School of Public Health.
"The risk of pertussis is always there, but when you have two infant deaths it's a really good opportunity to communicate that this is a real threat to the health of children," Sharfstein said.
By not acting more quickly, Karan said he believes the department may have set itself up for a worse outbreak.
"Because then what we see is this train wreck thereafter, of like an insanely large outbreak, a lot of hospitalizations," Karan said.
The outbreak continued
As of Sept. 20, Louisiana had counted 387 cases of whooping cough in 2025, according to the Centers for Disease Control and Prevention. The previous 35-year high was 214 cases, in 2013.
Until the Sept. 30 post on X, the Louisiana Department of Health did not appear to put out any public communications about pertussis over the preceding four months, as hospitalizations continued and case levels surpassed the 2013 levels.
The health department should be responding aggressively and consistently, said Dr. Joseph Bocchini, the president of the Louisiana Chapter of the American Academy of Pediatrics.
"Where people are updated on a regular basis and reminded of what needs to be done," he said. "Get your vaccines. Moms, if you're pregnant, get vaccinated. And if you have a cough illness, see your doctor."
This story comes from NPR's health reporting partnership with WWNO and KFF Health News.
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