Kentucky is experiencing its largest spike in whooping cough cases since 2012, an alarming rise that has already claimed the lives of three infants in the past year. In this episode, Dr. Steven Stack, Secretary of Kentucky’s Cabinet for Health and Family Services, joins us to unpack what’s driving the surge, why waning vaccination rates matter, and how misinformation is complicating public health response efforts. Dr. Stack, ASTHO member and former ASTHO president, explains the cyclical nature of pertussis, how the pandemic disrupted typical disease patterns, and why the current spike is more severe than expected. He discusses the heartbreaking reality that none of the infants who died were vaccinated, and neither were their mothers, despite well-established evidence that maternal vaccination can provide newborns with lifesaving early protection.
Creating Shared Vision and Governance for Data Modernization in Vermont | ASTHO
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This is Public Health Review
Morning EDITION from Monday,
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December 8th, 2025.
I'm John Sheehan with news from
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the Association of State and
Territorial Health Officials.
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Today we discuss rising whooping
cough, or pertussis rates in
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Kentucky and the public health
response with Doctor Steven
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Stack, Secretary of Kentucky's
Cabinet for Health and Family
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Services.
As we'll hear, Kentucky is
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seeing its highest rate of
pertussis since 2012, despite
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the availability of an effective
vaccine.
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Right.
So the, the rise in a whooping
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cough cases that we're having or
Bordella pertussis, which is the
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name of the the bacteria happens
in a cyclical pattern.
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So every three to five years we
see an uptick.
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So that's pretty typical.
The pandemic disrupted this
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probably because people were
social distancing and wearing
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masks and so we saw a
suppression.
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So we were due probably for an
increase.
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But that being said, this is a
vaccine that does work well to
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reduce the severity of illness,
but it's immune protection wears
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off over time.
And so if people don't get
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boosters when their children and
if they don't get an occasional
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booster when they're an adult,
their protection wanes.
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And so they can still get
infected, though the
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immunization still reduces their
severity.
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So what seems to be happening
now is as immunization rates are
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declining, that surge or that
little spike we would expect
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every few years is actually
becoming a much bigger spike.
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So we currently have the largest
number of cases so far this year
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in 2025 that we've had in 13
years.
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So it's the highest that we've
had since 2012.
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And so we're concerned about
that because vaccination rates
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continue to decline, which means
more people are at risk, which
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means that the vulnerable among
us face a greater danger from
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the disease.
Yeah.
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And how should state agencies
respond to that?
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Well, I think we need to stay
the course and we need to, at
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least my approach is, I think we
need to try to continue to be
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steady, fact based, supportive.
We need to be very careful not
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to, you know, pillory or impugn
people for not doing what we say
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they need to do.
It's confusing out there.
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There's all sorts of mis and
disinformation on social media.
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There's there's people in
positions of authority sharing
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things that are scientifically
wrong, long proven to be false.
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And it's creating confusion.
And that's going to cause
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problems for a population of
over 330 million Americans and
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certainly for four and a half
million Kentuckians who who
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start to wonder, well, what is
true and what is accurate.
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So my goal is to try to treat
people like mature adults, give
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fact based information, do my
very best to stay dispassionate
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about advocating for these
things that are important and
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rely upon the fact that all of
us want to be healthy and well
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generally and every parent wants
their child to be healthy and
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well.
People don't choose to not do
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things because they want to harm
their child with regard to
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vaccines.
But but people may think that
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they're helping their child
avoiding vaccines.
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And unfortunately, science has
proven that that is a bad choice
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to make, that over the long
haul, vaccines have saved
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hundreds of millions, if not
more lives across all of
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humanity that would have
otherwise been lost to these
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diseases.
And to your point, the three
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infants have have died from
this.
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Both the infants and their
mothers were unvaccinated.
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How?
How?
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Can.
Public health officials.
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Reach out and try and strengthen
that message to to mothers, to
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expectant mothers that.
It's it's really good to.
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Get vaccinated.
Yeah, it breaks my heart when I
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hear these things because not
always, but almost always those
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deaths are preventable.
And, and there's two ways there.
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The the vaccine.
All pregnant women should
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receive a booster for pertussis
during their pregnancy to
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protect their unborn child
because their antibodies pass on
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to the child.
