Whooping cough cases surged nearly sixfold worldwide in 2024, and older adults face some of the highest risks for serious complications from the diseases Tdap protects against. If you’re over 50 and can’t remember your last tetanus-pertussis booster, or if you’ve never had one, now is the time to catch up. The combination of waning immunity, a global resurgence in pertussis, and zero-cost coverage under Medicare makes the case more urgent than it has been in years.
Pertussis Is Surging Globally
Whooping cough hit its lowest point in 2022, with just 3,284 cases reported across the Americas. Then the numbers exploded: 11,202 cases in 2023, followed by 66,184 in 2024. Globally, the World Health Organization logged 973,000 pertussis cases in 2024, a 5.8-fold jump from the year before. The pattern is consistent across multiple continents, driven in part by vaccination gaps that widened during the pandemic years.
This isn’t just a childhood disease. An Australian population study found pertussis incidence rates between 57 and 91 cases per 100,000 people among adults over 50. Those with chronic lung conditions like COPD or asthma had even higher rates. In adults, whooping cough typically causes weeks of violent coughing fits that can crack ribs, cause urinary incontinence, and lead to pneumonia.
Immunity Fades Faster Than Most People Realize
Even if you were vaccinated as a child or received a booster years ago, your protection has likely worn off. Anti-pertussis antibodies drop rapidly after the first year following a Tdap dose, and real-world effectiveness studies show that pertussis protection starts declining within two to four years. By the time a decade has passed, you have very little defense left against whooping cough specifically.
That timeline matters because the CDC recommends a Td or Tdap booster every 10 years. Many adults lose track of their schedule, and the gap between “some remaining protection” and “next booster due” can leave years of vulnerability. If you’re unsure when you last received a dose, it’s safe to get one now rather than wait.
Tetanus Is Deadliest in Older Adults
Pertussis gets the headlines, but the tetanus component of Tdap deserves attention on its own. Tetanus incidence is highest among adults 80 and older, and the fatality numbers are stark. Among people aged 65 to 79 who contracted tetanus, the case fatality rate was 30.8%. For those 80 and older, it climbed to 63.3%. Overall, 83.8% of tetanus deaths occurred in people 65 and older.
About half of all tetanus patients had no documented history of ever receiving a tetanus-containing vaccine. On the other end: no deaths were reported among people who had completed at least three doses of a tetanus vaccine. Zero. That’s as clear-cut as vaccine data gets. The two people who died despite having some vaccination history had never finished their primary series, reinforcing that partial vaccination isn’t enough.
Protecting the Grandchildren
Babies under 12 months are the most vulnerable to severe pertussis, and they can’t be fully vaccinated yet. Household members are the source of infection 75% to 83% of the time. While parents account for the largest share of transmission (around 55%), grandparents are responsible for about 6% of identified cases in infants.
That number may sound small, but the strategy of vaccinating everyone around a newborn, sometimes called “cocooning,” has a measurable impact. When grandparents are added to a vaccination ring that already includes the mother and father, infant pertussis cases drop by 32%, hospitalizations by 32%, and deaths by 29% compared to no cocooning at all. If you’re expecting a new grandchild, getting your Tdap at least two weeks before meeting the baby gives your body enough time to build protective antibodies.
What the CDC Recommends by Age
The current adult immunization schedule is straightforward. Every adult 19 and older should receive at least one lifetime dose of Tdap (the version that includes pertussis protection), followed by a Td or Tdap booster every 10 years. This applies equally to adults 50 to 64 and those 65 and older. There is no upper age limit.
If you’ve only ever received Td boosters (tetanus and diphtheria without the pertussis component), you should swap one of those for a Tdap dose. If you have a wound that needs medical attention, your provider may give you a Td or Tdap at that visit regardless of your schedule, but relying on an injury to trigger your next booster is not a plan.
Medicare Covers It at No Cost
Cost used to be a barrier for some older adults, but that’s no longer the case. Tdap is covered under Medicare Part D with zero out-of-pocket cost for any vaccine recommended by the CDC’s Advisory Committee on Immunization Practices. This applies even if you go to an out-of-network provider. In that case, you may need to pay the administration fee upfront, but your Part D plan is required to fully reimburse you.
You can get Tdap at most pharmacies, your primary care office, or a public health clinic. No special appointment is needed. The entire visit takes a few minutes.
Side Effects Are Mild and Brief
Safety reviews covering the general population, pregnant women, and adults over 65 have found no unexpected safety concerns with Tdap. The most common side effects are soreness, redness, or swelling at the injection site. Some people experience a mild fever, headache, fatigue, or brief stomach upset. These reactions typically resolve within a day or two and are far milder than the diseases the vaccine prevents.
There is no evidence that the vaccine poses greater risk to older adults than to younger ones. If you’ve tolerated a tetanus shot in the past, you can expect a similar experience with Tdap.