And all of children should
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receive 6 doses of the vaccine
between the ages of zero to six
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years of age to get themselves
up to a good level of immunity.
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And so we're going to continue
to encourage people to do that.
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And what I've said consistently
is I strongly encourage people
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to go to licensed healthcare
providers to get the best
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possible advice.
If you can't be sure who to
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trust because you don't know if
your social media platform is
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giving you good stuff or bad
stuff, unfortunately, now you
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can't really have the same
confidence in the federal
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government websites and then
maybe even some of the other
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sources of information.
Your your licensed healthcare
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provider is someone who has
trained for many, many years to
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provide quality medical guidance
to you and is overseen by a
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board of medical licensure and
so would be accountable for
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providing high quality and good
information to you.
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So I'd encourage people to talk
to doctors and nurses and
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pharmacists and and physician
assistants and hope that you can
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get good information from your
medical professional.
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Another challenge is that
whooping cough, pertussis, it
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starts off with very mild
symptoms.
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What can what can clinicians do
to sort of help out that early
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detection?
Right.
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So I think clinicians are going
to have to do more asking about
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immunization status now than
maybe we had in the past.
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It used to be you could rely
that the vast majority of people
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were immunized.
And so that was, you know, some
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diseases were unlikely to occur.
Thankfully, we still have 8590%
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or more of the population
immunized.
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So let's be very clear about
this.
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This is not even close.
It's a slam dunk when you know
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90% of the population or more is
immunized.
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Overwhelmingly, the population
has understood that the vaccines
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are important.
The problem is some of these
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diseases are so contagious that
when you fall and you lose 10%,
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it's enough people to spread
disease and cause problems.
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So I think we're going to have
to continue to focus on
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encouraging people to be
immunized, but then the
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clinicians, the doctors, the
nurses, the PAS are going to
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have to ask more often, have you
received all of your
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immunizations?
And perhaps verify that to the
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extent they can through an
immunization record.
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Because normally a child who
comes in who's got a runny nose,
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cough and a fever just has a
viral illness and you don't give
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them antibiotics because it's
not a good idea to do that.
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But if they're unimmunized, then
you may ask other questions and
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then you may find through your
questioning that they were
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exposed to someone with whooping
cough and that therefore they
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they are in a different bucket
or different category.
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So it's going to require
clinicians to continue to evolve
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based on the choices the
population makes and fear it
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out.
When When are things not just a
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common cold, but maybe something
different that requires a
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different approach?
That's really good advice.
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Finally, how is Kentucky working
with federal partners in
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response to the to the rise?
Yeah.
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So we have our own laboratory
reporting requirements and
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pertussis or whooping cough is a
reportable disease in Kentucky.
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So the hospitals, the doctors
have to inform us if they find a
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patient with pertussis.
So we rely on a robust set of
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statewide information streams to
try to keep on top of this.
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We certainly partner with our
fellow States and historically
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we have partnered really
robustly with the CDC.
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We certainly work very hard in
Kentucky to make sure that the
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advice we give from our Kentucky
Department for Public Health and
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and to our people is the best
fact based scientifically based
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guidance we can provide that
improves their chances of health
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and Wellness.
Well, Doctor Stephen Stack,
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thanks so much for joining us.
Thanks, it's been a pleasure to
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be here.
Doctor Stephen Stack, secretary
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of Kentucky's Cabinet for Health
and Family Services.
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An ASTO blog highlights how the
Vermont Department of Health
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leverage the Public Health
Infrastructure Grant, or FIG, to
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create a Data Modernization
Advisory Committee and how they
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will continue to make strategic
improvements to modernize
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infrastructure over the next two
years.
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Read more by clicking the link
in the show notes and an ASTO
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webinar.
Don't Panic, a panel on how to
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be an effective crisis
communicator, explored
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strategies for strengthening
jurisdictional capacity for
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public health risk
communication.
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The session showcased best
practices for communicating
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about trending public health
threats, innovative resources
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for applying the latest risk
communications research, and an
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overview of practical tools to
help public health communicators
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effectively address crises.
And emergencies.
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Across diverse jurisdictions.
You can watch the webinar
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recording by clicking the link
in the show notes.
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This has been Public Health
Review MORNING Edition.
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I'm John Sheehan for the
Association of State and
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Territorial Health Officials.